Early in my midwifery practice, I learned that patients don’t always tell their providers the whole story.

I had a patient who told me during her annual exam that she had been married for 18 years, and that her only sexual partner was her husband. During the visit, she expressed interest an IUD for contraception.

Per practice protocol, I informed the patient that we would have to screen her for chlamydia and gonorrhea prior to IUD insertion, and she agreed to have it done that day.

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I was surprised when her cultures came back positive for chlamydia. I called to inform her of the results and discuss treatment. The patient was very quiet after I relayed the positive chlamydia result.

Finally she said, “I wasn’t completely honest with you. My husband and I have been together for 18 years, but we also have threesomes sometimes. I didn’t think I could get anything from another woman.”

This patient and her husband had contracted chlamydia from one of their third partners. All were treated, and I encouraged my patient to come in for a complete screening for sexually transmitted infections (STIs), including serology.

The patient agreed and during that visit we had a long discussion regarding safer sex practices and ways to protect herself and her husband in these unique circumstances.

After that patient encounter, I changed the way I approached the topic of STI screenings. I now ask every single patient at every single annual exam if they need STI testing, as well as at other appropriate visits. I offer testing regardless of age, sexual orientation, relationship status, and number of partners.

Practitioners cannot assume that the 65 year-old patients are automatically immune to acquiring an STI based on their age. We can’t assume that because a couple is married, they are only having sex with each other.

Some patients are offended when I offer STI testing to them. Many of my married patients can’t understand why I’d ask them about STIs.. Being quick to explain that I ask every patient about STI screenings tends to make female patients more comfortable with the discussion.

Offering universal STI testing to every patient helps me ensure that no one slips through the cracks. Also, I don’ t have to decide who is offered testing and who isn’t.

I have found that if patients are hesitant to discuss their sexual histories or practices, offering a STI screening often can lead to an informative and more open discussion.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.