Martha's Case: The Unwelcome Phone Call

Pre-Test Answers

1. When someone is referred through the partner notification process, what issues should you include when taking a history?

1. Current relationships
2. Safer sex practices
3. Contraceptive methods
4. The reason for so many partners
5. All of the above
6. A, B, C

The correct answer is F. (A, B, C)

Current relationships, safer sex practices and contraceptive methods are important components of the STI Risk Evaluation Questionnaire helping you to determine a patient's risk for STI. Asking about current relationships is important and may come into play if it is necessary to initiate the partner notification process. Asking about safer sex practices and contraceptive methods will help to guide you when examining and testing for STI.

Being named as a contact can be difficult and embarrassing for patients. It is very important not to be judgemental when a patient is referred through the partner notification process. While finding out how many partners they have had is necessary in evaluating their risk (and may come into play if you need to initiate the partner notification process) asking why they have had that number of partners is not necessary or helpful.

An understanding and non-judgemental approach will help to put your patient at ease allowing you to get the information you need. Your patient will also be more open to a discussion of STI risk reduction strategies instead of viewing it as a "lecture" to be endured and ignored.

2. According to the Canadian STD Guidelines, an asymptomatic person presenting as a contact of someone with chlamydia should also be screened for:

1. Gonorrhea (N. gonorrhoeae)
2. HSV (Herpes simplex virus)
3. HIV with pre and post-test counselling
4. HPV (Human Papillomavirus)
5. All of the above
6. A, C

The correct answer is F. (A, C)

A person who has been in contact with someone with a known case of chlamydia is also at risk for other STI and should be screened accordingly. This includes gonorrhea and HIV. Screening should also include testing for syphilis, as well as an examination for ulcers or papules. HSV testing should be performed only if lesions are present and is not routinely indicated. The usefulness of HPV testing for STI prevention has never been shown and is therefore not currently recommended. However, research involving HPV is continuing and may lead to future changes in testing recommendations.

3. As a contact, an individual should also be counselled about STI prevention practices. These include:

1. Asking partners about STI symptoms
2. Hepatitis B vaccination
3. Regular STI and HIV screening
4. Safer sex practices
5. All of the above
6. B, D

The correct answer is: F. (B, D)

Counselling patients about safer sex practices and offering hepatitis B vaccination are valuable components of an STI prevention strategy. Safer sex practices such as consistent condom use can help to prevent the majority of STI, including HIV, hepatitis B, HSV, chlamydia and gonorrhea. Hepatitis A and B are the only sexually transmissable infections that can be prevented by licensed vaccines and vaccination represents a very effective preventive measure. In fact universal hepatitis B vaccination for infants and pre-adolescents is recommended.

Asking partners if they have any STI symptoms is not an effective preventive strategy. The majority of those with an STI are asymptomatic. For example, greater than 50% of males and 70% of females with chlamydia do not have any symptoms.

Although regular STI and HIV screening every 3 months may be important for some sexually active individuals it is not an effective STI prevention tool. It may however prevent long-term complications of STI and prevent further spread.