Sexual History Documentation Research Articles

Discussion and Initiation of HIV Pre-exposure Prophylaxis Were Rare Following Diagnoses of Sexually Transmitted Infections Among Veterans.

Healthcare encounters for the diagnosis and treatment of sexually transmitted infections (STIs) are common and represent an opportunity to discuss and initiate HIV pre-exposure prophylaxis (PrEP). Little is known about how frequently PrEP is discussed and initiated in association with encounters for STIs. Retrospective cohort and nested case-control study, matched by STI date, in national Veterans HealthAdministration (VHA) facilities from January 2013 to December 2018. Veterans with a first STI diagnosis (i.e., early syphilis, gonorrhea, or chlamydia) based on ICD codes, excluding those with prior HIV diagnosis, prior PrEP use, or STI diagnosed on screening during a visit to initiate PrEP. Frequency of PrEP initiation within 90 days of healthcare encounter for STIs. In the case-control study, we performed a structured chart review from the initial STI-related clinical encounter and quantified frequency of PrEP discussions among matched patients who did and did not initiate PrEP in the following 90 days. We identified 23,312 patients with a first STI, of whom 90 (0.4%) started PrEP within 90 days. PrEP initiation was associated with urban residence (OR = 5.0, 95% CI 1.8-13.5), White compared to Black race (OR = 1.7, 95% CI 1.0-2.7), and syphilis diagnosis (OR = 5.7, 95% CI 3.7-8.6). Chart review revealed that discussion of PrEP was rare among people with STIs who did not subsequently start PrEP (1.1%, 95% CI 0.1-4.0). PrEP initiation was associated with documentation of sexual history (80.0% of initiators vs. 51.0% of non-initiators, p < 0.01) and discussion of PrEP (52.2% vs. 1.1%, p < 0.01) during the initial STI diagnosis encounter. Discussion and initiation of PrEP were rare following healthcare encounters for STIs. Interventions are needed to improve low rates of sexual history-taking and discussion of PrEP during healthcare encounters for STIs.

63. Menstrual Suppression in the Myelosuppressed: A Retrospective Chart Review

<h3>Background</h3> Adolescents receiving myelosuppressive cancer treatment are at high risk of abnormal uterine bleeding (AUB) in the setting of thrombocytopenia. There are no validated menstrual suppression regimens in this setting, and clinical management is based on studies in healthy women. There has been minimal evaluation of patterns of care in this population. <h3>Methods</h3> We established a retrospective cohort of patients who were aged 15-39y at diagnosis with new or relapsed lymphoma, acute myeloid leukemia, or sarcoma and treated with chemotherapy +/- radiation at a single tertiary pediatric institution between 2008-2019. Our aim was to understand patterns of care by describing patient characteristics and symptoms (packed red blood cell and/or platelet transfusions). The following was abstracted from the medical record: cancer diagnosis, chemotherapy, clinical characteristics, race/ethnicity, payor, menarchal age, menstrual pattern prior to therapy, and cycle control agents utilized. IRB approval was obtained. <h3>Results</h3> Our cohort included 52 patients, the majority of whom were newly diagnosed (73%) and received highly myelosuppressive chemotherapy (85%). The majority of patient records had no documentation of menstrual cycles (81%) or sexual history (89%). A minority of records documented discussion of potential therapy-related infertility (30%) or fertility preservation options (11%); all fertility preservation options discussed were accurate. Eighty-five percent of patients received blood product transfusions. The majority of patients (79%) were prescribed hormonal agents for menstrual suppression; the most utilized agents were depo-medroxyprogesterone (49%) and combined oral contraceptives (39%). The initiation of a menstrual suppression agent varied from prior to (20%), simultaneous with (25%), or after initiating (44%) chemotherapy (Table 1). <h3>Conclusions</h3> Despite AUB being a likely consequence for adolescents receiving myelosuppressive therapies, not all at-risk patients were prescribed menstrual suppression. Agents prescribed and timing of initiation varied widely. The majority of patients received blood products. The majority of patients did not have relevant gynecologic details documented by oncologists. Our study is limited by small sample size and being from a single institution. Ongoing work is evaluating these patterns in a larger cohort, aiming to understand differences in symptomatic AUB and healthcare utilization according to cycle control agents, along with the impact of AUB on adolescent quality of life.

Intent, Substance, and Care: Characteristics of Adolescent Ingestion Hospitalizations.

To characterize the patient population of adolescents hospitalized at a tertiary center for ingestions and identify opportunities to improve health care delivered and resources offered to these adolescents. Retrospective study of a consecutive sample of adolescent patients (12-18 years old) discharged from the hospitalist service at a large academic pediatric tertiary care center from May 2017 through April 2018. Data were collected regarding patient and hospital encounter characteristics including length of stay, admission service, reason for ingestion, substance(s) ingested, previous suicidal ideation (SI) screening, sexual history documentation, pregnancy testing, disposition at discharge and follow-up with primary care physicians (PCPs). Most hospitalizations for ingestions were reported as intentional suicide attempts (79%). Most commonly, adolescents ingested exclusively prescription medications (45%) or over-the-counter medications (32%). Of adolescents with a reported suicide attempt for whom PCP records were available, 56% did not have SI screening documented in the medical record. One-quarter of adolescents hospitalized for an ingestion did not have a sexual history documented, and 11% of female patients were not tested for pregnancy before discharge. A majority (66%) of the adolescents with PCP records available did not follow-up with their PCP within 2 months after their hospitalization. On the basis of our study results, opportunities to improve adolescent health include increased screening for SI and mental health symptoms throughout medical environments, comprehensive risk assessment of all adolescents hospitalized for an ingestion and increased guidance for caregivers of adolescents regarding prescription and over-the-counter medication storage in the home.

2. Missed Opportunities for Sexual History Documentation and STI Testing in the Pediatric Emergency Department

2. Missed Opportunities for Sexual History Documentation and STI Testing in the Pediatric Emergency Department

Sexual History and Contraception Documentation in Hospitalized Adolescents: Are Technology-Dependent Patients Overlooked?

Adolescents are at high-risk for sexually transmitted infections and pregnancy, yet many do not receive regular preventive care. Hospitalization represents an opportunity for providing sexual and contraception counseling for this high-risk population. Our aim in this study was to assess the frequency of sexual and contraception history documentation in hospitalized adolescents and identify subgroups that may benefit from more vigilant screening. A retrospective chart review of adolescent patients 11 years of age and older who were discharged from the pediatric hospitalist service at an urban, academic children's hospital from July 2017 to June 2018 was conducted. Patient and admission characteristics were analyzed for presence of sexual and contraception history documentation. Technology-dependent patients were analyzed separately. In addition, technology-dependent patients were assessed by chart review for developmental appropriateness for screening. Twenty-five percent of patients (41 of 165) had a sexual history documented, and 8.5% (14 of 165) had a contraception history documented. Among patients with any technology dependence, 0 had a sexual history documented and only 1 had a contraception history documented, whereas 31.5% (12 of 38) were deemed developmentally appropriate for screening. Female and older patients were more likely to have sexual and contraceptive histories documented than male and younger patients. Patients transferred from the PICU had lower rates of sexual history documentation compared with direct admissions. Hospitalized adolescents, especially those with technology dependence, did not have adequate sexual and contraception histories documented. Improving documentation of these discussions is an important step in providing adolescents with preventive medicine services while hospitalized.

I’m Too Sexy For My … Taking A Sexual History In The Hospital Setting To Capitalize On A Missed Opportunity

Background: Half of all new sexually transmitted infections occur among 15-24 year olds and 1 in 4 adolescent females has an STI. Adolescents are known to have poor access to reproductive health care. Hospitalized adolescents are a captive audience, yet reproductive healthcare is not often discussed during hospitalization as preliminary research, from our institution, demonstrated only 55% of hospitalized adolescents had any documentation of sexual history, with males, patients admitted directly to the intensive care unit (ICU), and those hospitalized for …

Documentation of Sexual and Menstrual Histories for Adolescent Patients in the Inpatient Setting

In this study, we aimed to determine the frequency of menstrual history and sexual history documentation in the inpatient setting. A retrospective chart review was conducted for 307 female patients ages 11-18years admitted from the emergency department at a single institution within a 7-month period. These charts were reviewed for documentation of menstrual and sexual history. Rates of menstrual and sexual history documentation were compared according to patient age, chief complaint, admitting specialty, and medical complexity. Sexual history documentation was noted in 158 (45.9%) of the 344 reviewed charts. Sexual history documentation rates were higher for patients with mental health symptoms (62.9%; 61 of 98 charts; P=.02) and lower for patients admitted to surgical services (30.6%; 19 of 62 charts; P=.04). At least 1 aspect of menses was documented in 113 (32.8%) of the 344 reviewed charts. Last menstrual period was the most commonly documented aspect of menstrual history, appearing in 100 (29.1%) of the 344 reviewed charts. Menarche (4.4%; 15/344), menses frequency (7.0%; 24/344), menses duration (2.6%; 9/344), flow quantity (4.9%; 17/344), and dysmenorrhea (4.4%; 15/344) were rarely documented, regardless of chief complaint or admitting service. Menstrual history documentation rates were significantly higher for patients requiring a gynecology consultation (73.3%; 11 of 15 charts; P<.01). Menstrual and sexual history documentation rates for adolescent patients requiring inpatient admission were low, with fewer than half of patients having a documented menstrual or sexual history.

Addressing Reproductive Health in Hospitalized Adolescents—A Missed Opportunity

PurposeAdolescents are at high risk for sexually transmitted infections (STIs) and pregnancy. Since many adolescents have poor access to preventive care, hospitalizations present a critical opportunity to address adolescents' reproductive health. The purpose of this study was to assess provision of reproductive health services within a hospital setting. MethodsRetrospective study of a consecutive sample of adolescent patients aged 13 years and older hospitalized on the hospitalist service at a large academic pediatric tertiary care center. Measures included sexual history documentation, pregnancy and STI testing, Human papillomavirus immunization status and administration, and provision of contraception. ResultsOnly 55% of 150 patients had sexual history documentation, and of those, 47% endorsed sexual activity. Associations with increased likelihood of sexual history documentation included female patients (67% vs. 36%, p < .01), hospitalizations for ingestion (71% vs. 48%, p < .01), hospitalizations to hospital medicine compared with critical care (59% vs. 14%, p < .01), and admission note written by an intern compared with a senior resident, advanced practice provider, or fellow (67% vs. 44%, 29%, 13%, p < .01). Eighteen patients (12%) were tested for STIs. Only 19% of patients due for human papillomavirus immunization received it. Sixty percent of females received a pregnancy test. Contraception was provided in two encounters (2% of females). ConclusionsResults demonstrate a substantial missed opportunity to provide reproductive health services to hospitalized adolescents. Providers in hospital settings should optimize the opportunity to screen for sexual activity and reproductive health needs, provide indicated services, and offer education regarding reproductive health to hospitalized adolescents.

Documentation of Sexual History by Psychiatry Postgraduate Trainees: Lessons to Be Learnt

Aim: The author reports on whether sexual history was documented in files of persons with alcohol-use disorders as part of initial intake by psychiatry postgraduate trainees. Methodology: Chart review of files of persons with alcohol use disorders. Results: A total of 53 charts were reviewed to determine whether sexual history was documented. Sexual history was not documented in 79.24% of the files as part of the initial psychiatric intake. Conclusions: Postgraduate psychiatric trainees do not document sexual history in files of persons with alcohol-use disorders as part of initial intake. This is an important issue to be addressed as part of postgraduate psychiatry training.

Missed Opportunities for HIV Screening Among a Cohort of Adolescents With Recently Diagnosed HIV Infection in a Large Pediatric Hospital Care Network

PurposeRoutine human immunodeficiency virus (HIV) screening reduces HIV progression and transmission. Our aims were to determine prevalence and factors associated with prior HIV screening among a cohort of youth living with HIV. MethodsRetrospective chart review of youth living with HIV aged 14–26 at an HIV clinic comparing characteristics between those with and without HIV screening within the year prior to diagnosis ResultsSubjects (n = 301) were male (85%), African-American (87%), and men who have sex with men (84%). Subjects seen 1 year prior to diagnosis (n = 58) contributed 179 visits for missed opportunities with 59% having a documented sexual history in the electronic health record and 48% tested for HIV. Subjects with symptoms suggesting acute HIV infection (51%) were more likely to be tested (p = .04). In the adjusted model, documentation of sexual history and demographic factors was not associated with prior testing. ConclusionWe identified high rates of missed opportunities for HIV testing and sexual history documentation in the year prior to diagnosis, underscoring the need for routine HIV screening in adolescents.

Documentation of Sexual History in Hospitalized Adolescents on the General Pediatrics Service.

To determine the frequency of sexual history taking and the associated characteristics of hospitalized adolescents in the pediatric hospitalist service. A retrospective chart review of adolescents 14 to 18 years old who were admitted to the pediatric hospitalist service at an urban, academic children's hospital in the Northeast from 2013 to 2015 was conducted. Repeat admissions, admissions to specialty services, and charts that noted impairment because of psychosis, cognitive delay, or illness severity were excluded. For charts that met the criteria, the admission history and physical was carefully reviewed for a notation of sexual history. For those with documentation, sexual activity status and a risk level assessment were recorded. Patient demographics and admission characteristics were extracted. χ2 tests and logistic regression were used to examine differences between those with sexual history and those without. A total of 752 charts met the criteria for inclusion. The majority of adolescents were girls (n = 506; 67.3%); the mean age was 15.7 years (SD = 1.2). Girls had 2.99 (95% confidence interval [CI] 2.18-4.11) higher odds of documentation than boys, and older adolescents had 1.41 (95% CI 1.03-1.91) higher odds than younger adolescents. Documentation did not differ significantly on the basis of admission type (medical or psychiatric), admission time, patient race and/or ethnicity, or provider gender. Among those with a documented sexual history, risk-level details were often omitted. Sexual history taking does not occur universally for hospitalized adolescents. Girls were screened more often than boys despite similar rates of sexual activity. The inpatient admission may be a missed opportunity for harm-reduction counseling and adherence to sexually transmitted infection testing guidelines.

Pediatric Emergency Provider Sexually Transmitted Infection Screening Practices in Adolescents With Oropharyngeal or Anorectal Chief Complaints.

Sexually transmitted infections (STIs) may present with oropharyngeal or anorectal symptoms. Little is known about the evaluation of adolescents with these complaints in the pediatric emergency department (PED). This study aimed to determine the frequency of and factors associated with STI consideration and testing in this population. Retrospective chart review of patients aged 13 to 18 years who presented to an urban PED with oropharyngeal or anorectal chief complaints between June 2014 and May 2015. Sexually transmitted infection consideration was defined as sexual history documentation, documentation of STI in differential diagnosis, and/or diagnostic testing. Multivariate logistic regression models were used to identify factors associated with consideration. Of 767 visits for oropharyngeal (89.4%), anorectal (10.4%), or both complaints, 153 (19.9%) had STI consideration. Of the 35 visits (4.6%) that included gonorrhea and/or chlamydia testing, 12 (34.3%) included testing at the anatomic site of complaint. Of those 12 tests, 50.0% were the incorrect test. Patients with older age (adjusted odds ratio [aOR] = 1.5, 95% confidence interval [CI] = 1.3-1.7), female sex (aOR = 1.6, 95% CI = 1.03-2.5), or anorectal complaints (aOR = 2.4, 95% CI = 1.3-4.3) were more likely to have STI consideration. In an urban PED, only 20% of visits for adolescents with oropharyngeal or anorectal symptoms included STI consideration. Testing was performed in only 5% of cases and often at an inappropriate anatomic site or with the incorrect test. Interventions to increase awareness of appropriate STI consideration and testing for individuals presenting with possible extragenital complaints may help reduce STIs among adolescents.

Increased Health Care Utilization and Costs Among Veterans With a Positive Screen for Military Sexual Trauma.

The effects of sexual trauma on long-term health care utilization and costs are not well understood due to infrequent documentation of sexual trauma history in health care systems. The Veteran's Health Administration provides a unique opportunity to address this constraint as sexual trauma is actively screened for as part of routine care. We used a retrospective cohort design to analyze Veteran's Health Administration mental health and medical service utilization and costs as a function of a positive screen for exposure to military sexual trauma (MST) among Veterans of recent conflicts in Iraq and Afghanistan. We computed adjusted 5-year estimates of overall utilization and costs, and utilization and costs determined not to be related to MST. The cohort included 426,223 men and 59,611 women. A positive MST screen was associated with 50% higher health care utilization and costs relative to a negative screen. Overall, a positive relative to negative MST screen was associated with a 5-year incremental difference of 34.6 encounters and $10,734 among women, and 33.5 encounters and $11,484 among men. After accounting for MST-related treatment, positive MST screen was associated with 11.9 encounters and $4803 among women, and 19.5 encounters and $8001 among men. Results demonstrate significant and consistent differences in health care utilization and costs between Veterans with a positive relative to negative MST screen. Even after accounting for MST-related care, a positive screen was associated with significantly higher utilization and costs. MST-related needs may be more readily recognized in women relative to men.

P049 Audit: rates of sexual history taking and screening in HIV positive men who have sex with men (MSM): Abstract P049 Table 1

Background/introduction Increased rates of STIs in MSM may in part be due to the emergence of ‘chemsex’; use of recreational drugs in the context of high-risk sex. BASHH has set a target of 97% of MSM attending for a new episode being offered a screen (80% acceptance). BASHH/BHIVA guidance recommends HIV-positive patients have 6 monthly sexual histories and annual STI screens. Aim(s)/objectives To evaluate whether HIV positive MSM patients were asked about recreational drug use, including chemsex and assessed and screened for STIs during consultations. Methods The notes of 142 HIV positive men seen in 2015 were available, of whom 85 were MSM. Information was collected regarding sexual history, recreational drug use documentation, STI screen offer and test results. Results 77 (91%) of the MSM had a sexual history documented, of whom 60 (78%) were sexually active. STI screens were offered to 58/60 (97%) of those who were sexually active and accepted by 53 (91%) 10 (19%) of these had an STI. A recreational drug history was taken in 63 (74%) with 17 (27%) admitting to use and 3 (5%) to chemsex (Table 1). Discussion/conclusion Sexual history documentation was below recommended levels. 19% men tested had an STI highlighting that frequent screening in this group is essential. A quarter of patients admitted to recreational drug use, although how many were explicitly asked about chemsex is unclear. Given the increasing concern around this practice, questions about chemsex should be incorporated into the sexual history proforma.

P227 Sexual health in trans* individuals: high risk and under represented

<h3>Background/introduction</h3> In the UK, the prevalence of sexually transmitted infections (STI) amongst trans* individuals is unknown. International data estimate HIV prevalence to be as high as 20%. Public health data is lacking primarily due to trans* not being recognised as a gender. <h3>Aim(s)/objectives</h3> To identify and characterise trans* individuals within our HIV+ cohort. <h3>Methods</h3> Trans* individuals attending for HIV care at three urban care centres were identified by their physician and added to a database. A retrospective review of each electronic patient record was undertaken. Demographics, clinical data and documentation of sexual history and risk behaviours were collated. <h3>Results</h3> 23 trans* individuals living with HIV were identified. All were trans*female. 10 (43%) had a detectable HIV viral load. Within the past 6 months 10 (43%) reported condomless anal sex and 6 (26%) had gonorrhoea and/or chlamydia infection. 11 (48%) were regularly using recreational drugs and 6 (26%) engaged in commercial sex work. 9 (39%) had no documentation of sexual history. <h3>Discussion/conclusion</h3> High levels of vulnerability and specific healthcare needs exist amongst trans* individuals. Within this HIV+ cohort particular concerns include risk of onward transmission of HIV, acquisition of new infections and drug misuse. Our clinic runs a dedicated sexual health, HIV and holistic well-being service for trans* individuals that is working to address these issues. Patient record systems need updating to recognise trans* individuals, allowing the prevalence of HIV and other STIs in this group to be accurately recorded. We believe trans* individuals are an at risk group whose healthcare needs should be better addressed.

Clinician Adherence to Recommendations for Screening of Adolescents for Sexual Activity and Sexually Transmitted Infection/Human Immunodeficiency Virus

To evaluate clinician adherence to guidelines for documentation of sexual history and screening for sexually transmitted infection (STI)/HIV infection during routine adolescent well visits. Secondary objectives were to determine patient and clinician factors associated with sexual history documentation and STI/HIV testing. Retrospective, cross-sectional study of 1000 randomly selected 13- to 19-year-old routine well visits at all 29 pediatric primary care practices affiliated with a children's hospital. We evaluated frequency of documentation of sexual history and testing for gonorrhea (GC)/chlamydia (CT) and HIV testing. Multivariable logistic regression was performed to identify factors associated with documentation and testing. Of the 1000 patient visits reviewed, 212 (21.2%; 95% CI, 18.7-23.7) had a documented sexual history, of which 45 adolescents' (21.2%; 95% CI, 15.7-26.8) encounters were documented as being sexually active. Overall, 26 (2.6%; 95% CI, 1.6-3.6) patients were tested for GC/CT and 16 (1.6%; 95% CI, 0.8-2.4) were tested for HIV infection. In multivariable analyses, factors associated with sexual history documentation included older patient age, non-Hispanic black race/ethnicity, nonprivate insurance status, and care by female clinician. Factors associated with GC/CT testing included male gender, non-Hispanic black race/ethnicity, and nonprivate insurance. HIV testing was more likely to be performed on older adolescents, those of non-Hispanic black race/ethnicity, and those with nonprivate insurance. Pediatric primary care clinicians infrequently document sexual histories and perform STI and HIV testing on adolescent patients. Future studies should investigate provider beliefs, clinical decision-making principles, and perceived barriers to improve the sexual health care of adolescents and evaluate interventions to increase rates of adolescent sexual health screening.

P121 Do guidelines help promote sexual health screening (SHS) and detect sexually transmitted infections (STIs) in older adults with HIV?

BackgroundAdults over 50 with HIV comprise 20% of the national cohort. BASHH/BHIVA guidelines recommend all patients have a sexual health assessment documented at presentation and 6-monthly, with a full SHS...

Patient, Resident Physician, and Visit Factors Associated with Documentation of Sexual History in the Outpatient Setting

Patient, Resident Physician, and Visit Factors Associated with Documentation of Sexual History in the Outpatient Setting

Sexual History Documentation in Adolescent Emergency Department Patients

To determine the frequency of physician-documented sexual histories in female adolescents who presented to an emergency department (ED) with symptoms suggestive of a sexually transmitted infection (STI). Our secondary objectives were to determine if physician-documented sexual history is associated with increased STI testing and to compare the concordance of physician-elicited sexual histories with patient-documented sexual histories by using confidential questionnaires. We conducted a secondary analysis of a prospective study of female adolescents who presented to a pediatric ED with chief complaints of lower abdominal pain and/or genitourinary complaints. Patient charts were abstracted for the presence or absence of documented sexual histories and demographics. A subset of patients completed a questionnaire pertaining to sexual health. The study population comprised 327 patients; 269 (82%) patients had a physician-documented sexual history, of which 204 (76%) reported being sexually active to the physician. Patient age (odds ratio [OR]: 2.6 [95% confidence interval (CI): 1.3-5.3]) and black race (OR: 2.0 [95% CI: 1.1-3.7]) were associated with physician-documented sexual history. The documentation of a sexual history was associated with increased STI testing (OR: 3.9 [95% CI: 2.0-7.6]). In the patients (n=109) who completed the questionnaire, physician-elicited sexual histories were highly concordant with patient-documented sexual histories on questionnaire (Spearman r=0.90; P<.001). These results indicate that ED physicians should obtain sexual histories from symptomatic patients, because it may increase STI testing and subsequent detection. In future studies factors should be evaluated that affect physicians' willingness to assess sexual history in the ED patient.

Sexual History Documentation in Adolescent Emergency Department Patients

Sexual History Documentation in Adolescent Emergency Department Patients