Sexually transmitted infections (STIs) are common. Young people account for nearly half of all infections. Many are asymptomatic and unreported, so the real incidence is much higher, increasing the spread of disease. Patients attend either general practice or go direct to GUM clinics. General practice should:
- Raise awareness of and give information about STIs.
- Provide early diagnosis and treatment to decrease transmission and the risk of complications.
- Screen high risk asymptomatic patients.
- Look for other sexually transmitted diseases. A patient with one STI often has others.
- Provide a clear management plan.
- Provide adequate follow up and advise about contact tracing.
Much depends on the facilities the practice offers and on patient preference. Many prefer the anonymity of the GUM clinic, the free prescriptions provided and the fact that the consultation will not be recorded in the GP notes. However, many practices can confidently treat common STIs within local guidelines and the surgery is a familiar place where patients may feel more comfortable.
Sexual History
This can be challenging. It is awkward asking intimate sexual questions particularly of someone already known well. The patient may be embarrassed so it is important to take the history in a non-judgemental way, putting the patient at ease and reassuring them that the consultation is confidential (where appropriate).
Listen to what the patient has to say, noting non-verbal clues and hidden agendas. The presenting complaint may be a trivial illness if the patient finds it hard to say what the real problem is. Be aware of and sympathetic to cultural differences. Above all, don’t make assumptions about type of sex, sexual orientation or age.
- Start with the least uncomfortable questions rather than immediately asking detailed questions about sex. Explain that the more intrusive questions are routine questions
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