Talking about sex may not be a regular part of the doctor-patient relationship, but it should be. This can be especially true for adolescents and young adults who are disproportionately impacted by sexually transmitted infections(STIs). Half of all new STI cases are in young people between the ages of 15 and 24. Below are tools and educational materials to help providers meet the sexual health needs of their patients, as well as guiding providers to resources to help improve patient care.
Taking a sexual history
The 5 “P”s of a Sexual History:
- Partners—Have they been and are they sexually active; any new partners lately; how many partners in past year; gender of partners; do their partners have other partners?
- Pregnancy Prevention—What do they do to prevent pregnancy or plan for a healthy pregnancy?
- Protection—What do they use or don’t use to protect themselves and how often do they use it?
- Practices—What types of sex (vaginal, oral, anal) do and did they have?
- Past history of STIs—What did they have, and when did they have it?
Screening Recommendations
Routine laboratory screening for common STIs is recommended for sexually active adolescents as followed:
- Routine screening for C. trachomatis on an annual basis is recommended for all sexually active females aged <25 years. Screening of sexually active young males should be considered in clinical settings serving populations of young males with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, and STI clinics) and multisite testing should be offered to young men who have sex with men (YMSN).
- Routine screening for N. gonorrhoeae on an annual basis is recommended for all sexually active females <25 years of age and other high risk populations. Multisite testing should be offered to YMSM.
- HIV screening should be discussed and offered to all adolescents. Frequency of repeat screenings of those who are at risk for HIV infection should be based on level of risk.
- Routine screening of adolescents who are asymptomatic for certain STIs (e.g., syphilis, trichomoniasis, BV, HSV, HPV, HAV, and HBV) is not generally recommended. However, YMSM and pregnant adolescent females should always be screened for syphilis.
Reporting Forms
Chlamydia, Gonorrhea, Syphilis, Herpes: Report Form. This form should be completed and submitted within 3 work days (WAV 246-101-101/301). Note on page 3 of this form there is a fax prescription for partners to pick up FREE medication at the pharmacy.
- Partner Treatment: GCHD asks that you make every effort to help patients assure that their partners are treated; either by seeing the partners yourself or by offering patients FREE medication to give to their partners expedited partner therapy (EPT).
Consent Laws
Washington State explicitly allows minors (individuals aged 14 and older) to consent for their own health services for STI screenings and treatment.
Healthcare Provider Resources
- STD Treatment Guidelines | DOH
- Taking a Sexual History | CDC
- STD Factsheets | CDC
- Health Care Providers & Teen Pregnancy Prevention | CDC
- Talking to Patients About Sexual Health
- American Sexual Health Association
- STD Clinical Consultation Network
Gonorrhea
Gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it.
Data
- Grant County STD Profile 2014 | DOH
- 2015 National Data for Chlamydia, Gonorrhea, and Syphilis | CDC
- Grant County Sexual Health Data
Because of the ongoing gonorrhea outbreak and high syphilis rates in Grant County, it continues to be essential to correctly diagnose, treat and timely report STIs. In addition, we encourage all providers who identify patients with STIs to also test for HIV.