A good sexual history can catch secondary STIs

When screening patients for sexually transmitted infections (STIs), physicians typically only screen the genitals, but STIs can also infect anal tissue. A comprehensive sexual health history is crucial to catching these secondary infections, says Jack Springer, M.D., assistant professor of emergency medicine at the Zucker School of Medicine at Hofstra/Northwell, in Manhasset, N.Y.

Part of the problem diagnosing anal STIs is that they often do not present any symptoms, Springer says. To determine if a patient is at risk for anal STIs, he says it’s necessary to take a comprehensive sexual history.

He describes an ER patient who presented with no rectal symptoms at all. “He had a very interesting rash,” Springer says. “It turns out this gentleman had anal receptive intercourse, unprotected. We made the diagnosis of secondary syphilis.”

Occasionally, he says, anal STIs may present with symptoms such as proctitis—inflammation of the rectum, which may cause itching and irritation—or discomfort on receptive intercourse, or pain moving the bowels. “Those would be obvious signs,” he says, but most of the time, there are no symptoms.

If he had not taken that patient’s sexual history, they might never have caught the infection.

As an ER doctor, he says he doesn’t have time to worry about a patient’s discomfort in addressing this sensitive issue. “I’m very matter of fact.” He asks if a person is sexually active, what their preference is—men, women, or both—whether they use protection, birth control, if they have ever had an STI, and if they have ever been pregnant. Read more via Medical Economics