The importance of social histories for assessing sexually transmitted disease risk

Although identifying risk groups for sexually transmitted diseases based on age or race may be useful for targeting screening efforts, clinicians should recognize that even members of most "low-risk" groups include some individuals at higher risk of infection.

This case series of generally older people with sexually transmitted diseases illustrates how assumptions regarding age and risk group can lead to missed opportunities for sexually transmitted disease prevention.

Records were compiled from two clusters of patients with sexually transmitted diseases seen at a Springfield, Mass., health center between March and September 1992.

Nine patients with a sexually transmitted disease (one with syphilis/human immunodeficiency virus co-infection, one with herpes/human immunodeficiency virus co-infection, two with human immunodeficiency virus infections, and five with syphilis) are described. Eight of the patients are linked epidemiologically.

A social history is essential during a medical encounter for sexually transmitted disease prevention purposes. Relying on assumptions regarding risk groups, as well as sexual activity, age, or other medical conditions, may lead to a patient's level of risk of infection going unrecognized. Discomfort associated with asking the sensitive questions involved in a social history also is a barrier to recognizing risks or infections. Non-judgmental sexual histories are appropriate when evaluating all patients.