'When did you last have sexual contact with someone?' (Describe briefly, for example the week as x/52, the month as x/12: this helps you ascertain the incubation periods for infections as well as the window period for HIV and hepatitis.)
'Was this person male or female?' This will guide your questioning and assist you in the risk assessment. Please remember that if the client is female and having sex with another woman this doesn't necessarily mean that they are not at risk: that other woman may have had male relationships in the past and may have acquired chlamydia, genital warts or HIV. The use of shared sex toys may also be a risk factor.
'Is this your regular partner, or someone you know, or was it a casual contact?' If it is a regular partner they may already know if the partner has signs or symptoms of an infection. If it is a casual contact this can help with your health promotion later and aid in partner notification. Describe using the sexual health abbreviations if you are comfortable with their use, e.g. Regular Male Partner (RMP), Regular Female Partner (RFP), Known Male Partner (KMP), Known Female Partner (KFP), Casual Male Partner (CMP), and Casual Female Partner (CFP).
'What type of sex did you have?' (You may need to prompt or clarify -'vaginal sex, that is your penis in her vagina', 'oral sex, that is his penis in your mouth', 'anal sex, that is his penis in your anus', 'mutual masturbation', etc. This helps you establish the relative risks.
'Which country do they come from?' - This gives you important clues in establishing the relative risks of potential infections/conditions that you might need to think about, e.g. tropical infections, or syphilis.
'Did you use condoms?' (if yes, any splits, breaks or other problems with condoms? If no: 'Do you usually use condoms' - record the result, and be aware that some people may not have used condoms initially but put them on later. You need to make them aware that they are still at risk for acquiring a sexual infection.
'Is your partner using another form of contraception?' (Describe - is pregnancy an issue that you need to be aware of?)
'When did you last have sexual contact with someone different?' (Repeat as above.)
Be aware that some clients will have more than one regular partner. This can be a cultural issue: for example some people will have a person who has borne their child that is their baby mother, but she may not be the only regular sexual partner. This is important in partner notification. Condoms may only be used with people other than the baby mother. If contacts are all casual or your intuition suggests multiple partners, clarify, for instance 'How many partners in the last three months (3/12)?'
'Could you give me an idea of how many different partners you have had, say in the last 3 months?' (Record the answer in a form that helps in your risk assessment, e.g. '7 CMP oral sex only', '2 KFP all protected', or '0 condoms', 'with & without condoms', 'x3 split', etc.)
'Have you ever been told that you have had a sexual infection in the past?' -Record yes/no. If yes when, and ask which one(s): this will give you assistance in a clinical diagnosis, such as a recurrent lesion that could be herpes.
'Where did you get treated?' - Identify the hospital or the country. This is important for assessing the type of treatment given.
'Did you go back for follow up?' Record response.
'Was/were your partner(s) treated at the same time?' - Record yes/no, and describe if the treatment was the same for both. This gives you a lot of information that may guide your differential diagnosis, help with treatment options, and assist in partner notification. It may be a failed treatment or a re-infection from a non-treated/incompletely treated partner.
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