Legalities + History taking

Question 1

What are the Fraser guidelines criteria for contraception / sexual health advice for under 16s?

Answer 1

1. YP understands the advice and has sufficient maturity to understand what is involved
2. Doctor cannot persuade the YP to inform parents nor allow doctor to inform them against permission
3. YP would be very likely to begin / continue having sex without contraception
4. In YP’s best interest to give contraception without parent’s consent
5. Without contraceptive advice / treatment, YP’s physical and mental health would suffer

Question 2

What broad topics should be covered in a sexual health history?

Answer 2

-HPC
-Partner history
–Last 3 partners or all partners in last 3 months
–When? Gender? Condoms? Type of sex?
–High risk encounters eg abroad, bisexual, MSM
-Female gynae history
–Menstrual, contraception, smears history
-PMHx
–Including vaccines + HIV / hep status
-DHX
-SHx
-HIV risk assessment

Question 3

What are considered risk factors for HIV infection?

Answer 3

-Previous tests
-IVDU (self or partner)
-MSM contact
-Sex abroad
-Partner from abroad
-Paid for sex
-Been paid for sex
-Known HIV +ve contacts

Question 4

In the instance of sexual assault, what additional information is required in the history?

Answer 4

-Details of the assault:
–Type
–Date
–Time
–Place
-Ask what occurred
–Vaginal / anal / oral penetration
–Other activities
–Any injuries
-Contraception use?
-LMP?
-HIV / hepatitis risk
-What is known about the assailant?

Question 5

What are the timescales for different swabs following sexual assault?

Answer 5

-48h = swabs following oral or digital penetration
-72h = swabs following anal (or vaginal if pre-pubertal) penetration and blood
-120h = urine
-168h = swabs following vaginal penetration if post-pubertal