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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

  • Explore every symptom
    • Timeframes
  • 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

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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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Discuss your differential diagnosis for genital discharge.

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List some risk factors for HIV infection?

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And some stations…

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