CONTENTS

          Chapters
  1. The Toll of STDs
  2. Reducing the Toll of STDs
  3. Managing STDs
  4. Diagnostic and Treatment Tips
  5. Getting Services to the People
  6. Getting People to Services
  7. Promoting Prevention—Condoms and Monogamy

HIGHLIGHTS

Population Reports is published by the Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA


Volume XXI, Number 1
June, 1993

Obtaining Information

 Information about patients' health and sexual activity can help providers identify symptoms that may be caused by STDs. For example, if a patient has vaginal discharge, such information can help a provider assess the likelihood that she has an STD. If her sexual partner also has STD symptoms or if she has had more than one partner in the previous four weeks, she is likely to have an STD. Questions about sexual activity, such as these, are often the first step in screening people for STDs when they seek health care for other reasons (see Chapter 6.2, Screening). Also, asking questions about sexual activity gives providers an opportunity to explain STD transmission and prevention and to begin counseling. For example, providers should ask STD patients if they use condoms when they have sex. Patients who say that they do not use condoms or do not use them regularly should be counseled at that point.

Providers may hesitate to ask about sexual activity, and patients may hesitate to answer. Often overworked, providers may not have the time to question patients fully, to reassure them, or to explain the reasons for their questions. Also, they may be uncomfortable talking about sex. Patients may fear that what they say will be revealed to others. To protect sexual partners, they may withhold information. Also, patients may feel intimidated by providers because of differences in social status or language. They may fear that providers will criticize them, or they may not understand what the provider is asking or why. Indeed, such questioning may discourage people with STD symptoms from seeking care.

Thus providers need to question patients with sensitivity and tact. To obtain a good sexual history, providers:

  • Greet patients warmly and with respect.
  • Find a private place to talk. Some clinics have private rooms. Where that is not available, others use movable partitions or find a secluded place out-of-doors to talk.
  • Assure patients that all information is kept confidential—and make sure that it is.
  • Practice asking questions to become accustomed to using sensitive language. Role-playing exercises help.
  • Put patients at ease at the start by asking questions that are easy to answer.
  • Speak a language in which patients can talk as easily as possible about sexual issues. Use words that patients understand. Discussion with groups of patients can help providers learn how people talk about sex and STDs (253).
  • Give complete attention to each patient.
  • Ask patients' permission to bring up personal questions. Avoid dwelling on a sensitive subject if patients are reluctant to answer. By bringing up the subject first, the provider allows and encourages patients to talk about it later (8).
  • If possible, arrange for a provider of the same sex as the patient. If this is not possible, acknowledge that men and women do not usually discuss such personal issues. US studies find that female patients disclose more symptoms to and obtain more information from female than male obstetrician-gynecologists (318).

Previous | Next
Top of Page | Table of Contents