Synopsis
Conduct a private, inclusive and clinically purposeful sexual history that identifies symptoms, anatomical exposure, prevention needs, reproductive context, safeguarding concerns and the tests or urgent actions that follow.
- Start in private, explain confidentiality and its limits, use the patient’s words for identity and anatomy, and ask permission before sensitive questions.
- Ask about symptoms and the last relevant exposure first when timing changes emergency contraception, HIV PEP, pregnancy testing or diagnostic reliability.
- Describe sexual practices by body site and exposure: oral, vaginal/front-hole, anal/rectal and shared-device contact guide sampling more accurately than identity labels.
Key red flags
Sex was unwanted, pressured, exchanged under duress, or occurred when capacity was impaired by substances, injury or another person.
Sudden severe pelvic, abdominal or testicular pain, heavy bleeding, collapse, fever or urinary retention needs urgent parallel clinical assessment.
Exposure within a time-limited HIV PEP or emergency-contraception window requires same-day action rather than completion of a routine screening template.
A child, marked age or power imbalance, position of trust, exploitation, trafficking, violence or fear of a partner requires a proportionate safeguarding assessment.
Ocular, neurological, widespread rash or systemic symptoms alongside possible STI exposure can indicate complicated infection and need urgent specialist review.
Start with symptoms, exposure time and the patient’s goal so an urgent condition or expiring intervention is not buried beneath a comprehensive template.
Ask privately whether activity was wanted, whether the patient felt able to stop, and whether violence, payment, dependence or surveillance affects safety.
Reasoning priorities
Convert the narrative into a complete anatomical testing plan.
A checked site means exposure was assessed, not that infection is present; each pathogen and site still requires a suitable specimen and assay.
Worked reasoning
An adult requests an STI screen after new oral and anal sex, has no symptoms, and is unsure when condoms were used.
- Explain confidentiality and ask permission to clarify timing, body sites, partner diagnoses, pregnancy potential and whether the contact was wanted and safe.
- Identify pharyngeal and rectal exposure and any genital exposure without inferring sites from the patient’s identity or the partner’s gender.
- Offer pathogen- and site-appropriate samples plus blood-borne-virus testing based on timing and risk, explaining that an early negative may require repeat testing.
- Confirm a safe results channel, prevention and vaccination needs, what symptoms require earlier review, and ask the patient to repeat the plan back.