Primary prevention of STIs includes assessment of behavioral
risk (i.e., assessing the sexual behaviors that can place persons
at risk for infection) and biologic risk (i.e., testing for risk
markers for STI and HIV acquisition or transmission). As part
of the clinical encounter, health care providers should routinely
obtain sexual histories from their patients and address risk
reduction as indicated in this report. Guidance for obtaining
a sexual history is available at the Division of STD Prevention
resource page (https://www.cdc.gov/std/treatment/resources.
htm) and in the curriculum provided by the National Network
of STD Clinical Prevention Training Centers (https://www.
nnptc.org). Effective interviewing and counseling skills,
characterized by respect, compassion, and a nonjudgmental
attitude toward all patients, are essential to obtaining a
thorough sexual history and delivering effective prevention
messages. Effective techniques for facilitating rapport with
patients include using open-ended questions (e.g., “Tell me
about any new sex partners you’ve had since your last visit” and
“What has your experience with using condoms been like?”);
understandable, nonjudgmental language (e.g., “What gender
are your sex partners?”and “Have you ever had a sore or scab
on your penis?”); and normalizing language (e.g., “Some of my
patients have difficulty using a condom with every sex act. How
is it for you?”). The “Five P’s” approach to obtaining a sexual
history is one strategy for eliciting information about the key
areas of interest (Box 1). In addition, health care professionals
can consider assessing sexual history by asking patients such
questions as, “Do you have any questions or concerns about
your sexual health?” Additional information about gaining
cultural competency when working with certain populations
(e.g., gay, bisexual, or other men who have sex with men
[MSM]; women who have sex with women [WSW] or with
women and men [WSWM]; or transgender men and women
or adolescents) is available in sections of these guidelines related
to these populations.
In addition to obtaining a behavioral risk assessment, a
comprehensive STI and HIV risk assessment should include
STI screening as recommended in these guidelines because
STIs are biologic markers of risk, particularly for HIV
acquisition and transmission among certain MSM. In most
clinical settings, STI screening is an essential and underused
component of an STI and HIV risk assessment. Persons
seeking treatment or evaluation for a particular STI should be
screened for HIV and other STIs as indicated by community
prevalence and individual risk factors (see Chlamydial
Infections; Gonococcal Infections; Syphilis). Persons should
be informed about all the tests for STIs they are receiving and
notified about tests for common STIs (e.g., genital herpes,