Obtaining a Sexual History: Conversation Starters

Date: 01/08/24

Obtaining an accurate and detailed sexual history is essential for proper screening for sexually transmitted infections (STIs). While this conversation may be uncomfortable for both provider and patient, a comprehensive sexual history should be part of routine, preventive health care. The conversation starter and sample questions below can help providers with a standardized approach to obtaining a sexual history.

Set the Stage

Create an environment that is welcoming to adolescents, establish a practice-wide policy of spending time with minor patients without a parent present. Kansas has state law that allow minors to consent to certain types of services without parent or guardian permission. These laws help young people seek confidential health care for sensitive issues.

Begin the conversation with the following: “I am going to ask you a few questions about your sexual history. I ask everyone these questions, as they are important to understand your health. Everything you tell me is confidential.”

Five Questions to Ask Every Patient

Have you ever been sexually active?
What is/are the sex and gender of your partner(s)?
How many partners have you had in the last 12 months?
What types of sexual activity do you have (oral/anal/vaginal/use of sex toys/other)?
When was the last time you got tested for STIs?

Best Practice Tip

It is important to recognize that sometimes taking a sexual history will lead to a longer discussion about sexual health and related illness.

Respond to the History

Based upon the patient’s answers, determine if a more detailed risk assessment is needed.

Use the five Ps approach:

Partners
Practices
Protection from STIs
Past history of STIs
Prevention of pregnancy

Best Practice Tip:

Language is important

AVOID	INSTEAD USE
Are you married?	What is your current relationship status?
You’re married, so you don’t need STI testing, right?	Have you had any new sexual partners in the last year?
Do you think your partner is cheating on you?	Does your partner have other partners?
Do you sleep with a lot of people?	How many sexual partners have you had?
Are you an IV drug user?	Have you ever injected drugs?

Starting in 2014, the Patient Protection and Affordable Care Act (ACA) required insurance plans to cover many clinical preventive services, including screening for chlamydia, gonorrhea, hepatitis B virus, HIV and syphilis.

As a best practice, it is important to work with those in your office who are involved with billing and other staff to ensure proper documentation and coding of claims.

Screening for Chlamydia

NCQA HEDIS^® Recommendations

Testing is recommended for women 16-24 years of age who are identified as sexually active and who had at least one test for chlamydia during the year. Sexually active is defined as anyone who: had a pregnancy test, had any other STI testing completed or had a contraceptive prescription filled.

Appropriate testing includes either a non-invasive nucleic acid amplification test (NAAT for chlamydia screening) or a urine test for chlamydia screening. Frequency of screening is annually for those identified as sexually active.

U.S. Preventive Services Task Force (USPSTF) & CMS Recommendations

The USPSTF assigns screening for chlamydia in sexually active women ages 24 years and younger and in older women who are at increased risk for infection. In terms of frequency, the USPSTF states, “in the absence of studies on screening intervals, a reasonable approach would be to screen patients whose sexual history reveals new or persistent risk factors since the last negative result.” CMS recommendations include sexually active adolescents and adults at increased risk for STIs. Frequency of testing is one annual occurrence of screening for chlamydia, gonorrhea and syphilis in women at increased risk who are not pregnant and up to two occurrences per pregnancy (of screening for chlamydia and gonorrhea in pregnant women) who are at increased risk for STIs and continued increased risk for the second screening.

CPT^®/CPT^® II Codes*

Chlamydia: 87110, 87270, 87320, 87490-87492, 87810

Kansas Code on Treatment of STIs

Minors

There is no Kansas statute that explicitly grants (1) privacy rights to a minor in his or her medical records; and (2) parental and/or guardian rights to access a minor’s medical records. Therefore, in the absence of state law stating otherwise, HIPAA controls.

It states: (A) The minor consents to such healthcare service; no other consent to such health care service is required by law, regardless of whether the consent of another person has also been obtained; and the minor has not requested that such person be treated as the personal representative; 45 CFR 502(g)(3)(i)(A).

As of 2022, all jurisdictions have laws that explicitly allow a minor of a particular age (*16 or older in Kansas) to give informed consent to receive STI diagnosis and treatment services.

38-123b. Consent by minor 16 or over to hospital, medical or surgical treatment or procedures. Notwithstanding any other provision of the law, any minor 16 years of age or over, where no parent or guardian is immediately available, may give consent to the performance and furnishing of hospital, medical or surgical treatment or procedures and such consent shall not be subject to disaffirmance because of minority. The consent of a parent or guardian of such a minor shall not be necessary in order to authorize the proposed hospital, medical or surgical treatment or procedures.

Treatment

Encourage patients infected with chlamydia to have their sexual partners treated, as potentially allowed by Expedited Partner Therapy (EPT).

Legal Status of EPT in Kansas: There is no statutory requirement that patients be examined by a physician prior to being given a prescription at a non-profit clinic. However, the need for a physical examination depends on the facts and standards of competent medical practice.