From the Guidelines
Knowing a patient's sexual and drug history is crucial for providing comprehensive healthcare and reducing the risk of morbidity, mortality, and improving quality of life. This information helps healthcare providers make accurate diagnoses, prescribe appropriate treatments, and avoid harmful drug interactions, as highlighted in the CDC's 2012 guidance on integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly 1. For example, certain medications like protease inhibitors for HIV treatment can interact dangerously with recreational drugs such as MDMA or methamphetamine, potentially causing life-threatening complications.
Key Considerations
- Sexual history reveals risk factors for sexually transmitted infections (STIs) like chlamydia, gonorrhea, syphilis, and HIV, which may require specific testing and treatment with antibiotics such as azithromycin 1g single dose for chlamydia or ceftriaxone 500mg IM for gonorrhea, as recommended by the CDC's 2010 STD treatment guidelines 1.
- Understanding a patient's complete history also helps establish trust and enables culturally sensitive care tailored to their specific needs and circumstances, ultimately leading to better health outcomes.
- The CDC recommends routine screening for other risk factors for infectious diseases, such as risky sexual behaviors or being a known contact of a person with active TB, and providing relevant preventive services and risk-reduction counseling 1.
- Medication-assisted therapy with methadone or buprenorphine is highly effective for opioid addiction and can promote adherence to needed medical care, reduce the frequency of heroin injection, and decrease criminal activity, as demonstrated by extensive evidence 1.
Preventive Care Recommendations
- HPV vaccination
- PrEP (pre-exposure prophylaxis) for HIV prevention with medications like Truvada (emtricitabine/tenofovir)
- Harm reduction strategies for people who inject drugs
- Regular testing for HIV, STDs, and TB
- Risk-reduction counseling and high-intensity behavioral counseling for all sexually active adolescents and adults at increased risk for STDs and HIV infection 1
From the FDA Drug Label
Risks are increased in patients with a personal or family history of substance abuse (including drug or alcohol addiction or abuse) or mental illness (e.g., major depression). Patients at high risk of buprenorphine hydrochloride abuse include those with a history of prolonged use of any opioid, including products containing buprenorphine, those with drug or alcohol abuse, or those who use buprenorphine hydrochloride in combination with other abused drugs.
The significance of knowing a patient's sexual history is not directly relevant to the provided drug labels. However, knowing a patient's history of substance (drug) use is crucial in assessing their risk for opioid addiction, abuse, or misuse when prescribing buprenorphine hydrochloride. This information helps healthcare providers to:
- Identify patients at high risk of abuse
- Implement intensive counseling and frequent reevaluation for signs of addiction, abuse, and misuse
- Develop strategies to reduce the risks of overdose and death associated with buprenorphine hydrochloride abuse 2, 2, 2.
From the Research
Significance of Knowing a Patient's Sexual History
- Knowing a patient's sexual history is crucial in identifying and managing their sexual health needs, particularly in assessing risk regarding sexually transmitted infections and HIV 3, 4, 5, 6.
- A comprehensive sexual history can help healthcare providers determine the need for timely screening and preventive care, ultimately reducing the incidence of sexually transmitted infections 4, 5.
- Studies have shown that healthcare providers often do not obtain thorough sexual histories, with rates of comprehensive sexual history taking being as low as 1.08% in some primary care settings 4.
Significance of Knowing a Patient's History of Substance Use
- There is limited direct evidence in the provided studies on the significance of knowing a patient's history of substance use.
- However, taking a comprehensive patient history, which may include substance use, is fundamental for accurate diagnosis and effective management of health conditions 7.
Barriers and Challenges in Taking a Sexual History
- Studies have identified barriers and challenges in taking a sexual history, including provider demographics, patient age, and level of training 4, 5.
- Nurses and healthcare providers may need to confront their own values and attitudes regarding sexuality to overcome barriers in discussing sexuality with patients 6.
- Education and training on taking a sexual history and discussing sexual health can help healthcare providers improve their practice and provide better care for patients 7, 6.