Sexual history and HIV risk assessment

Question 1

What key symptoms do you need to ask about in a sexual history for someone with a vagina?

Answer 1

SOCRATES

• Abdominal and pelvic pain
• Post-coital PV bleeding
• IMB
• Post-menopausal bleeding
• Abnormal vaginal discharge
• Dyspareunia
• Vulval skin changes and itching
• Systemic symptoms
• Dysuria

Question 2

What are the potential causes of abdominal and pelvic pain in a female (sexual health specific)?

Answer 2

• Ectopic pregnancy
• Ruptured ovarian cyst
• Endometriosis
• PID
• Ovarian torsion

Question 3

What are the potential causes of post-coital PV bleeding?

Answer 3

• Cervical ectropion
• Cervical cancer
• Gonorrhoea
• Chlamydia
• Vaginitis

Question 4

What are the potential causes of IMB?

Answer 4

• Contraception (Mirena coil)
• Ovulation
• Miscarriage
• Gonorrhoea
• Chlamydia
• Uterine fibroids
• Perimenopause
• Malignancy

Question 5

What are the potential causes of post-menopausal bleeding?

Answer 5

• Gonorrhoea
• Chlamydia
• Vaginal atrophy
• HRT
• Malignancy

Question 6

What are the potential causes of abnormal vaginal discharge?

Answer 6

• Bacterial vaginosis
• Chlamydia
• Gonorrhoea
• Trichomonas vaginalis

Question 7

What are the potential causes of dyspareunia?

Answer 7

• Endometriosis
• Vaginal atrophy
• Gonorrhoea
• Chlamydia

Question 8

What are the potential causes of vulval skin changes and itching?

Answer 8

• Vaginal thrush
• Gonorrhoea
• Genital herpes
• Chlamydia
• Vaginal atrophy
• Lichen sclerosis

Question 9

What systemic symptoms might you want to ask about when taking a sexual history?

Answer 9

• Fever (secondary to PID)
• Malaise
• Weight loss (e.g. HIV)
• Rash
• Swelling of large joints, conjunctivitis, and cervicitis (reactive arthritis secondary to chlamydia)

Question 10

What other information must you ask people with vaginas about?

Answer 10

1. Menstrual history
2. Past gynaecological history (previous infections/procedures/cervical smears/STI screens)
3. Obstetric history

Question 11

What are key symptoms to ask people with a penis when taking a sexual health history?

Answer 11

• Abdominal and pelvic pain
• Testicular pain or swelling
• Itching or sore skin
• Skin lesions
• Urethral discharge
• Dysuria
• Systemic symptoms

Question 12

What are potential causes of abdominal and pelvic pain in males?

Answer 12

• Orchitis/epididymo-orchitis

- Prostatitis

Question 13

What are potential causes of testicular pain and/or swelling?

Answer 13

• Orchitis/epididymo-orchitis (secondary to chlamydia, gonorrhoea)

Question 14

What are potential causes of itching or sore skin in males (sexual health specific)?

Answer 14

• Genital herpes
• Thrush
• Gonorrhoea
• Chlamydia

Question 15

What are potential causes of skin lesions in males (sexual health specific)?

Answer 15

• HSV
• HPV
• Syphilis (chancre)

Question 16

What are potential causes of urethral discharge from the penis?

Answer 16

• Chlamydia

- Gonorrhoea

Question 17

What are potential causes of dysuria in males (sexual health specific)?

Answer 17

• Chlamydia
• Gonorrhoea
• HSV

Question 18

What questions are important to ask regarding the sexual encounter?

Answer 18

• Sign-post
• Timing
• Consent
• Relationship (casual, regular partner)
• Patient demographics (sex)
• Type of sex
• Contraception (inc problems with the contraception; do they always use contraception?)
• Sexual partners in the last 3 months

Question 19

What questions do you need to ask as part of a HIV risk assessment?

Answer 19

• “Have you ever had a partner who is known to be HIV positive?”
• “Have you ever had sex with a bisexual man/engaged in male homosexual activity?”
• “Have you ever had sex with someone abroad, or who was born in a different country?”
• “Have you ever injected drugs?”
• “Are you aware of any of your previous partners having ever injected drugs?”
• “Have you ever paid someone for sex, or been paid for sex?”

Question 20

What medications might interact with contraception or cause sexual health issues?

Answer 20

• St John’s Wart increases the metabolism of the COCP reducing its effectiveness
• Abx may cause secondary vaginal thrush

Question 21

What is first and second line treatment for chlamydia?

Answer 21

1. Doxycycline 100mg oral BD for 7 days (contraindicated in pregnancy)
2. Azithromycin 1g oral, followed by 500mg daily for 2 days

Question 22

What is 1st and 2nd line treatment for gonorrhoea?

Answer 22

1. Ceftriaxone 1g IM injection as a single dose
2. Ciprofloxacin 500mg orally as a single dose (only where antimicrobial sensitivities are known)
3. Cefixime 400mg orally as a single dose with azithromycin 2g orally as a single dose (if IM injection contraindicated)

Question 23

What is the treatment for primary, secondary, and early latent syphilis?

Answer 23

Benzathene benzylpenicillin 2.4 million units IM injection as a single dose

Question 24

What is the treatment for late latent, cardiovascular, and gummatous syphilis?

Answer 24

Benzathene benzylpenicillin 2.4 million units IM injection weekly for 3 weeks (i.e. 3 doses)

Question 25

What is the treatment for primary episode of genital herpes?

Answer 25

Aciclovir 400mg PO TDS for 5 days

Question 26

What is the treatment for recurrent episodes of genital herpes?

Answer 26

Aciclovir 800mg PO TDS for 2 days

Question 27

What is genital herpes prophylaxis in patients with >5 episodes per year?

Answer 27

Aciclovir 400mg BD

Question 28

What is the 1st and 2nd line treatment for trichomonas vaginalis?

Answer 28

1. Metronidazole 400-500mg BD for 5-7 days

2. Metronidazole 2g oral as a single dose

Question 29

What is the treatment for cervicitis/urethritis caused my mycoplasma genitalium?

Answer 29

Doxycycline 100mg BD for 7 days followed by azithromycin 1g as a single dose then 500mg daily for 2 days (10 days abx treatment)

Question 30

What is the treatment for PID/epididymo-orchitis caused by mycoplasma genitalium?

Answer 30

Moxifloxacin 400mg daily for 14 days