Sexual history taking and Partner notification

Question 1

why take a sexual hx

Answer 1

assess a clinical condition
assess risk of STIs
health promotion (vaccination, PREP)
assess for other risks (pregnancy, PEP)
plan investigations
enable partner notification

Question 2

things we need to know

Answer 2

• sx
• sexual behaviour
• previous STIs
• date of last period (LMP), contraception, cytology, gynaecologist, surgical hx
• medical and drug hx, allergies
• vaccinations: HPV/Heb B and A
• blood transfusion: IVDU, MSM, partner’s risk, commercial sex, unsafe tattoos, piercing
• alcohol, intimate partner violence, recreational drug use
• FGM
• Smoking and family hx

Question 3

what to ask in sexual behaviour

Answer 3

Question 4

what physical extra-genital sites to consider to examine

Answer 4

eyes, hand, mouth, skin

Question 5

questions to ask

Answer 5

• when did you last have sex?
• have you had sex with other partners over the last 3-6 months?
• is sex with a regular or non-regular (i.e. casual) partner?
• vaginal/anal/oral
• when was the most recent unprotected sex
• do you have sex with men, women or both
• do you use condoms, sometimes or never
• where was your partner from?
• MSM = giving/receiving?

recent stis:

• date of diagnosis
• stage of infection
• which clinic tx from
• tx they received

hx paying for sex or injecting drugs

testing = when last passed urine (better if not passed urine for at least 1 hour)

risk

• HIV = obtain date of most recent HIV test and the result. Injecting drugs, needle-sharing, sexual risk. if sexual activity in past 72 hours with high risk of HIV transmission you may need to consider PEPSE
• Hepatitis = injecting drugs, needle-sharing, sexual risk
• emergency contraception = if UPSI in past 5 days, you may need to consider emergency contraception
• recent travel

Question 6

closing a sexual hx

Answer 6

• check pt has no other concerns which have not yet been discussed
• explain need for clinical examination and tests as appropriate
• offer a chaperone and document the offer if declined
• the pt should be asked how they would like to receive results

Question 7

Partner notification

voluntary or not

why PN

what medical conditions

Answer 7

voluntary in UK

pt must feel safe and aware of implications for themselves and others

conditions for PN:

• HIV
• Gonorrhoea
• Chlamydia
• Trichomoniasis
• Syphilis
• Lymphgranuloma venereum
• Pelvic inflammatory disease (PID)
• Hepatitis B and C
• Epididymitis
• Mycoplasma genitalium
• herpes/genital warts

Question 8

what pt need to understand the important of PN

Answer 8

The infection they have

How it is transmitted

Why treatment is important

Importance of abstaining from sex

Importance of follow-up/test of cure

Complications of untreated infection

Question 9

PN: contacting partners

Answer 9

contact slip with service access information

• Provide anonymity and confidentiality for the index patient
• Enable sexual contacts to seek medical advice or treatment
• Inform the contact’s clinic of index patient’s diagnosis, reference number and date of diagnosis
• Enable cross referencing and evaluation of partner notification action when the slips are returned to the issuing service

Telephone

Text

Email

Letter

ePN

Question 10

PN: what to tell partner

Answer 10

initial explanation = who you are, where you are coming from, if they are in private/personal space, tell they have been in contact with easily txable sti (if not HIV)

explain nature of infection

offer tx

the importance of tx

do not divulge info of index pt

HIV referrals = not really told it is HIV unless adamant over telephone, book an appointment