THE IMPORTANCE OF SOCIAL HISTORIES FOR ASSESSING SEXUALLY-TRANSMITTEDDISEASE RISK

Background: Although identifying risk groups for sexually transmitted diseases based on age or race may be useful for targeting screening ef forts, clinicians should recognize that even members of most ''low-ris k'' groups include some individuals at higher risk of infection. Goal of this Study: This case series of generally older people with sexuall y transmitted diseases illustrates how assumptions regarding age and r isk group can lead to missed opportunities for sexually transmitted di sease prevention. Study Design: Records were compiled from two cluster s of patients with sexually transmitted diseases seen at a Springfield , Mass., health center between March and September 1992. Results: Nine patients with a sexually transmitted disease (one with syphilis/human immunodeficiency virus co-infection, one with herpes/human immunodefi ciency virus co-infection, two with human immunodeficiency virus infec tions, and five with syphilis) are described. Eight of the patients ar e linked epidemiologically. Conclusions: A social history is essential during a medical encounter for sexually transmitted disease preventio n purposes. Relying on assumptions regarding risk groups, as well as s exual activity, age, or other medical conditions, may lead to a patien t's level of risk of infection going unrecognized. Discomfort associat ed with asking the sensitive questions involved in a social history al so is a barrier to recognizing risks or infections. Nonjudgmental sexu al histories are appropriate when evaluating all patients.