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Contraception - Management
How should I assess someone's risk for sexually transmitted infection?

  • Take into consideration the local prevalence of sexually transmitted infections, the person's age, and their sexual activity.
  • Consider their risk for having been exposed to sexually transmitted infection, including HIV:
    • Ask about their current circumstances, current and recent sexual partners, age of onset of sexual activity, type of sexual activity and use of alcohol and other substances.
  • Key groups at risk of sexually transmitted infections include:
    • People involved in prostitution.
    • Men who have sex with men.
    • People who have come from or who have visited areas of high HIV prevalence (and have been sexually active there).
  • Behaviours that increase the risk of sexually transmitted infections include:
    • Misuse of alcohol and/or substances ('recreational' drugs), and especially sharing equipment such as needles.
    • Early onset of sexual activity.
    • Sexual activity without protection (e.g. provided by condoms).
    • Frequent change of and/or multiple sexual partners.
Clarification / Additional information
  • Basic rules on sexual history taking [RCGP and BASHH, 2006]:
    • Privacy and the assurance of confidentiality are essential.
    • Many STIs can be asymptomatic, but when symptoms are present (see below), the patient may not link them to an STI, so you may have to raise the subject sensitively.
    • Do not make assumptions about:
      • Sexual orientation (a married man may still have sex with other men).
      • Age (sexual liberation is not exclusive to the young).
      • Anything!
    • Sometimes you will need to ask direct questions when the person does not volunteer information; explain why you need to ask something, but only ask what is relevant.
    • Embarrassment can be infectious; try not to let your own feelings/opinions interfere.
    • Have a non-judgemental attitude.
    • Clarify terms: 'sex' does not always mean peno-vaginal penetration, and many sexually transmitted infections are spread easily from oral or anal sex.
    • Be aware that condoms are often put on after some penetration has already taken place, and condoms also split/come off.
    • Be alert to non-consensual sex and child protection issues.
    • Alcohol and drug use can lead to risk-taking sexual behaviour, and financial difficulties may lead to prostitution.
Basis for recommendation
  • These recommendations are based on guidelines from the Faculty of Sexual and Reproductive Healthcare (FSRH), (formerly the Faculty of Family Planning and Reproductive Healthcare [FFPRHC]), and the National Institute for Health and Clinical Excellence, and information from the fpa (Family Planning Association) [Belfield et al, 2006; FFPRHC, 2006b; RCGP and BASHH, 2006; NICE, 2007a].

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