Computer-assisted interviewing can encourage the disclosure of sexual risk-taking behaviour, a study has found. However, this approach was not accompanied by an increase in STI diagnoses.

A total of 2,351 patients over the age of 16 with a new clinical episode attending two large sexual health clinics in central and SW London were enrolled in the trial. Patients were randomised into three arms: computer-assisted self-interview (CASI) with a touch-screen computer in private, after which a clinician assessed a computer printout of the history; computer-assisted personal interview (CAPI) where patient and clinician view the screen together but the data is input by the clinician, using the same interview schedule as in CASI; pen and paper interview (PAPI) with a clinician as per usual care completing a proforma. In the third group, data from clinic notes were transferred into same electronic format as CASI and CAPI.

The primary outcome measures included patterns of STI diagnostic testing and STI diagnoses. Secondary outcome measures were: uptake of testing for bloodborne viruses (HIV, hepatitis B and C), rates of diagnosis of HIV, hepatitis B and C, rectal gonorrhoea and chlamydia, identification of indications for emergency contraception, referral to health advisors and rates of disclosure of sexual behaviour such as same-sex partners, concurrent relationships, multiple partners, selling sex, not using condoms with casual partners, and anal sex.

Testing for STIs was carried out at a significantly higher rate among patients in the CAPI arm compared with PAPI, OR 1.32 (95% CI: 1.09-1.59). STI diagnosis was highest in the CAPI arm but was not significantly different between the trial arms. Testing for hepatitis B and hepatitis C and rectal infections was carried out significantly more often in CAPI patients, whereas HIV testing was significantly less in the CASI arm. There were no significant differences in the rates of diagnosis of these infections by trial arm.

The need for emergency contraception was identified significantly more so among CASI patients; referral to health advisors did not differ among the different groups. Reporting of sensitive sexual behaviours was significantly higher with CASI, OR 1.41 (95% CI: 1.20-1.65) and CAPI, OR 1.42 (95% CI: 1.21-1.66) compared with PAPI.

Embarrassment is a huge barrier for both doctors and patients in general practice which gets in the way of good sexual healthcare. It appears the use of computers to take sexual histories can yield more sensitive sexual behaviours, but whether patients are willing to disclose these to their GP and have them recorded in their notes might be a different matter.

Dr Richard Ma

• Richens J, Copas A, Sadiq ST et al. A randomised controlled trial of computer-assisted interviewing in sexual health clinics. Sex Transm Infect 2010; 86:

310-314