Early-stage Chlamydia trachomatis infections often cause few or no signs and symptoms. Even when signs and symptoms occur, they're often mild, making them easy to overlook. Signs and symptoms of Chlamydia trachomatis infection can include: • Painful urination • Vaginal discharge • Painful sexual intercourse • Bleeding between periods and after sex Chlamydia trachomatis can also infect the rectum, either with no signs or symptoms or with rectal pain, discharge or bleeding. You also can get chlamydial eye infections (conjunctivitis) through contact with infected body fluids. It's not difficult to treat, but if left untreated it can lead to more serious health problems: pelvic inflammatory disease (PID), tubal factor infertility, ectopic pregnancy, and chronic pelvic pain.

Gonorrhoea is a sexually transmissible infection (STI) caused by the bacterium Neisseria gonorrhoeae. It usually affects the genital area, although the throat or anus (rectum) may also be affected. Symptoms of gonorrhoea in women may include: • unusual vaginal discharge • pain while urinating • pain during sex. Gonorrhoea in the throat may cause a sore throat – however, it usually occurs without symptoms. Anal gonorrhoea often occurs without signs or symptoms but symptoms may include discharge, irritation and pain when defecating Complications of Gonorrhoea include: pelvic inflammatory disease and epididymo-orchitis, painful swollen testicles

Syphilis is a bacterial infection. It is usually spread by sexual contact during oral, vaginal or anal sex. The disease starts as a painless sore - typically on the genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores. It is very contagious when sores are present. Primary syphilis occurs 3 or 4 weeks after the infection (although it can take up to 90 days for the sore to appear). Symptoms may include a single painless sore usually about a centimetre big at the site where the infection entered the body — such as on the penis, vagina, cervix, mouth or anus. There may also be swollen lymph nodes. The sore, or sometimes multiple sores, can go unnoticed because it is usually painless and may be hidden from view in areas such as the back of the throat, vagina or anus. The sore usually heals on its own within 4 weeks. Even if the sore heals, if you had not had treatment, you still have syphilis and can pass it on to others or develop secondary syphilis. Secondary syphilis can occur 2 to 4 months after the initial infection. Symptoms can last for 6 months or more and may include: • a red rash on the palms, soles, chest or back • fever • enlarged glands in the armpits and groin • sore throat • hair loss • weight loss • headaches • pain in the bones, muscles and joints • tiredness • ulcers in the mouth, nasal cavity or genitals • neurological symptoms Latent (sleeping) syphilis generally has no symptoms and it is only picked up on blood tests. If syphilis is not treated at this stage, it can remain latent or develop into tertiary syphilis. Latent syphilis is infectious within the first 12 to 24 months. Tertiary syphilis can appear anywhere from 5 to 20 years after primary infection. At this stage, the bacteria can damage almost any part of the body including the heart, brain, spinal cord, eyes and bones, resulting in heart disease, mental illness, blindness, deafness and neurological problems. Without treatment, syphilis can severely damage the heart, brain or other organs, and can be life-threatening. Syphilis is treated with penicillin. If you are allergic to penicillin, there are alternative treatments.

Hepatitis A is an infection of the liver caused by the hepatitis A virus (HAV). The virus is primarily spread from contaminated food or water but transmission can also occur during sex by direct mouth to anal contact. In adolescents and adults, hepatitis A symptoms include: • Fever • Nausea • Pain in the stomach area • Jaundice (yellow skin and eyes). • Loss of appetite • Vomiting • Itching • Pale-coloured faeces, dark urine • Joint pain • Diarrhoea • Fatigue Symptoms usually start about 2 to 4 weeks after catching hepatitis A, and can last for several weeks.

Hepatitis B is an infection of the liver caused by the hepatitis B virus. It can cause both Acute (short than 6 months) and Chronic (last more than 6 months or lifetime) disease. The virus is most commonly transmitted through contact with blood or other body fluids during sex with an infected partner, unsafe injections, exposures to sharp instruments or household contacts. Signs and symptoms of hepatitis B range from mild to severe. They usually appear about one to four months after you've been infected, although you could see them as early as two weeks post-infection. Some people, usually young children, may not have any symptoms. Hepatitis B signs and symptoms may include: • Abdominal pain • Pale-coloured faeces, dark urine • Fever • Joint pain • Loss of appetite • Nausea and vomiting • Weakness and fatigue • Yellowing of your skin and the whites of your eyes (jaundice)

Hepatitis C is an infection of the liver caused by hepatitis C virus. It causes liver inflammation, sometimes leading to serious liver damage. The hepatitis C virus (HCV) spreads through contaminated blood. This is usually through sharing injection drug equipment, unsafe health care, unscreened blood transfusions and sexual practices that lead to exposure to blood. Acute hepatitis C usually goes undiagnosed because it rarely causes symptoms. When signs and symptoms are present, they may include: • jaundice, along with fatigue, • nausea, vomiting and diarrhoea • fever and • muscle aches • Abdominal pain • Pale-coloured faeces, dark urine Acute symptoms appear one to three months after exposure to the virus and last two weeks to three months. Chronic hepatitis C is when the infection lasts more than six months. The virus causes inflammation in the liver over a long period of time. It is usually a "silent" infection for many years, until the virus damages the liver enough to cause scarring in the liver. Extensive scarring of the liver is called cirrhosis.

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system and makes it difficult for the body to fight off simple infections and diseases. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). HIV is a sexually transmitted infection (STI). It can be spread by contact with infected blood, semen, vaginal fluids, and anal mucus. It can also be transmitted through breast milk from mother to child, and from illicit injection drug use or sharing needles. Some people have flu-like symptoms within 2 to 4 weeks after infection (called acute HIV infection). These symptoms may last for a few days or several weeks. Possible symptoms include: • Fever, • Chills, • Rash, • Night sweats, • Muscle aches, • Sore throat, • Fatigue, • Swollen lymph nodes, and • Mouth ulcers. But some people may not feel sick during acute HIV infection. Some people can have the infection for several years without any symptoms.

If you have tested positive for an STI, your doctor will discuss with you at your follow up appointment when it is advised to retest. Timeframes for this vary depending on the STI and the personal circumstances. If you are unsure, please contact us at support@sistr.com.au and one of our clinical team will contact you to let you know, or book in for an STI consult for follow up testing https://www.sistr.com.au/consult-now As a general rule, the Australian STI Guidelines recommend the following: https://sti.guidelines.org.au/ Chlamydia Test of cure not routinely recommended, however if there are concerns for medication adherence or early re-infection, Test of Cure should be performed no earlier than 4 weeks after treatment completed, to prevent false positive results due to persistent chlamydia DNA. Test of Reinfection recommended at 3 months Gonorrhoea Test of cure should be performed 2 weeks after treatment is completed, due to antimicrobial resistance. Test of reinfection recommended at 3 months Syphilis Repeat Syphilis RPR testing should be performed at 3 months, then at 6 months and (if necessary) at 12 months after completing treatment. This is usually offered by the treating clinic locally, however please contact us if you require support with this testing at support@sistr.com.au Mycoplasma Genitalium A need for a test of cure should be informed by presence of ongoing symptoms and/or ongoing risk of reinfection. Usually a test of cure will be offered to patients 14-21 days after treatment is completed. Trichomonas Test of cure is not recommended. Test of reinfection is only recommended for patients who remain symptomatic or where partner treatment remains uncertain. Retesting should be performed after 4 weeks. Hepatitis A/B/C and HIV All ongoing care will be handled by a specialist such as a sexual health clinic or s100 provider, local to the patient.