Sexual History Case
Sexual History Case
Please assess the student as they take the following history.
Student's Email

CASE - The evaluating student should read the following case and role-play for their peer

 Dear Student: The following exercise is meant to be done as a role-play.  One student should read the case and role-play the patient.  The other student should act as the physician, and should not read the case or the checklist in advance. A third student, or the "patient", should complete the checklist during the interview to track their peer's progress.

 

Case:  Mr. GC

 

     You are Mr. GC, a 24-year-old recent university graduate.  You live on your own in Toronto, where you just began working as an App developer.  You are going to see the doctor because you are interested in learning about STI testing.

 

     You have been sexually active since the age of 21.  You have had 2 sexual partners: one female partner throughout a 13-month monogamous relationship, and one male partner who you began seeing casually 3 months ago.  You only had vaginal sex with your first female sexual partner and have been participating in oral and anal sex with your current male partner. 

 

     You have never received STI testing.  You and your previous female partner had not been sexually active before meeting each other so you felt no need to be tested.  You are unaware of your current partner’s STI history.  You have always used a condom when participating in vaginal or anal sex, but not when participating in oral sex.

 

     You are an active 24-year old.  You do not take any medications, do not have any diagnosed medical illness, and you have no allergies.  You regularly work out at the gym, which is where you met your current sexual partner. You also enjoy spending time with your friends on the weekend playing frisbee or meeting at the local bar.  You do not smoke cigarettes or use recreational drugs.  You drink socially on the weekend (10 drinks/week).  You have one younger sister, who lives at home with your parents.  You are close with your family and see them regularly.

 

     You have told anyone about your current male sexual partner, as you fear they may have a negative reaction.  As a result, you are feeling a bit socially isolated about your feelings.  As you do not have a close relationship with your current partner, you do not feel comfortable discussing this with him.  While you are always careful to use protection when having sex, you are unaware of your current partner’s sexual history and thus concerned about what risks you are exposing yourself to.

 

A common guideline to take a sexual history includes the “5 Ps”.  For more information, see: http://www.cdc.gov/std/treatment/SexualHistory.pdf .

 

INTRODUCTION - The student should inquire about the following:

Washes hands
       
Introduces self to patient
       

IDENTIFYING DATA- The student should inquire about the following:

Name of patient
       
Age of patient
       

CHIEF CONCERN - The student should inquire about the following:

Nature of concern
       
Duration of concern
       

SEXUAL HISTORY - The student should inquire about the following:

Age at start of sexual activity
       
Number of sexual partners
       
Current sexual relationships
               
Gender of partners (men, women, or both)
       
Partners' risk of STIs (# of partners, IV drug use, last STI testing)
               
Type of sexual contact (i.e. genital, anal, oral, digital)
               
Use of contraception (includes: type, consistency)
               
Use of protection against STIs (includes: type, consistency, which sex acts, lubricant for anal sex)
               
Drug-related behaviour (includes: IV drug use, sex under the influence)

Drug-related sexual behavior is considered high-risk behavior.

               
Past history of STIs
       
Current symptoms of STIs (includes: urethral discharge, dysuria, scrotal/testicular pain, lesions/ulcers)
               

Though not necessary in this particular case, it may be necessary to ask the patient about survival sex/prostitution, and sexual abuse/violence to best understand their risks.

Medications (includes: prescription, over-the-counter, and herbal/alternative medicines)
               
Allergies to drugs or otherwise (includes: nature of reaction, timing of reaction, formal testing performed)
               

PAST MEDICAL HISTORY- The student should inquire about the following:

It is important to ask about diagnosed medical illnesses, surgeries, hospitalizations, and immunization history, this is not relevant for this case.

SOCIAL HISTORY AND HABITS- The student should inquire about the following:

Smoking (includes: pack years; if they quit, when)
               
Alcohol (includes: quantify)
               
Drugs (includes: types, frequency of use, quantity, methods)
               
Living arrangement
               
Relationships & Children
               
Hobbies & Interests
               
Occupation
               
Social support
               

REVIEW OF SYSTEMS - The student should inquire about the following

Though it is important to perform a thorough review of systems when seeing patients, this is not relevant for this case.