What are the 5 P’s of STD prevention? (how to take a sexual history)

What are the 5 P’s of STD prevention? (how to take a sexual history)

This page is mainly written for health professionals.

The following questions are part of the 5P’s approach to taking a sexual history:

1. Partners
2. Practices
3. Protection from STDs
4. Past History of STDs
5. Pregnancy Intention.

Asking these questions facilitates your understanding of a patient’s HIV risk factors, identifies any screenings or vaccinations they may need, and helps you offer appropriate counseling to your patients.

1. Partners

• Are you currently having sex of any kind – oral, vaginal, or anal – with anyone?
• If no, have you ever had sex of any kind with another person?
• In the last 12 months, how many sex partners have you had?
• What is/are the gender(s) of your sex partner(s)?
• Do you or your partner(s) currently have other sex partners?

2. Practices

I need to ask some more specific questions about the kinds of sex you have had over the last 12 months to better understand if you have risk factors for sexually transmitted infections or STIs. Would that be OK?

We have different tests that are used for the different body parts people use to have sex.

• What kinds of sexual contact do you have, or have you had? What parts of your body are involved when you have sex?
• Do you have genital sex (penis in the vagina)? Anal sex (penis in the anus)? Oral sex (mouth on penis, vagina, or anus)
• Are you a top and/or bottom?
• Have you or any of your partners used drugs?
• Have you exchanged sex for your needs (money, housing, drugs, etc.)?

3. Protection from STDs

• Do you and your partner(s) discuss STD prevention?
• If you use prevention tools, what methods do you use? (For example, external or internal condoms—also known as male or female condoms – dental dams etc.)
• How often do you use this/these method(s)? More prompting could include specifics about:
• Frequencies: sometimes, almost all the time, all the time, never.
  • If “sometimes,” in which situations, or with whom, do you use each method?
• Have you received human papilloma virus (HPV), hepatitis A, and/or hepatitis B shots?
• Are you aware of pre-exposure prophylaxis or PrEP, a medicine that can prevent HIV? Have you ever used it or considered using it?

4. Past history of STDs

• Have you ever been tested for STDs and HIV? Would you like to be tested?
• Have you been diagnosed with an STD in the past? When? Did you get treatment?
• Have you had any symptoms that keep coming back?
• Has your current partner or any former partners ever been diagnosed or treated for an STD? Were you tested for the same STD(s)? Do you know your partner’s (or partners’) HIV status?

5. Pregnancy intention

• Do you think you would like to have (more) children at some point?
• When do you think that might be?
• How important is it to you to prevent pregnancy (until then)?
• Are you or your partner using contraception or practicing any form of birth control? Would you like to talk about ways to prevent pregnancy? Do you need any information on birth control?

Summary

We have described the 5 P’s of STD prevention, and demonstrated how to take a sexual history. We hope it has been helpful.