Key sexual behaviors

A number of key sexual behaviors have been associated with STD/HIV transmission as listed in the Table. The impact of preventive measures and the treatment of infected individuals in these groups are likely to have the greatest impact on STI prevention and control in the community.

Partner variables

• Number of sexual partners
• Frequency of acquiring sexual partners
• Concurrence of sexual partners
• Types of partners i.e. commercial, unknown

Sexual act variables

• Age at first sexual intercourse
• Type of sex i.e. oral, vaginal, anal

Other variables

• Frequency of sex
• Non-penetrative sex

The 1998 Canadian STD Guidelines identify seven key practice points for primary care providers that should be part of all physicians’ routine care⁴.

1. Routinely communicate to patients awareness of STI and sexual health concerns e.g. pamphlets in the office, discuss with each patient as appropriate
2. Provide appropriate information on STIs
3. Help patients plan for and motivate them to practice STI prevention as a laudable and healthy behavior
4. Provide appropriate STI prevention medical services e.g. routinely offer HBV vaccination, cervical cancer screening, STI/HIV testing to all pregnant women
5. Secondary prevention e.g. screen all sexually active patients for common STIs such as chlamydia, genital herpes and HPV when the opportunity arises at annual examinations and during the assessment of genital and non-genital tract symptoms compatible with a STI.
6. Establish a referral network of “user-friendly” specialist colleagues experienced in STI for assistance in addressing STI and sexual health issues.
7. Self-evaluation e.g. look at areas that require improvement in office practice: No you prescribe oral contraceptives without discussing the need for barrier methods to reduce the risk of STI? Are you ware of the atypical presentations of genital herpes? Are you up to date on treatment recommendations for common STIs?