Practice patterns for the elicitation of sexual history, education, and counseling among providers of STD services: Results from the Gonorrhea Community Action Project (GCAP)

Background: The frequently asymptomatic nature and high incidence of severe complications of sexually transmitted diseases (STD) calls for targeted ef forts to identify those at greatest risk. Earlier studies have shown incons istencies regarding STD evaluation by primary care chinicians and physician s. However, the literature regarding the consistency of practice patterns r egarding elicitation of sexual history is limited. We examined practice pat terns for the elicitation of sexual history among providers across seven si tes nationwide. Methods: As part of a multisite study to encourage health seeking for popul ations specifically at risk for gonorrhea (GC) and other STDs, semistructur ed interviews that included questions regarding sexual history elicitation were conducted with 208 service providers in a total of 121 publicly and pr ivately funded clinics, managed care organizations (MCOs), hospital clinics , community- and school-based clinics in Denver, New York, Los Angeles, Bir mingham, St. Louis, Indianapolis, and Prince Georges County, MD. Results: Among the providers interviewed, practice patterns for the elicita tion of sexual history were inconsistent. Sexual histories mere described a s routine (i.e., solicited from every client regardless of reason for visit ) in 57% of sites. Providers most frequently asked clients their number of sex partners (57%), their contraceptive history (55%), and STD history (34% ). Client discomfort among 46% and provider discomfort among 13% was cited as barriers to the elicitation of sexual history. A quarter (26%) of provid ers agreed that the elicitation of sexual history can be fostered by improv ed provider communication skills and 16% agreed increasing training and exp erience for providers is needed. Conclusions: These findings suggest that interventions with providers to st andardize sexual history elicitation can help to reduce barriers to prevent ion, diagnosis, and treatment of STD.