Sexual Health History OSCE: How to Take an STI History

Why the Sexual Health History Feels Awkward — and Why It Shouldn't

Students often dread the sexual health history station because it feels intrusive or embarrassing to ask. But to patients, a confident, non-judgemental clinician who asks these questions clearly and professionally is far less uncomfortable than one who stumbles, apologises, or avoids asking at all.

The sexual health history is a core clinical skill — it is the foundation of diagnosing STIs, preventing onward transmission, and protecting patient safety. Examiners are looking for structure, sensitivity, and your ability to ask direct questions without embarrassment or judgement.

The OSCE Structure for a Sexual Health History

A complete sexual health history covers:

1. 1Presenting complaint and symptom history
2. 2Last sexual intercourse (LSI) — timing, partner, protection
3. 3Sexual partners in the past 3 months (and 12 months for some STIs)
4. 4Condom use and barrier methods
5. 5Previous STIs and treatment
6. 6Contraception
7. 7For women: LMP, menstrual history, smear history
8. 8HIV risk and testing history
9. 9Blood-borne virus risks (IV drug use, blood transfusions, tattoos abroad)
10. 10Social history: alcohol, drugs, travel history

Presenting Complaint: Symptom Framework

Start with the presenting complaint using SOCRATES. Common presentations:

Taking the Sexual History: Questions to Ask

Last Sexual Intercourse (LSI)

• "When did you last have sex?"
• "Was this with a man, a woman, or a person of another gender?" (Do not assume orientation)
• "Was this a regular partner or a new partner?"
• "Did you use any protection, such as a condom?"

Number and Gender of Partners

• "How many sexual partners have you had in the last 3 months?"
• "And in the last 12 months?"
• "Have any of your partners been men who have sex with men?"
• "Have any of your partners been from abroad — particularly sub-Saharan Africa, Southeast Asia, or Eastern Europe?" (HIV risk stratification)

Protection and Contraception

• "Do you use condoms? All of the time, sometimes, or never?"
• "What contraception do you currently use?"
• "Have you ever had a failure of contraception or unprotected sex when you weren't intending to?"
• "Have you ever taken emergency contraception?"

Previous STIs

• "Have you ever had a sexually transmitted infection before?"
• "If so, which one, and when was it treated?"
• "Have you ever been told you or a partner had an STI?"
• "Have you ever been to a GUM clinic or sexual health clinic before?"

HIV

• "Have you ever had an HIV test?"
• "When was your most recent test, and what was the result?"
• "Do you have any concerns about your HIV risk?"
• "Have you ever injected drugs or shared needles?"
• "Have you ever received a blood transfusion outside the UK?"
• For high-risk patients: "Are you aware of PrEP (pre-exposure prophylaxis)?"

Blood-Borne Virus Risks

• "Have you ever used intravenous drugs or shared needles or works?"
• "Have you had any tattoos or piercings, particularly abroad?"
• "Have you had any blood transfusions or organ transplants, particularly in countries outside the UK?"
• For MSM: "Have you ever used chemsex drugs — such as mephedrone, crystal meth, or GHB?"

For Women: Gynaecological History

• "When was your last period?"
• "Are your periods regular?"
• "Have you had any bleeding between periods or after sex?"
• "When was your last cervical smear and was it normal?"
• "Is there any possibility you could be pregnant?"
• "Have you ever been pregnant before?"

Partner Notification

Partner notification (contact tracing) is a core part of sexual health management and frequently comes up in OSCE stations and examiner questions.

Common STI Overview for OSCEs

How to Summarise and Close

At the end of the history:

"Thank you for answering all those questions — I know some of them are quite personal. Based on what you've told me, I'd like to arrange some tests today to check for common sexually transmitted infections, including swabs and a urine sample. I'd also like to offer you an HIV test as we routinely offer this to everyone. I'll explain what happens next and we can talk through what support is available."

Common Examiner Follow-Up Questions

"A 22-year-old woman presents with lower abdominal pain, fever, and vaginal discharge. What is your differential diagnosis and initial management?"

"The most likely diagnosis is pelvic inflammatory disease (PID) — ascending genital tract infection, most commonly caused by chlamydia or gonorrhoea, though often polymicrobial. I would take a full sexual health history and perform endocervical and high vaginal swabs, urine pregnancy test (to exclude ectopic pregnancy — a critical differential), bloods including FBC and CRP, and perform a bimanual examination assessing for cervical excitation (extremely tender uterus on cervical movement — Chandelier's sign). Treatment: empirical antibiotics per BASHH guidelines — IM ceftriaxone 1g stat, oral doxycycline 100 mg BD and metronidazole 400 mg BD for 14 days. Admission for IV antibiotics if severe, pregnant, or diagnosis uncertain."

"What is the window period for HIV testing and what tests are available?"

"The window period is the time between infection and when a test can reliably detect it. Fourth-generation combined p24 antigen/HIV antibody tests, which are standard in UK labs, have a window period of 45 days — a negative test at 45 days after the last risk event is considered conclusive. Point-of-care rapid tests using oral fluid or finger-prick blood have a longer window period of 90 days. HIV RNA PCR testing can detect infection from 10 days post-exposure and is used in post-exposure prophylaxis (PEP) follow-up. PEP must be started within 72 hours of exposure and is taken for 28 days."

"A 19-year-old man presents to your GP asking for a chlamydia test. He is asymptomatic. How would you proceed?"

"I would welcome his proactive approach — asymptomatic STI screening is an important part of sexual health. I'd take a brief sexual history to determine his risk and when he was last tested. For chlamydia, I would offer a NAAT test on a first-catch urine sample or a self-taken rectal or pharyngeal swab if he has had receptive anal or oral sex. I would routinely offer an HIV test and screen for gonorrhoea and syphilis depending on his risk history. If positive for chlamydia, I would treat with doxycycline 100 mg twice daily for 7 days and initiate partner notification for contacts in the past 6 months. I would advise him to retest in 3–6 months and discuss condom use and PrEP if he is at ongoing high risk."