Quality statement 1: Asking people about their sexual history

Quality statement

People are asked about their sexual history at key points of contact.

Rationale

Asking people about their sexual history enables healthcare professionals to identify if they are at risk of sexually transmitted infections (STIs) and ensures that they can be given information and support to prevent infection. It can also help local services to understand the needs of their populations.

Quality measures

Structure

a) Evidence of local agreement on the key points of contact when people will be asked about their sexual history.

Data source: Local data collection, such as service protocols.

b) Evidence of local processes to ensure that people are asked about their sexual history at key points of contact.

Data source: Local data collection, such as service protocols.

Process

Proportion of people who have a discussion about their sexual history at key points of contact.

Numerator – the number in the denominator who have a discussion about their sexual history.

Denominator – the number of people attending a key point of contact.

Data source: Local data collection. Documenting that a discussion has taken place could form part of an electronic health record.

Outcome

Coverage of testing for STIs: proportion of people attending the service who are tested for STIs.

Data source: Local data collection, for example, the proportion of young people screened for chlamydia and HIV testing coverage is collected as part of Public Health England's Sexual and reproductive health profiles.

What the quality statement means for different audiences

Service providers (such as primary care services, contraceptive services, genitourinary medicine clinics, abortion services, community sexual health services, and voluntary and community organisations) ensure processes are in place and staff are trained to ask people about their sexual history in a sensitive and supportive way at key points of contact. Service providers can help staff to ensure sexual history taking becomes routine by providing tools such as self-completion checklists.

Healthcare professionals (such as GPs, midwives, nurses, doctors, and drug and alcohol workers) ask people about their sexual history at key points of contact. Healthcare professionals ensure that they discuss sexual history in a sensitive and supportive way.

Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that they commission services that identify people who are at risk of STIs by asking them about their sexual history at key points of contact. Commissioners agree key points of contact when people should be asked about their sexual history with service providers. Commissioners ensure that services that engage with people who are less likely to attend primary care or sexual health services are included.

People using healthcare services are asked about their sexual history, for example, the gender of their last partner and their use of condoms, when they attend relevant appointments. This will ensure that they are given the support they need if they are at risk of getting an STI.

Source guidance

Sexually transmitted infections and under-18 conceptions: prevention (2007) NICE guideline PH3, recommendation 1

Definitions of terms used in this quality statement

Key points of contact

Key points of contact could be consultations:

  • with newly registered patients

  • about contraception, pregnancy (including planning a pregnancy), abortion, alcohol or substance misuse

  • when carrying out a cervical smear test, offering an STI test, or providing travel immunisation.

[NICE's guideline on sexually transmitted infections and under-18 conceptions: prevention, recommendation 1]

Asking about sexual history

Services may take a brief core sexual history to establish whether someone is at any risk of STIs and then take a more detailed history if the screen is positive. A more detailed sexual history should include:

  • the gender of sexual partner(s)

  • the type of sexual contact/sites of exposure (oral, vaginal, anal)

  • condom use/barrier use (and whether properly used)

  • relationship with the partner (for example, live-in, regular or casual partner), duration of the relationship and whether the partner could be contacted

  • the time interval since the last sexual contact

  • any symptoms or any risk factors for blood-borne viruses in the partner including known or suspected STIs, injecting drug use, previous homosexual sex (for male partners) and any other risk of sexual infection.

[Adapted from the British Association of Sexual Health and HIV's UK national guideline for consultations requiring sexual history taking, recommendation 3.3.1]

Equality and diversity considerations

When asking people about their sexual history, be aware that they may have additional needs such as physical, sensory or learning disabilities, and that they may not speak or read English, or may have reduced literacy skills. People should have access to an interpreter or advocate if needed.

Healthcare professionals should ensure that older people are asked about their sexual history in order to identify if they are at risk of STIs. Healthcare professionals should also be trained to identify and respond to the specific needs of lesbian, gay, bisexual, and transgender people when asking about their sexual history.

Safeguarding links should be in place with all services that may engage with young people and vulnerable adults about their sexual health. Services should be clear what action should be taken if concerns are raised about child sexual exploitation or abuse, female genital mutilation, human trafficking or modern slavery.