Reproductive & Maternal Health Resource Center

Reproductive & Maternal Health Resource Center

Perspective from Ann Avery, MD
Perspective from Melanie Thompson, MD
Disclosures: The authors report no relevant financial disclosures.
October 01, 2020
4 min read
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Few PCPs take complete sexual histories, perform HIV tests

Perspective from Ann Avery, MD
Perspective from Melanie Thompson, MD
Disclosures: The authors report no relevant financial disclosures.
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A complete sexual history was taken at less than 2% of initial visits to a primary care physician in 2015 in the United States, and HIV testing occurred at less than 1% of PCP office visits annually from 2009 to 2017, data show.

In a cross-sectional cohort study, Leonidas Palaiodimos, MD, MSc, an assistant professor of hospital medicine at Montefiore Medical Center, and colleagues reviewed 1,017 first-time visits that adults made to a PCP. To meet the definition of a complete sexual history, the visit needed electronic health record documentation of discussions about sexual partners, sexual practices, pregnancy prevention, protection from sexually transmitted infections (STI) and past history of STIs — also known as the CDC’s “five P’s” approach.

Palaiodimos L, et al.
Source: Palaiodimos L, et al. J Sex Med. 2020;doi:10.1016/j.jsxm.2020.05.004.

Researchers reported that only 11 (1.08%) visits met those criteria. There were 345 (33.92%) visits that partially followed it, and the remaining 661 (65%) visits did not follow it at all. Also, sexual history was more likely to be taken from female patients than male patients (P < .001) and less likely to be obtained from older patients vs. younger ones (P < .001). Although a PCP’s title and the level of training were independent predictors of sexual history taking (P < .001), their sex was not (P = .753).

“Overall, the rates of sexual history taking were alarmingly low,” Palaiodimos and colleagues wrote in The Journal of Sexual Medicine, adding that previous studies have shown that educational materials, intervention workshops and educational role-playing have improved physicians’ abilities to obtain a thorough sexual history.

In a recent MMWR, Karen W. Hoover, MD, a medical epidemiologist at the CDC, and colleagues analyzed data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to estimate trends in HIV testing of males and nonpregnant females aged 13 to 64 years at physician offices, community health centers (CHCs) and EDs from 2009 to 2017.

Hoover and colleagues reported that HIV testing was performed at 0.63% of 516 million physician office visits, 2.65% of 37 million visits to CHCs and 0.55% of 87 million ED visits during the study period. The percentage of visits with an HIV test did not increase at physician offices, according to the researchers, but rates did increase at CHCs and to some extent at EDs.

“Clinical decision supports can be developed that use information in EHRs to order an HIV test for patients who need one and standing orders can increase routine opt-out testing, thereby reducing clinical barriers to HIV testing,” the researchers wrote.

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