title: Sexual history taking in the emergency department - more specificity required.
abstract: BACKGROUND
  Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the most reported diseases in the United States, and emergency departments (ED) serve a population presenting with increased infection risk. However, identifying patients for whom sexually transmitted infection (STI) screening is appropriate requires accurate sexual history reporting.
  
  
  OBJECTIVE
  To examine the consistency with which ED patients answer general and specific sexual activity questions, and how responses relate to perceived STI risk.
  
  
  METHODS
  Urban ED patients aged 15-34 years completed a sexual history survey containing sexual activity and perceived infection risk questions and provided urine and pharyngeal specimens for CT/GC analysis.
  
  
  RESULTS
  Participants included 192 males and 301 females with a mean age of 25.2 years and were 65.7% white and 33.3% black. Thirty-eight (7.7%) were infected with CT or GC. In patients denying sexual activity in the past year (general question), 40.7% of such males and 45.0% of females also reported some form of specific sexual activity (activity misclassification). Among self-identified heterosexuals, 7.2% males and 7.5% females reported some form of homosexual activity (orientation misclassification; OM). OM individuals were more likely to perceive themselves at risk of infection both orally (odds ratio 2.92, confidence interval 1.12-7.63) and genitally (odds ratio 3.36, confidence interval 1.55-7.30).
  
  
  CONCLUSIONS
  Given that reported sexual activity and age are the only criteria for routine female screening, and that homosexual activity is one of the few screening criteria for males, our results show that a substantial proportion of ED patients eligible for screening may not be identified by reliance upon general sexual history questions.
authors.affiliation: Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois; Family and Community Medicine, Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Wiley D
authors.initials: WD
authors.lastname: Jenkins
authors.affiliation: Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Kelsey R
authors.initials: KR
authors.lastname: LeVault
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods* / Q000592:standards; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D014481:United States; D055815:Young Adult
keywords: Chlamydia trachomatis; Neisseria gonorrhoeae; emergency department; sexual history; sexually transmitted infection