STI Counselling and Expedited Partner Therapy

How I Practice Video Series 
Sarah Horvath, MD, FACOG
New York, NY

One of the hardest things that you are going to have to do is tell a patient that she has a positive test for a sexually transmitted infection. I remember feeling awkward when I would have to do this and I had one patient in particular, very early on, where this look of recognition crossed her face and then she started crying because in addition to telling her that she had chlamydia I was also inadvertently telling her that her partner was cheating on her. This is something you should be prepared for because if your patient gets really emotional when they hear this news they’re going to shut down and it’s going to be harder for them to comply with the medical therapy and follow up that you know is very important.

It’s also a really nice opportunity to have empathy for your patient and to really build trust with them. So you can discuss not only their positive results but then make sure that they’re tested for all other sexually transmitted infections, including HIV, make sure that you give them a pregnancy test, and that you administer emergency contraception if that is something that they do want. And then you can roll this experience into talking about fertility desires more broadly and maybe a discussion of contraception. Certainly you want to discuss safe sex and condoms with this patient and then also discuss with them do they have more than one partner, do they have only one partner, how to talk to their partner about their positive STI screen and then also getting their partner treated. It’s going to be really important to have that partner get into treatment if they have their own provider, and if they don’t certainly you can look into expedited partner therapy. Most areas will allow that if you’re not sure you can do that you can go on the CDC website to find out about expedited partner therapy. But you can really take an opportunity with this patient to turn around what starts out as a very negative and difficult emotional experience and turn it into one that’s very positive and forward looking. This is how I practice.

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