Why would an STI clinic ask about prescription medications?
November 16, 2017 6:28 PM   Subscribe

So I went to a clinic recently for STI testing, and while most of the pre-testing questions made sense (in terms of determining risk factors etc), a few of the questions left me confused afterwards as to what the purpose might be. One question was whether I'm taking any prescription medications and what conditions those medications were for. Why/how is this relevant to an STI test?

Maybe certain medications or medical conditions could interfere with testing or treatment, but if so, how? These were just simple throat swabs and urine samples - no blood tests involved.

This was routine testing, so it's not like there were any symptoms for which they were looking for alternative explanations like pre-existing medical conditions. The clinic is only for sexual health, which means the nurse wasn't just reading off a standard list of general health questions.

The particular exchange that left me wondering was when I said I was taking lamotrigine. The nurse asked what for, I said a mood disorder (rather than epilepsy), and she asked "depression?". Then when I said bipolar, she asked me whether it was type 1 or 2.

So - how are these questions relevant? (To be clear, I wasn't bothered - otherwise I would have raised it at the time - but in retrospect it has me curious why the nurse asked them)
posted by ersatzhuman to Health & Fitness (12 answers total)
If they’re going to prescribe medication, they need to know what medications you’re already taking in case any are contraindicated. Also, some medications might exacerbate symptoms of conditions you may have, so they want to know why you’re taking whatever meds. This is standard for any healthcare provider.
posted by tatiana wishbone at 6:39 PM on November 16, 2017 [19 favorites]

yeah, I'd say standard of care. My dentist asks the exact same questions every time: what are you taking, what dose, how often, short or long term (ie like antibiotic for infection is short term, a statin is long) etc
posted by k5.user at 6:49 PM on November 16, 2017 [4 favorites]

If your regular doctor doesn't ask you this every time you go in for a check-up, you should find another doctor!
posted by praemunire at 7:11 PM on November 16, 2017 [7 favorites]

This is how any interaction with a health professional should go. I work for an optometrist, and we ask the same questions. Most of our patients don't get medicine prescribed, but it's really great to have a complete history already when we do.
posted by piedmont at 7:19 PM on November 16, 2017 [5 favorites]

Totally standard that any healthcare environment will assess your medications and diagnoses. They are unlikely to impact your STI treatment, but this is incredibly standard.
posted by latkes at 8:19 PM on November 16, 2017

Also, sometimes people will name medications without diagnosis, which gives clues to providers and can also indicate if infections would be more common.

For example, if your on an antibiotic for something else, women are more likely to develop a yeast infection.
posted by AlexiaSky at 8:26 PM on November 16, 2017 [2 favorites]

Thanks! I think I was just thrown off by the nurse asking detailed questions about my medical diagnoses alongside questions about my sexual history (which left me wondering "wait, why would it matter whether it's bipolar type 1 or 2?"), instead of handing me a generic medical history form like my dentist and optometrist.

Totally makes sense that they'd want detailed medical info to avoid exacerbating pre-existing conditions in case of eventual treatment, among other reasons, and that they'd gather this info upfront even though the initial appointment was only for testing. Now I feel a bit silly for asking this question :)
posted by ersatzhuman at 9:06 PM on November 16, 2017

Slightly different rationale: I used to work for an organization that dealt with blood products and a lot of the screening questions were designed to uncover things that people “forget”. Like, every single person answered the question about sexual history (“Have you ever had sex with someone who’s sexual history is unknown?”) in the negative *cough* bullshit *cough*, but we also asked other questions that would suggest whether or not the person was telling the truth about that. (Spoiler: they were not.) Some questions may be designed to determine whether or not answers to previous questions were accurate or truthful.
posted by Nyx at 10:05 PM on November 16, 2017 [1 favorite]

"wait, why would it matter whether it's bipolar type 1 or 2?"

It quite likely wouldn't matter.

Here's a hypothesis, though. One thing that's changed a lot in health care over the last few decades is how much of your chart is computerized. This is very often a good thing: computerized records are harder to lose, easier to search, etc. But it does mean that sometimes you'll be asked a question just because The Computer Wants To Know.

If the particular software they use had Bipolar 1 and Bipolar 2 as separate items, then your provider wouldn't be able to enter your bipolar diagnosis in your chart without picking one or the other — and at that point, rather than guess or make something up, it would be better just to ask, even when it's unlikely to make a difference.
posted by nebulawindphone at 7:16 AM on November 17, 2017 [1 favorite]

Actually bipolar type 1 can indicate more risky sexual behavior.

Lots of people who experience mania really like sex, and mania can reduce ability think about consequences, increase rash decision making (impulsivity) and people who are grandiose may severely underestimate risk of some sexual behaviors.
Not always true, but it is a flag.
posted by AlexiaSky at 7:46 AM on November 17, 2017 [2 favorites]

I have to go against the grain here and say that having a reason for asking ("because medical!") does not always mean it's reasonable to ask.

One of the fundamental principles of privacy pertains to collection of data. Google "Data minimisation principle privacy". AFIK the majority of developed countries have mention of it in privacy legislation. Data collected should be only what is necessary to provide the service.

It could very much be argued that the question about the type of bipolar was invasive and unreasonable. I think the question was tangentially relevant to the previous question but not (necessarily) necessary for providing you with testing for STIs.
posted by i_mean_come_on_now at 10:17 AM on November 17, 2017

I strongly suspect that nebulawindphone is right and the nurse asked clarifying questions so that the diagnoses could be coded in the EMR. The ICD-10, which is the grand directory of medical codes, gets VERY granular, and it prompts users to be specific when entering diagnoses (the other options being entering something that sounds foolishly vague). For tracking/research/billing reasons, the EMR makes it difficult to free text responses.
posted by treehorn+bunny at 9:20 PM on November 17, 2017 [1 favorite]

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