Sexual health history

Introduction

• Wash hands
• Introduce self
• Ask Patient’s name, DOB and what they like to be called
• Explain and obtain consent
• Set the scene: explain that some of the questions you will need to ask will be sensitive in nature and you may need to ask details about sex and sexual partners
• Stress confidentiality
• Check the reason for attendance: check-up or any symptoms (e.g. pain, discharge, ulcers, lumps)

History of presenting complaint

• Exploreevery symptom
  • Timeframes
  • Symptom-specific questions (see exploring symptoms)
• Sexual health systems review
  • Discharge (urethral/vaginal/rectal)
  • Dysuria
  • Swellings/growths/ulcers
  • Pain (anogenital, pelvic, dyspareunia)
  • PV bleeding and menstural history (if female)

Partners

• Sexual orientation (‘do you have sex you men/women or both?’)
• Current partners (casual/regular partners?)
  • When last had sex
  • When last had sex with anyone else
• Sexual contacts in last 3 months
  • Male/female
  • Country born
  • Condom use
  • Type of sex (oral/vaginal/anal)
• High risk encounters for HIV
  • Sex with men (if male)
  • Sex with partners who: were born abroad, have sex with men, or who are known to be HIV-positive
  • Paying for (or being paid for) sex
  • ‘ChemSex’ (use of recreational drugs by men who have sex with men before or during sex, often with multiple partners)
  • Needle sharing
  • Tattoos/piercings/transfusions/medical treatment abroad

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Past medical history

• Previous STIs and tests
• HIV and hepatitis B/C status
• Vaccination history (including hepatitis B)

Drug history

• Regular medications and allergies
• Contraception and adherence
• Use of PrEP if male (pre-exposure prophylaxis for HIV)

Social history

• Alcohol use
• Smoking
• Recreational drug use (including ChemSex and needle sharing)

Now for some questions…

What are the causes of genital ulceration? Please classify them by painful and non-painful.

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What would be your differential diagnosis for genital discharge?

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According to NICE, list the risk factors for HIV infection.

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A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

And some stations…

1. Female sexual health history
2. Urethral discharge
3. Epididymo-orchitis
4. And there’s lots more!