Discussing STIs: Doctors are from Mars, patients from Venus

Abstract

Background. Primary care plays an important role in promoting sexual health, but in this setting counselling regarding sexually trnsmitted infections (STIs) is rarely performed and often inadequate. Objective. Our aim was to identify and quantify the barriers physicians encounter in discussing STIs with their patients. Methods. A postal questionnaire-based survey was carried out in a random sample of 200 primary care physicians in Antwerp, Belgium. Results. The response rate was 68%. Among the 122 respondents, only 44.3% provide some form of counselling (asking about sexual history, informing about safe sex or informing about STIs) regularly, at least once a week. Major barriers are language and comprehension problems (for 74.2% of respondents), ethnic differences (68.4%), insufficient training (69.4%), lack of time (60.8%), presence of the patient's partner (89.2%) or mother (94.2%), first contact with a patient (60.8%), fear of embarrassing the patient (30.6%) and a patient without genital complaints (71.4%). About half of the GPs fail to counsel an asymptomatic patient with obvious STI risk, and as many give no safe sex advice in a first contraception consultation. Conclusions. Physicians have many and various barriers to discussing STIs with their patients. Features of contemporary STI counselling and solutions to its problems are discussed. Education of health care providers should be given priority.