2. Taking a sexual history Ria Daly ST5 GU Medicine/Clinical Teaching Fellow

3. Why can taking a sexual history be difficult? Sensitive issues Embarrassment (patient and ours) Unfamiliarity Need to remain unassuming

4. When would you take a sexual history? When patient presents to GU clinic When assessing need for screening If symptoms could be related to STI/BBV –Could be related to a number of presentations

5. Overview HPC PMH/Prev STIs O+G DH FH SH – inc drug use/travel SR Detailed sexual history

6. HPC – Symptoms of STIs Start with an open question Asked closed questions regarding other symptoms Establish chronology

7. Common/important GU conditions Chlamydia Gonorrhoea NSU Genital warts Herpes Complications – PID, epididymo-orchitis, conjunctivitis Syphilis HIV

8. PMH/Prev STIs Usual PMH Prev STIs –When, what, treatment, partner treated, abstain form sex as advised?

9. O&G LMP – risk of pregnancy Contraception – are they taking it correctly? Previous pregnancies/miscarriages/TOP Smear

10. DH Regular medication Any recent antibiotics (may inadvertently treat/partially treat STI) If skin problem – any topical treatments? Any new drugs? Allergies

11. SH Safeguarding/Fraser competence Job usually not relevant initially Travel/ IV drug use

12. SR Depends on presenting symptom/s Fever, rash, diarrhoea Joint pain Uveitis/conjunctivitis

13. Sexual history What do you need to know? Why do you need to know?

14. Identify cause of symptoms/presenting complaint Identify if they need screening (risk of acquisition/transmission) Which specimens are required Assess whether tests will need repeating Identify areas for education/support Assess if emergency contraception/PEP is required

15. Tips Ensure privacy to take history See patient alone Only ask what you need to know (and be able to explain this) Allow patients time Acknowledge difficulties Don’t assume anything! Respect differences Be clear with your language Clarify terms used by patients Remember confidentiality including between partners.

16. Last Sexual Contact PartnerType of sexCondom 2/7RMP 6/12 O/A Active and passive For anal onlyFrom UK 1/52CMPO Active NoFrom UK Known HIV positive No other partners last 3 months

17. I need to ask you a few more personal questions if that is ok… When was the last time you had any sexual contact? Was that with a regular partner or casual? (if regular – for how long have they been in a sexual relationship with this person) Was that partner male or female? Where was that partner from? What type of sexual contact was that? Vaginal, oral, anal? –Are you active or passive (give/receive)? –Depending on response may ask specifically about use of sex toys, fisting, oral/anal contact etc Any condoms? Sometimes, always, never? Prior to that person when did you last have sex with somebody different? This very detailed history is the norm for patients presenting to GU clinic. In other settings, you may not need all this information, or it may not be appropriate to ask due to a lack of time or privacy. Often, doctors will take enough history to establish that the patient is at risk then either go ahead with testing or refer to GU.

18. Further risk assessment I have a few routine questions I need to ask … Have you ever had a male sexual partner (male patient)? Have you ever sex with a bisexual male partner (female patient)? Have you ever paid or been paid for sex? Have you ever injected drugs? Had sex with someone who injects drugs? Had sex with someone who is known to be HIV/Hep B/C positive? Had sex with someone whilst abroad or someone who has lived/worked abroad?

19. Summary Ensure privacy to take history See patient alone Only ask what you need to know (and be able to explain this) Allow patients time Acknowledge difficulties Don’t assume anything! Respect differences Be clear with your language Clarify terms used by patients Remember confidentiality including between partners.

20. Thank you