Are You Asking These Seven Sexual Health Questions?

Medscape

14-07-2025

At the 2025 Argentine Society of Infectious Diseases (SADI) Congress held June 12-14 in Mar del Plata, Argentina, updated guidelines for the diagnosis and treatment of sexually transmitted infections (STIs) were presented. The chapter, developed by the HIV and STI Commission on a comprehensive approach to sexual health, offers step-by-step recommendations for taking a sexual history, designed for both specialist and primary care clinicians.
Romina Mauas, MD, one of the chapter's authors, is an outpatient physician at Hospital de Infecciosas F.J. Muñiz and a researcher at the Center for Studies for the Prevention and Control of Communicable Diseases at ISALUD University, Buenos Aires, Argentina.
'This content is entirely new. This highlights the key questions that should never be missed when taking a medical history. It also promotes an inclusive, respectful environment free from stigma, prejudice, or moral judgment while protecting privacy, confidentiality, and individual rights,' she said.
The chapter was co-authored with José Barletta, MD; Franco Bova, MD; Iael Altclas, MD; Adriana Basombrío, MD; Luciana Spadaccini, MD; Mara Huberman, MD; and Sergio Maulen, MD, PhD, all of whom are medical professionals.
'This material hasn't been available before, isn't covered in other guidelines, and can benefit any healthcare professional in the region,' said Alejandra Cuello, speaking with Medscape Spanish. She was one of the two coordinators of the recommendations. Cuello heads the Infectious Diseases Service at the Juan D. Perón Regional Polyclinic and was an adjunct professor of infectious diseases at the National University of Villa Mercedes, both in Villa Mercedes, Argentina.
The new guide included 21 chapters covering a wide range of topics, including urethritis, acquired syphilis, genital herpes, human papillomavirus, viral hepatitis, gonorrhea, Zika virus, sexual abuse and rape, STIs in pregnant women, and emerging STIs, such as mpox.
'Instead of just copying the international guidelines, this version includes local epidemiology, available diagnostic methods, and treatments tailored to the regional context,' Cuello said.
Patient Interaction
A unique feature of the updated guidelines is that they begin with recommendations on how to explore aspects of a patient's sexuality during consultations, an area often avoided due to 'lack of knowledge, modesty, or discomfort,' Cuello noted.
Mauas, speaking to Medscape Spanish said, 'We need to be warm because we are asking intimate questions. You cannot rush into conversations about sexual practices without creating a comfortable environment. She emphasized that a lack of empathy is often the first barrier to timely and appropriate care.
These guidelines highlighted the importance of the first interaction in building trust and obtaining the patient's accurate sexual history. Clinicians are encouraged to pay attention to initial greetings, maintain appropriate eye contact, and use supportive body language.
'Consultations should begin with open-ended questions. Clinicians are advised to first explore general concerns and then gradually move into more sensitive topics. Each question should be explained clearly using simple and respectful language. The approach should accommodate explicit sexual terms when necessary and be responsive to signs of anxiety or distress,' she said.
Core Components
The guidelines outlined seven key areas to consider in sexual health consultations.
Reason for consultation. Begin by understanding the reason for the patient's visit. Review any signs or symptoms to help guide the examination and diagnostic tests. History of STIs. Inquiring about a patient's history of STIs is important, as this can affect the current risk assessment, choice of diagnostic tests, and interpretation of results. 'Some people are aware of this; others are not because the infection may have been asymptomatic,' Mauas noted. Assess personal and partner(s) risk perception, including prior testing for HIV, viral hepatitis, and other STIs. Ask whether the patient has received postexposure prophylaxis for HIV, especially in the past 6-12 months. Sexual partners. Determine the time since the patient's last sexual contact. When possible, estimate the number of regular and casual partners in the past 3 months or during the 3-month period. Avoid making assumptions about a person's sexual orientation; instead, ask respectfully. 'What is your sexual desire? Do you like being with a woman or a man? What is your orientation? How do you perceive or define yourself?' Mauas explained. Sexual practices. Gather information about the sites of potential exposure and specific practices, including oral, vaginal (receptive/insertive), and anal (receptive/insertive). Also ask about group sex, transactional sex (in exchange for money, drugs, or services), use of sex toys, dating apps, and recreational drug use — including alcohol and sex-related substances. 'These are individual situations that need to be considered,' Mauas emphasized. STI protection. Ask about the frequency of condom use during vaginal or anal intercourse over the past 3 months. Discuss any barriers to condom use. In addition, the vaccination status for hepatitis A, hepatitis B, and human papillomavirus must be assessed. Pregnancy prevention. Discuss pregnancy planning, contraceptive use, and access to safe abortion services when relevant. If necessary, refer to the appropriate specialized health departments. 'Although it depends on the specialty, we can — and should — work together with the sexual and reproductive or nonreproductive health department, depending on what the patient wants, such as whether they need counseling on contraception,' Mauas said. Other sexual health issues. Screening for problems related to sexual satisfaction, function, or psychosexual concerns. Ask about experiences of gender-based violence and offer appropriate referrals to the relevant services. These guidelines also encourage clinicians to leave room for patients to raise additional personalized concerns.
Practical Recommendations
The guide outlines general recommendations for consultations with key populations and priority groups at a higher risk of STIs, including transgender people, sex workers, men who have sex with men, adolescents and young adults, incarcerated individuals, people who use drugs, and migrant populations.
The guide offered several recommendations to improve consultations, as follows.
Avoid making assumptions about sexual orientation. Ask open, respectful questions about sexual practices, such as the gender of sexual partners, relationship status, and whether the patient is monogamous.
Ask about self-identified gender at the beginning of the consultation to avoid mistakes or assumptions regarding sex or gender based on appearance. Gender-neutral languages should be used wherever possible. Ask questions such as, 'Are you taking any medication?' instead of 'Are you on any medication?'
Genital examination should be delayed unless clinically necessary. This can be postponed until a greater level of trust is established.
Recognize that not all individuals are sexually active or wish to initiate sexual practices.
Offer flexible services to accommodate different needs. For example, evening clinic hours may better serve those with nighttime work schedules.
Training the entire healthcare team to promote, inclusive stigma-free care is essential.
'Anyone who chooses to work in sexual health must be properly trained — not only in clinical knowledge but also in addressing personal biases that may come from cultural or religious beliefs. Primary care providers should familiarize themselves with these guidelines and build their capacity to manage consultations. If they are unable to complete the assessment, they should be referred appropriately; however, they must not become a barrier to care. When a patient feels mistreated due to administrative or bureaucratic hurdles, they often choose not to return,' Mauas said.
Mauas and Cuello reported having no relevant financial relationship.
This story was translated from Medscape's Spanish edition.