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Aim
To enable participants to take an appropriate
sexual history to facilitate the diagnosis and
management of sexually transmitted infections
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Learning Outcomes for this session
By the end of the session participants will be able to describe:
the key components of a sexual history
the concerns of a patient who suspects that s/he may have an
STI and describe strategies to deal with these
the verbal and non-verbal factors which may affect a
consultation
the experience of a consultation about STIs from a patient's
perspective
ways of raising the issue of STIs in a routine consultation.
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Presentation overview
sexual history?
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Why take a sexual history?
to assess clinical condition
to assess risk for STIs (including HIV)
looking for additional risks (PEPSE, Emergency Contraception)
plan tests
when is the best time to take tests?
which tests should be taken and from which sites?
enable partner notification
identify need for immunisation
Identify need for health promotion
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What's different about a sexual history?
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What's different about a sexual history?
Emotional issues
Emotive issues
Embarrassment
Usually involves other people
Attendance as a contact (asymptomatic)
Moral/legal issues
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What are the barriers to taking a good
sexual history?
Patient and provider embarrassment
Stereotyping:
May influence both clinician AND patient
Common stumbling block in sexual history taking
Can be difficult to avoid- natural human response
Increased risk of misunderstanding:
consultation is hurried
provider is embarrassed
patient is embarrassed/anxious
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Embarrassment, anxiety, fear and preoccupation can
affect patient recollection of sexual history
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Patient embarrassment
Best allayed by a sympathetic, non-judgemental, entirely un-
embarrassed clinician
Who is comfortable asking intimate questions
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How can you address issues of sexuality
sensitively when talking with patients?
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What about raising sex in a non-related
consultation?
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Patients not expecting the questions
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So-what do you need to know?
Symptoms and their duration
Partner history
(including partner symptoms and any known or suspected STIs)
Sexual orientation
Dont forget:
http://man2man.ie
Regular v casual partners
Regular partner
Someone with whom they have sex on a regular basis i.e.
spouse, civil partner, boyfriend/girlfriend
Casual partner
Someone they do not know and do not intend to have sex
with again
Someone they know but do not have a regular
relationship with.
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Public Health Strategies to control STIs
Appropriate epidemiologic targeting- target high risk groups
Primary prevention and access to means of prevention
condoms, information
Provision of effective clinical services to shorten the
duration of infectivity
An enabling environment for prevention among
marganilised populations; increased access to health
seservices
Reliable data to guide decision-making surveillance, STI
prevalence data.
2011 - 2012 31
How to ask the questions
5. MSM question:
When you have sex up the bum is that you going into him-insertive (IAI)
Or him going into you- receptive (RAI)
Summary
Ensure privacy and confidentiality
Dont appear judgmental or make assumptions
Explain why you are about to ask personal questions
Signpost before asking questions about sexual activity
Have a clear idea about what questions are relevant,
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Learning Outcomes for this session
By the end of the session participants will be able to describe:
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