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Case History

image A 23-year-old woman visits the clinic requesting a 'check-up'. She had unprotected sex with a casual partner three weeks ago and now has some offensive vaginal discharge. She has recently begun a new relationship and is concerned about the possibility of infection.

What are the important questions to ask as part of a sexual history?

What is the differential diagnosis and which tests should be undertaken?


image Sexually transmitted infections (STIs) remain a major public health challenge. In the United States (US), the Center for Disease Control and Prevention estimate that 19 million new infections occur each year, almost half of them among young people aged 15 to 24 years.1 Direct medical costs associated with STIs in the US are estimated at up to $14.1 billion annually. In the United Kingdom (UK) there has been a gradual rise in the number of diagnoses of acute STIs.2 Chlamydia cases increased by 206% between 1996 and 2005, gonorrhoea by 55% and syphilis, although uncommon, by 1949%. In 2001, the UK Department of Health produced The national strategy for sexual health and HIV. 3 The key objectives are to ensure that all individuals have access to the knowledge and skills necessary to achieve positive sexual health and that services should be available to all who require them.4 Specifically, the aims are to reduce the undiagnosed prevalence and transmission of STIs and human immunodeficiency virus (HIV), to reduce unintended pregnancies and to improve social and health care for people with HIV. Targets were introduced to reduce the incidence of HIV and gonorrhoea by 2007.

What are the important questions to ask as part of a sexual history?

When taking a sexual history, it is important to communicate with the patient on their level and in a non-judgemental manner, assuring confidentiality (Table 35.1). Firstly, details of the presenting complaint should be taken. A description of the discharge, duration of symptoms and the presence of any associated symptoms, such as dyspareunia or dysuria, should be recorded.

Table 35.1Taking a sexual history

Full details of past and present sexual partners, at least for the previous twelve months, should be taken, including use of barrier contraception, whether regular or casual relationships and nationality.

Method of contraception, if any, is important to assess risk of pregnancy and to discuss and provide emergency contraception if appropriate. Previous STI diagnoses and treatment and also confirmation of partner treatment and compliance should be noted.


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