CDC Expert Commentary

Taking An Adolescent's Sexual History

Gail Bolan, MD

Disclosures

June 13, 2011

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Hello, I'm Dr. Gail Bolan, Director of the Division of Sexually Transmitted Disease (STD) Prevention at the Centers for Disease Control and Prevention (CDC). I am speaking to you as part of the CDC Expert Commentary Series on Medscape.

Each year in the United States, there are about 19 million new STDs, almost half of which are in younger people, ages 15-24.[1] Research suggests that as many as 1 in 4 teens may have an STD. Many of these infections are asymptomatic, yet some can cause serious health consequences, including infertility, if left untreated.

Taking a sexual history is an important part of any clinic visit but is especially important with your teen patients. A brief sexual history will help you identify individuals at risk for STDs and what anatomic sites to screen. It will also provide you an opportunity to counsel your patients on how to make healthy decisions about their sexual activities. Teens expect their providers to bring up the issue of STD testing; and many assume they are automatically tested during routine visits.

This commentary will offer you tips on taking a sexual history and direct you to additional resources. For teens, the sexual history can be included as a routine component of a broader risk assessment, which also addresses issues related to home, school, drug use, and smoking.

When taking a teen's sexual history, it is important to:

  • Set expectations for the clinical encounter. Speak to the parent(s) and teen together to let them know what to expect in the visit, including that the teen will have some private time with you;

  • When appropriate, respectfully disengage the parent so that you can speak with the teen alone;

  • Before talking to your patient, reinforce confidentiality. Teens are more likely to disclose sensitive information if consent and confidentiality are explained to them. Clarify the laws and limits of confidentiality, explaining situations where confidentiality may have to be breached, such as in cases of reported abuse or suicidal thoughts;

  • Avoid assumptions about the patient's sexual orientation, sexual behaviors, or number of partners;

  • Be nonjudgmental and supportive. Using gender-neutral language can help teens feel more comfortable;

  • Be concrete and specific with your questions; and

  • Describe how screening test results will be delivered.

Make sure clinic staff are also aware of how results will be delivered to ensure patient confidentiality.

To begin the conversation, you may want to normalize the discussion by stating that all patients are asked the same questions and letting the teen know that by asking personal questions you can provide them with the best care possible.

Next, you can use the "5 Ps" as a general guide for taking a patient's sexual history. Remember to use open-ended questions. The "5 Ps" stand for:

  1. Partners: Ask questions to determine the number, sex, and concurrency of your patient's sex partners. You may need to define the term "partner" to the patient or use other, relevant terminology.

  2. Practices: Explore the types of sexual activity that your patient engages in, such as vaginal, anal, and oral sex.

  3. Protection from STDs: Ask about condom use, with whom they do or do not use condoms, and situations that make it harder or easier to use condoms. You can also discuss topics such as monogamy and abstinence.

  4. Past STD history: Ask about the teen's history of STDs, including whether their partners have ever had an STD. Teens who have had a previous STD are more likely to get another infection in the next few months. Rescreening can greatly reduce their risk.

  5. Pregnancy prevention: Explore whether your patient wants to become pregnant and discuss current and future contraceptive options.

Additional questions should be considered for assessing a patients HIV and hepatitis risks. Examples of questions can be found on the slides accompanying this video transcript.

End the discussion by thanking your patient for being open and honest and asking if they have any questions or other concerns -- and offer support by letting them know these concerns are normal. Recognize and reinforce any protective practices mentioned; encourage STD testing and explain the different tests you recommend and why; and provide risk-reduction counseling for patients at risk. Remind your sexually active female patients under age 26 that annual chlamydia screening is recommended.

The "GYT" -- Get Yourself Tested Campaign, a partnership effort between CDC, MTV, Kaiser Family Foundation, and Planned Parenthood Federation of America, offers teen-friendly sexual health information, and free materials to promote STD talking and testing in your clinic. You can visit the campaign Website to access STD trainings, sexual history questionnaires, talking tips and other support resources to help you engage in sexual health conversations with your patients.

Finally, the National Network of STD/HIV Prevention Training Centers has additional resources for clinical trainings and technical assistance. We hope these resources are useful to you and thank you for your dedication to the health and well-being of our youth.

Web Resources

Get Yourself Tested

National Network of STD/HIV Prevention Training Centers

CDC Division of STD Prevention

Dr. Gail Bolan is the Director of the Division of Sexually Transmitted Disease Prevention (DSTDP) within the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC). She earned her medical degree from the Dartmouth Medical School in Hanover, New Hampshire. She completed her training in internal medicine at the University of Virginia, Charlottesville, and subspecialty training in infectious diseases at the Tufts New England Medical Center in Boston and the Stanford Medical Center.

Dr. Bolan began her public health career in 1982 as an EIS officer in the Respiratory and Special Pathogens Branch at CDC. She gained international experience with a 3 month meningitis surveillance project in Burkina Faso, Africa. Following EIS, she completed an infectious disease fellowship that included bench research on the characterization of a Neisseria gonorrhoeae iron-regulating protein that was thought to be a potential vaccine antigen candidate.

In 1987, she began a lifetime career in the field of STD prevention and control as Director of the STD Prevention and Control Program at the San Francisco Department of Public Health jointly with an academic appointment in the Department of Medicine at University of California San Francisco Medical School. Since 1997, she has served as the Chief of the STD Control Branch at the California Department of Public Health as well as the Director of the California STD/HIV Prevention Training Center. In these positions, she has consistently demonstrated a strong and enthusiastic commitment to the field of STD prevention.

In 2010, Dr. Bolan received the CDC Jack Spencer Award, which honors an individual for a career of exceptional contributions to excellence in STD prevention characterized by outstanding commitment to science-based programs, continuous innovation, and profound commitment to helping people.

Throughout her career, Dr. Bolan has held numerous scientific leadership positions on many national committees related to STD prevention and control and has been a senior technical consultant with the CDC on a wide variety of strategic scientific initiatives. She has published more than 125 articles of which many appear in high profile journals such as Nature, Proceedings of the National Academy of Sciences, Lancet, The New England Journal of Medicine, and Journal of the American Medical Association.

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