What are the recommended history intake questions for a male patient requesting Sexually Transmitted Infections (STI) testing?

Recommended History Intake Questions for Male Patients Requesting STI Testing

For comprehensive STI risk assessment in male patients, healthcare providers should use the "Five P's" approach: Partners, Practices, Prevention of Pregnancy, Protection from STDs, and Past History of STDs. 1

Partners

• "Do you have sex with men, women, or both?" 1
• "In the past 2 months, how many partners have you had sex with?" 1
• "In the past 12 months, how many partners have you had sex with?" 1
• "Is it possible that any of your sex partners in the past 12 months had sex with someone else while they were still in a sexual relationship with you?" 1

Sexual Practices

• "To understand your risks for STDs, I need to understand the kind of sex you have had recently." 1
• "Have you had vaginal sex, meaning 'penis in vagina sex'?" If yes, "Do you use condoms: never, sometimes, or always?" 1
• "Have you had anal sex, meaning 'penis in rectum/anus sex'?" If yes, "Do you use condoms: never, sometimes, or always?" 1
• "Have you had oral sex, meaning 'mouth on penis/vagina'?" 1
• For condom answers:
  • If "never": "Why don't you use condoms?" 1
  • If "sometimes": "In what situations (or with whom) do you use condoms?" 1

Prevention of Pregnancy (for heterosexually active males)

• "What are you and your partner(s) doing to prevent pregnancy?" 1

Protection from STDs

• "What do you do to protect yourself from STDs and HIV?" 1

Past History of STDs

• "Have you ever had an STD?" 1
• "Have any of your partners had an STD?" 1

Additional Risk Assessment Questions

• "Have you or any of your partners ever injected drugs?" 1
• "Have you or any of your partners exchanged money or drugs for sex?" 1
• "In what situations or locations do you typically meet your sexual partners?" 1

Anatomical Site Assessment

• Ask about specific sexual activities to determine appropriate anatomical sites for testing, as symptom-based testing alone misses more than half of anorectal infections in men who have sex with men 2, 3
• For men who have sex with men, universal testing at all potential exposure sites (urogenital, anorectal, and oropharyngeal) is more effective than selective testing based on reported symptoms or behaviors 3

Symptom Assessment

• Ask about any genital symptoms including urethral discharge, dysuria, genital lesions, or rashes 1
• Ask about anorectal symptoms such as pain, discharge, or bleeding if the patient reports receptive anal sex 3
• Note that most anorectal (83%) and oropharyngeal (100%) infections are asymptomatic and would remain undiagnosed with symptom-based protocols alone 2

PrEP and HIV Prevention

• "Are you currently taking or have you ever taken PrEP (Pre-Exposure Prophylaxis) for HIV prevention?" 4
• "When was your last HIV test?" 4

Testing Frequency

• For sexually active men who have sex with men, recommend screening at least annually, or every 3-6 months if they have multiple or anonymous partners, use illicit drugs during sex, or have partners who engage in these activities 1
• For heterosexual men, screening frequency should be based on individual risk factors and local prevalence rates 1

Important Considerations

• Use gender-neutral and non-judgmental language throughout the history-taking process 5
• Explain the importance of honest answers for appropriate testing 5
• Reassure about confidentiality to encourage disclosure of sensitive information 1
• Document sexual history to guide appropriate testing and future screening intervals 5

Research shows that many STI infections are asymptomatic, with one study finding only 13.73% of patients with chlamydia, gonorrhea, or syphilis reporting symptoms when screened 6. This underscores the importance of comprehensive history-taking and appropriate site-specific testing based on sexual behaviors rather than symptoms alone.