Practices and Barriers in Sexual History Taking: A Cross-Sectional Study in a Public Adult Primary Care Clinic

Abstract

Background Surveys report low frequencies of sexual history (SH) obtained in primary care. Sexually transmitted infections incidence can be reduced with timely screening. It is important to determine whether providers obtain thorough SH and to identify needs for improvement. Aim To evaluate the frequency and depth of SH taking in primary care. Methods In this cross-sectional cohort study, 1,017 primary care visits were reviewed (1,017 adult patients, female 55.26%). 417 patients were seen by male providers and 600 patients were seen by female providers. Multivariate ordered and logit models were deployed. Main Outcome Measures The primary outcome measures included SH taking rates and completeness based on the 5 P model as described by the Centers for Disease Control and Prevention. Results All components of SH were explored in 1.08% of visits. Partial SH was obtained in 33.92% of visits. No SH was taken in the majority of visits (65%). SH was more likely to be taken from female patients than from male patients (P < .001), and was less likely to be obtained from older patients as compared to younger individuals (P < .001). There was no significant difference in SH taking between male and female providers (P = .753). The provider title and the level of training were found to be independent predictors of SH taking (P < .001). Clinical Implications The results of this study highlight an unmet need for more comprehensive and consistent SH taking amongst providers, particularly in high-risk settings, so that SH can be used as a valuable tool in preventive care. Strengths & Limitations To the best of our knowledge, this is the largest study to date examining SH taking in the primary care setting. Limitations include the retrospective study design, lack of generalizability to other hospitals, and inconsistencies in available data. Conclusion The SH taking rates in primary care clinics are globally low with a variation depending on the provider position or level of training, provider gender, and patient age.

Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa

“…22 However, a cross-sectional study in the USA on documentation of sexual history taking in primary care found partial sexual history taking in 34%, and none in the other 65% of the primary care consultations. 15 A South African study found that the prevalence of non-communicable disease and HIV infection is high, and that community-based screening must be expanded. 25 This prompted the researcher's interest in understanding what the nature of sexual history taking entails in a rural primary care setting in South Africa.…”

“…A sexual history usually covers sexual practices, partners, previous STI, prevention of STI and pregnancy, and other factors such as sexual wellbeing, trauma, gender identity, sexual orientation, and other sexual concerns. 14 , 15 In the literature, there is an emphasis on a culturally sensitive and respectful sexual history taking, where good communication and an inclusive attitude are important. 16 When taking a sexual history, lay terminology makes it easier for doctors and patients, not only in terms of concepts, but also to ease the discussion or patient-doctor interaction.…”

“… 22 However, a cross-sectional study in the USA on documentation of sexual history taking in primary care found partial sexual history taking in 34%, and none in the other 65% of the primary care consultations. 15 …”

Talking about premature ejaculation in primary care: the GET UP cluster randomised controlled trial

“…However, GPs often find it difficult to talk about their patients' sexual problems, and do not include sexual history taking in their routine practice 11 . The rate of sexual history taking in primary care is low and depends on the patient's age and GP's training level and gender 12 .…”

Attitudes and Perceived Barriers to Sexually Transmitted Infection Screening Among Graduate Medical Trainees

“…10,11 Strategies to reverse STI trends will require expansion of routine STI testing and treatment beyond sexual health service platforms and integration into other health services. 12 Integrating sexual and reproductive health (SRH) into other health services poses challenges at many health-system levels including the provider level. 10,11,13 Graduate medical education, in which resident physicians complete mentored-training, is an opportunity to improve provider delivery of STI screening and treatment as physicians establish medical practices that continue throughout their professional careers.…”