Essential Features
General Considerations
Collecting an accurate sexual history from patients is essential to the effective clinical management of patients with sexually transmitted diseases (STDs). Many clinicians, however, do not feel comfortable or well-trained in sexual history taking. A useful sexual history is collected in a nonjudgmental manner in which the patient shares personal information about sexual behaviors that might put him or her at risk for STDs. Such information not only guides further evaluation of patients but also may provide opportunities to introduce consideration or reflection about risk-reduction measures into the provider-patient discourse. Key aspects of obtaining a sexual history are summarized in Table 31–1.
| Assure confidentiality and be nonjudgmental |
| Remind patients of why the information is clinically relevant |
| Be specific and use nonmedical terminology |
| Ask about sexually transmitted diseases as well as preventive and sexual risk behaviors, including type of sex, condom use, and number and types of partners |
| Make no assumptions based on patient characteristics |
| Explore situations that place individuals at increased risk (eg, alcohol or substance use) and, together, develop a concrete risk-reduction plan |
| Use direct questions such as, “Do you have sex with men, women or both?”; “How many partners have you had in the past 2 months, past 1 year”; and “How do you protect yourself from getting STDs?” |
The Setting
The initiation of a sexual history requires that the patient feel comfortable and empowered. The interview should be in a private space with the patient in street clothes sitting at a level equal to or higher than the clinician. There should be no physical barrier (eg, table or desk) between the patient and clinician. The body language of the clinician should suggest openness and acceptance, with hands and legs uncrossed. The clinician should look directly at the patient, nodding encouragement, prompting, and offering periods of silence and reflection of statements.
Early in the session, the clinician should remind the patient that all the information collected during the interview is confidential and cannot be shared with others without the expressed permission of the patient. The clinician should articulate why the sexual history is valuable in a direct and noncondescending manner, using a statement such as the following: “In order for me to take better care of you, I need to ask a few personal questions about your history of sexually transmitted diseases and sexual behavior. Some of these questions may make you feel uncomfortable or may be embarrassing. That is normal and I assure you everything you tell me will stay in this room.” Similarly, many patients find it reassuring to be encouraged to ask questions if they do not understand why some elements of the sexual history are being asked.
Ascertainment of Sexually Transmitted Disease History
Many clinicians often begin by eliciting a history of STDs, because they have more experience with collecting information about a patient’s medical history and believe this meets the more immediate expectations of the patient. Unfortunately, many patients assume that they have been tested for “everything” in the course of usual care. Although questions such as “In the past have you ever had a sexually transmitted disease or STD?” are typically too general for an accurate sexually history, they may be a useful introduction to the topic. Such an opening should be followed by specific questions regarding each STD: “Were you ever told by a doctor or nurse that you had or were you ever treated for syphilis? Gonorrhea? Chlamydia? Herpes? Nongonococcal urethritis [in men]? Epididymitis or infection of the testicles [in men]? Pelvic inflammatory disease or infection of the fallopian tubes or uterus [in women]? Proctitis (infection of the rectum)?”
