What should be included in an initial consultation questionnaire for STI (Sexually Transmitted Infection) screening based on Australian guidelines?

STI Screening Initial Consultation Questionnaire Based on Australian Guidelines

Use the CDC's "Five P's" framework as your structured approach to STI risk assessment during initial consultations, supplemented with specific questions about injection drug use and sex work to identify HIV and viral hepatitis risk. 1

Core Sexual History Assessment: The Five P's

1. Partners

Ask these specific questions in sequence:

• "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

2. Practices

Frame this section by stating: "To understand your risks for STDs, I need to understand the kind of sex you have had recently." 1

Then ask:

• "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 use responses, follow up with:

• If "never": "Why don't you use condoms?" 1
• If "sometimes": "In what situations (or with whom) do you use condoms?" 1

3. Prevention of Pregnancy

• "What are you doing to prevent pregnancy?" 1

4. Protection from STDs

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

5. Past History of STDs

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

Additional High-Risk Behavior Screening

These questions are essential for identifying HIV and viral hepatitis risk:

• "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

Demographic and Social Context Assessment

Document non-modifiable risk factors that influence screening decisions:

• Age (screening recommendations differ for those under 25 years) 1, 2
• Geographic location (southern states and urban centers have higher STI prevalence) 1
• Race and ethnicity (may serve as surrogate markers for social factors affecting STI risk in some communities) 1

Consider community-level factors when determining screening intensity:

• Local STI prevalence rates 1
• Social network influences 1
• Socioeconomic factors including poverty and discrimination 1

Risk-Based Screening Frequency Determination

Based on the responses above, determine screening frequency:

• Annual screening minimum: All sexually active women under 25 years for chlamydia and gonorrhea 2
• Every 3-6 months: Men who have sex with men with multiple or anonymous partners, methamphetamine use, or sex in conjunction with drug use 2
• Annual screening: All sexually active HIV-infected persons for syphilis 2
• Increased frequency: Anyone with new or multiple sex partners, inconsistent condom use, sex while using drugs or alcohol, or partners with these behaviors 2

Common Pitfalls to Avoid

Reassure patients about confidentiality before asking sensitive questions to encourage honest disclosure. 3 Many patients will not disclose high-risk behaviors without explicit confidentiality assurances.

Do not assume heterosexuality or limit partner questions to opposite-sex partners only. 1 Always ask about the gender of sexual partners using neutral language.

Avoid stopping at the first "no" response. 1 Patients may not initially disclose all sexual practices; the structured approach ensures comprehensive assessment.

Remember that age alone does not eliminate STI risk. 1 Persons continue to be at risk regardless of age if exposed to pathogens, though screening may reasonably stop at menopause or age 55 for women at increased risk only due to demographic factors.