Hello Daze,
Thank you for your question.
My search returned two excellent resources.
=======================================================================
Approach to Sexual History Taking and STD Screening
CME Program
Medical Education Sponsored by the Massachusetts Medical Society
This program was developed by the STD/HIV Prevention Training Center
of New England and produced by the Boston University School of
Medicine
Educational Media Center.
Download the full STD Program book 140 pages (3.2 MB)
http://www2.mms.org/pages/std.pdf
“This is a series of self-study modules on the topic of sexually
transmitted diseases (STDs). The material in this book will address
sexual history taking and the laboratory diagnosis of STDs: we will
challenge you by giving you the opportunity to answer questions about
different cases.”
Source:
Massachusetts Medical Society Website
http://www2.mms.org/pages/std_cme.asp
You must have Adobe Acrobat installed on your computer to be able to
print or read the above publication.
Adobe Acrobat can be downloaded for free.
The Adobe Website
http://www.adobe.com/products/acrobat/alternate.html#505
=======================================================================
I located A 112 page publication on Diagnosis & Management of STDs.
STD Services Website
http://www.stdservices.on.net/publications/pdf/diagnosis_management.pdf
This publication includes:
The STD Interview – Checklist
This determines:
WHOM to test, WHICH sites to test, WHAT tests to perform.
Source: Information for Medical Students
STD Services Website
http://www.stdservices.on.net/student_info/med_students.htm
=======================================================================
Search Criteria:
history taking and examination for std
://www.google.com/search?sourceid=navclient&ie=UTF-8&oe=UTF-8&q=history+taking+and+examination+for+std
how to diagnose step-by-step std
://www.google.com/search?sourceid=navclient&ie=UTF-8&oe=UTF-8&q=how+to+diagnose+step%2Dby%2Dstep+std
History-taking and Examination shows step-by-step what to ask, how to
ask it and how to examine patients.
://www.google.com/search?q=History-taking+and+Examination+shows+step-by-step+what+to+ask,+how+to+ask+it+and+how+to+examine+patients.&hl=es&lr=&ie=UTF-8&oe=UTF-8&start=20&sa=N
I hope you find this helpful.
Best Regards,
Bobbie7-ga |
Request for Answer Clarification by
daze-ga
on
01 Oct 2002 06:12 PDT
do either of the two sources you found address the issue I mentioned
in my question, regarding the health history of patient's partners?
....should the interviewer try to learn anything about the health
history of patient's partners? Most answers I get amount to wafling.
A nurse practitioner at an std clinic , evaded my question, but when
I pushed her,, she said that the interviewer should try to get every
piece of info, even if it is second hand,, but most physicians will
not ask such questions. They should, she said, but they wont't. Do
tese books address this issue? IF not, they are of no use to me.
Thanks,
|
Clarification of Answer by
bobbie7-ga
on
01 Oct 2002 08:33 PDT
Hello Daze,
Thank you for your clarification request.
Both publications are a source of information on the "by the book"
diagnostic procedures for STDs.
In the two publications, the patient's partners are addressed on the
following pages:
In the 112 page publication on Diagnosis & Management of STDs:
Page 7-8
HIV Testing and Counselling Checklist
Implications of a confirmed positive result
- Discuss the difference between HIV and AIDS
- Contact tracing of past sexual partners
Page 19
(ii) Health advice/contact tracing:
The clinician is responsible for counselling the patient about the
natural history of the disease, its sequelae and method of spread;
about the therapy and its possible side effects; and about the
necessity of follow-up and investigation of sex partners. The
clinician should enquire routinely about any anxieties the patient has
and any uncertainty about instructions given.
Contact tracing is required for all cases of gonorrhoea, chlamydia,
syphilis, hepatitis B, hepatitis C and HIV infection.
(iii) Follow-up
At least one follow-up visit is essential to
- assess clinical response to therapy
- perform investigations to demonstrate cure
- assess side effects of therapy
- confirm that all current sex partners have been investigated and
treated
Page 22
Trichomoniasis 5-10 days for test of cure
Regular partner tested and treated even if test negative
Hepatitis B surface antigen positive
Regular sex partner(s) should be offered hepatitis B vaccination
Page 40
Health Advice
Stress the importance of immediate testing of all sex partners
Page 42
A presumptive diagnosis can be made if a typical ulcer is associated
with a consistent history of syphilis in sex partners and/or serologic
pattern before or after treatment in the patient.
Page 44
Stress the importance of examining all contacts immediately. The
patient should not have sex until treatment is completed and sex
partners have been examined (if possible).
Page 45
All patients are to be referred for contact tracing.
Follow-up - 4 weeks - clinical assessment and sex partner review.
Page 52
Epidemiologic Treatment
Epidemiologic treatment is given to sexual partners, regardless of
age or gender, of persons with proven chlamydia.
Page 58
Women with genital warts, or female partners of patients with genital
warts should be encouraged to have regular Pap smears.
Page 60
Regular sex partners need to be examined and treated even if
trichomonads are not detected.
The patient should not have further sex until the regular partner is
treated and cured. In the absence of microbiologic test of cure, this
means when therapy has been completed and both the patient and partner
are without symptoms.
Page 80
Treatment of partners
Regular sex partners of all women with PID should be evaluated for STD
and treated empirically for chlamydia and/or gonorrhoea even when
there are no symptoms of disease.
Page 97
Notification of HIV Infection
Purpose of HIV notification:
- to enable surveillance of HIV infection in SA
- to facilitate contact tracing/partner notification; medical officers
notifying the infection can either initiate contact tracing and send
relevant information to the HIV epidemiologist or, after consultation
with the client, request the HIV epidemiologist to investigate the
case.
In the 140 page STD Program book:
Page 13
A more casual presentation to Mr. Corporate would be the following:
“Mr. Corporate, I know you’re married. But have you had any sex
partners other than your wife, either men or women, in the last year?”
Reaffirming confidentiality is still important.So, you will be the
judge as to which approach is more comfortable for you as well as for
the patient depending on the circumstances and setting.
Page 14
C.- Do you have sex with men, women or both?
E.- How many sexual partners do you have?
G.- Do you think your wife has other sex partners?
Page 15
Question C facilitates disclosure of same gender sexual activity and
that you are open to hearing about the patient’s experiences.
Question E and G are straight forward in assessing whether the
relationship is monogamous, but you first need to clarify what he is
doing C before assessing what the partner is doing G.
Page 17
You need to appear relaxed and pursue the history as you would for any
other medical problem. The next step is to ask Mr. Corporate in what
sexual behaviors he engages in,if he uses condoms, (if he answers
“yes,” when and under what circumstances he uses them), and what he
knows of the sexual partners.
Page 32
What about the other questions?
They are all appropriate, and can be asked in any order. They are not
gender specific. Another way to ask about sexual partners without
assuming heterosexuality is: “Tell me about your sexual partner(s)”…
Page 34
You need to ask Ms. Shy if she has ever had sex with men, and if so,
when was the last exposure. You can also ask her about her female
partner and whether she thinks she has other partners, including
males. Inquire about a history of STDs.
The majority of women who define themselves as lesbians report past
heterosexual contacts. It is important to ask about past exposures in
your patient and their partner(s).
Page 56
What you need to know when taking a Sexual History:
About the sexual partner(s):
4. Any regular sexual partner? Casual partners?
5. Does the partner(s) have other sexual partners?
7. Any partners STD/HIV infected?
Page 75
The issue of partners is most usefully raised after testing. There’s
no use in getting into this potentially contentious issue before the
results are known. This can be part of the post test counseling
Page 94
Susan is at very low risk of syphilis and HIV infection, so testing
for these is not necessary at this time, given the examination.
However, her partner may be at high risk. You need to explore this
further.
Page 112
* Partner Management is always crucial for appropriate STD care. Tracy
needs to tell her partner that he needs to be evaluated and treated.
You can proceed as described above. Keeping drug company samples of
medications for STD treatment in your office is useful. Tracy’s
partner will also need partner evaluation (where did the gonorrhea and
chlamydia come from?). Alternatively, her partner can be referred back
to his primary care provider and or to a clinic that offers free and
confidential care. Remember that most states have laws that permit
evaluation and treatment of STDs in minors without parental consent.
Page 122
Congratulations on completing this first self-study module on the
management of Sexually Transmitted Diseases! You should now be more
knowledgeable on sexual history taking, STD laboratory diagnostic
tests and screening recommendations as well as partner management.
I hope this helps.
--Bobbie7-ga
|
Clarification of Answer by
bobbie7-ga
on
01 Oct 2002 09:01 PDT
I located another source that may interest you which addresses the
patient’s partners in history taking.
A Guide to Sexual History Taking by the California Chlamydia Action
Coalition
http://www.stdhivtraining.org/educ/training_module/docs/08v2-Guide-SexHist_Taking.pdf
1. Partners
“For sexual risk, it is important to determine the number and gender
of a patient’s sexual partners. One should make no assumptions of
partner gender in the initial history taking. If multiple partners,
explore for more specific risk factors, such as condom use with
partners and partner’s risk factors, such as, other partners,
injection drug use, history of STDs and drug use with sex. If one
partner, ask about length of the relationship and partner’s risk, such
as, other partners and injection drug use.”
|
Request for Answer Clarification by
daze-ga
on
01 Oct 2002 19:55 PDT
You gave good answers........I gave a poor question..Let me try
again....
should the patients partner's symptoms in cases of suspected AIDS or
AIDS-like viruses, be sought? .......even if that person cannot be
found, and the interviewer has to rely on patients description of the
partnersm health hist. and symptoms?....This is for cases where an std
is suspected, but it does not look like any known std...yet it seems
to be "like" HIV/AIDS.
So, in essence, I am looking for "the book" on How To Diagnosea
Hertofore unknown AIDS - virus. There might not be a book, per se,
but surely someone has written a paper on the issue of how to be
prepared for the so called emerging viruses. What do you think?
|
Clarification of Answer by
bobbie7-ga
on
01 Oct 2002 20:31 PDT
Hello Daze,
Posting a entirely new question would be a good idea. Please give as
much detail as you can in your question, and be specific as to what
you expect in the answer. If you want a paper or an article in a
journal, you must say so. The researchers here at Google Answers want
our customers to be pleased with our work and with the information we
provide.
Best regards,
Bobbie7-ga
|
,
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