This guideline is aimed at paediatric doctors, rather than us. However, it is a really good reminder of how to approach taking a sexual history from adolescents. I’m not going to summarise it as there really isn’t much new, but there are a few bits I wasn’t aware of, so I shall list these. If you have an affected patient, this is worth looking at.
Adolescents with HIV:
Transmission. Risks depend on the number of exposures and the route, but advice is to always use a condom / oral dam.
- Legal Issues. If a patient knowingly doesn’t use protection and if their partner gets HIV, then the patient could be prosecuted. A patient doesn’t have to disclose their HIV status if they are engaging in safe sex, but ideally they should be encouraged to.
- Vaccination. All HIV positive patients should have Hep B vaccination and boys as well as girls should have quadrivalent HPV vaccination.
- Cervical Smears. Girls should have annual smears once sexually active (as risks are higher).
- Fertility – refer before conception for advice on how to achieve this safely (eg sperm-washing or self-insemination). If they don’t conceive within 6-12m, refer as fertility may be reduced because of the HIV.
- Pregnancy – risk of transmission is less than 1% if properly managed.
- Emergency contraception – ideally use a copper coil if on enzyme inducers (otherwise use 3000mg Levonelle).
Taking a sexual history from an adolescent:
- Offer to talk to them alone.
- Keep the language simple.
- Don’t overload them with questions.
- Ask them what they want to know / if they have questions.
- Don’t assume they are sexually active or not, nor make assumptions about their sexual orientation.