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

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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And some stations…

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