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STI Risk Assessment for Women
Questions about risk often focus on various factors, including: age, marital status, current or past STI symptoms, number of sexual partners, nature of relationships, the possibility of partners having other sexual partners, and current symptoms in partners. Risk assessment can be done using a brief checklist, which is more appropriate for screening purposes. It can also be done by providing information about risks and asking clients to self-assess whether or not they are at risk without revealing specific information. This approach is often used where it is deemed culturally inappropriate to probe for more specific information. More often, information about specific practices and circumstances of the individual client is sought as part of an interactive, exploratory counseling process. For example, during counseling, a provider can help clients to determine and perceive their individual risk of acquiring an STI (including HIV), as well as becoming pregnant. This requires not only providing information about transmission and risks in general, but also exploring the clients’ and partners’ particular sexual practices and history, as well as contextual factors of their lives that may make them vulnerable to infection. Providers should keep in mind the many factors that may influence a woman’s perception of her risk, including the fact that she may see herself as safe if she is monogamous, without recognizing the risks posed by her partner's behavior. Likewise, young people often do not perceive their risk of infection due to feelings of invulnerability and lack of future focus. Use of risk assessment in the vaginal discharge algorithmSTI risk assessment has been promoted for use in conjunction with the vaginal discharge algorithm as a way to determine appropriate treatment and, thus, improve the effectiveness of syndromic management. The idea is that vaginal discharge in women who are determined to be at high risk for STIs would be more likely related to cervical infections (gonorrhea and chlamydia) than to vaginal infections. However, risk assessment has not been found to be very precise in these instances (i.e., women without cervical infection often appear as high risk on assessments and vice versa) and provides only marginal improvement in the vaginal discharge algorithm compared to when it is not used. More research is needed to better understand the purpose of risk assessment, its limitations, and its appropriate use. For example, in settings where chlamydia testing is available, risk assessment might be useful to decide who should have a chlamydia test. Chlamydia testing following risk assessment has been successful in decreasing chlamydia prevalence in some parts of the United States. Risk assessment for asymptomatic infectionsSTI risk assessment has been advocated as a means of screening women who may be infected with an STI but are asymptomatic. There is debate, however, among the international community about the utility of STI risk assessment as a means of screening asymptomatic women in family planning/maternal-child health (MCH)/antenatal settings to determine who might be at higher risk of having gonorrhea or chlamydia. There are two main issues:
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STI risk assessment involves
using clients’ responses to questions about symptoms of STIs, demographic
characteristics, and behaviors to gauge their risk of exposure to infection,
and to help them perceive their own risk. Risk assessment can be done
in various ways and used for various purposes. It can be used as part
of prevention counseling, as a way to determine who should be tested or
treated for STIs, or as an adjunct to syndromic management algorithms.