United States: A National Survey of Clinic Sexual Histories for Sexually Transmitted Infection and HIV Screening

Noting that optimal elements of a sexual history for sexually transmitted infection (STI) and HIV risk assessment remain undefined, the authors designed the current study with the goal of describing sexual histories in use at STI clinics across the United States.

The study was a cross-sectional survey of facilities in 65 cities with populations greater than 200,000. Within each city, a public health STI clinic (71 percent of the sample) or other STI care facility (29 percent) was randomly selected and sexual history forms were requested. The authors had a 74 percent response rate: information was obtained from 48 clinics.

The researchers found that most forms recorded information on symptoms and prior STI (96 percent), condom use (88 percent), other contraception (85 percent), and numbers and gender (83 percent) of sex partners. Common HIV risk questions were injecting drug use (IDU; 94 percent), sex for drugs or money (58 percent), and sex with an HIV-positive or IDU partner (52 percent). Ascertainment of time during which risks occurred (contact periods) varied from the past 14 days to the past 12 months, with only 38 percent of clinics using any one time period. Only 17 percent of histories incorporated questions for men who have sex with men. Just two (4 percent) had space to record information about sexual behaviors by the HIV status of the sex partner. Condom use was infrequently assessed specifically for vaginal and anal sex (13 percent), and condom use problems were rarely explored (10 percent). Most forms documented STI/HIV counseling, although just 25 percent included specific risk-reduction plans.

"Sexual histories are highly variable," the authors concluded. "Although challenging to accomplish, STI/HIV care, surveillance, and prevention may be improved by developing consensus on core questions to be used in sexual histories."

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