Taking a sexual history & contact tracing
Posted in General
How to take a sexual history
Adapted from the NSW STI Programs Unit’s STI Testing Tool
How do I start the discussion?
Normalise
- We are offering chlamydia testing to all sexually active people under the age of 30. This is because chlamydia is common and it is important to treat it early. Would you like to have a test while you’re here today?
- [If patient hesitates] Can I give you some information, so you can think about it?
Use a hook
- Have you heard about the hepatitis B or HPV vaccines? They protect against infections that can be sexually transmitted. Would you like to find out more while you’re here?
Incorporate into existing discussion
- Since you’re here for a Pap test [or to talk about contraception], could we also talk about other aspects of sexual health?
- I suggest that we test for… [e.g. chlamydia]. We can check for chlamydia with a urine test. Chlamydia is an infection that is easily treated but people often don’t know they have it. Are you happy to have a test today? If the result is positive, we can also talk about recent partners you’ve had being tested as well.
- Since you’re here for your travel vaccines, let’s talk about other ways you can keep yourself safe while you’re travelling.
Sexual history – example questions:
I’d like to ask you some questions about sex so we can decide what tests to do. Is that ok?
- When was the last time you had sex?
- Who have you been having sex with?
- [Prompt further if required. If they answer ‘my partner’ you can then ask] Other than your regular partner have you had sex with anyone else? [or] When was the last time you had sex with someone other than your regular partner?
- How did you have sex? Vaginal sex/oral sex/anal sex? Did you use a condom? [Repeat question to ask about all sexual contact/partners disclosed by Q.2]
- [If not obvious already] Have your partners been male or female?
- In the last 3 months, how many sexual partners have you had?
- Have you ever been diagnosed with (or thought you had) an STI?
Detailed risk assessment – example questions:
Here are some examples of questions that may help identify risk; ask as appropriate.
I’d like to ask you about some other activities that could increase someone’s risk of some sexually transmitted infections and blood-borne viruses, is that ok?
- [If the patient has had sex with men] Have any of your male partners ever had sex with men?
- [If the patient is a female] Have you had sex with other women?
- [If the patient is a female] Are you pregnant?
- Have you ever been paid to have sex? When?
- Have you ever paid for sex? When?
- Have you ever had any tattoos? If yes, was that here or overseas?
- Have you ever injected drugs? Have you ever shared needles or any of the equipment used for injecting?
- Have you ever been in gaol?
- Are you a refugee or a recent migrant?
- Do you identify as Aboriginal or Torres Strait Islander?
- Have you ever experienced violence from a partner?
Consent:
I suggest we should test for … [e.g. chlamydia]. This will involve a urine test. Can you tell me what you know about chlamydia? Are you happy to have a test while you’re here?
If the result is positive, we can also talk about your other recent partners being tested as well.
Resources to support you:
- STI Testing Tool
- Key Features in Managing STIs - STI Testing Tool [ThinkGP online module]
Partner Notification/Contact Tracing in General Practice
Adapted from the NSW STI Programs Unit’s Contact Tracing Tool
What is my role in contact tracing/partner notification?
When making an STI diagnosis, it is the diagnosing doctor’s responsibility to initiate a discussion about contact tracing/partner notification. Contact tracing/partner notification aims to reduce the transmission of infections, through early detection and treatment for STIs.
How do I raise it?
From what you have told me today, we know there are other people who may be infected with [diagnosed STI(s)]. Would it be ok to talk about how you might tell them or I might help?
Resources to support your patients:
These sites can help your patients to tell their partners that they need to get tested.
- www.letthemknow.org.au
- www.thedramadownunder.info (for men who have sex with men (MSM))
- ww.bettertoknow.org.au (for Aboriginal and Torres Strait Islander people)
Resources to support you:
- Contact Tracing Tool
- Contact Tracing Manual
- STI Contact Tracing for General Practice (ThinkGP online module)