Sexual history: its importance in averting detrimental misdiagnosis and delayed diagnosis

Two cases where the sexual history proved important in reaching the diagnosis are presented. Case 1 concerns a 37-year-old HIV positive homosexual man, who presented with symptoms of rectal pain associated with bleeding. He was unsuccessfully treated for Crohn disease. A subsequent review of his sexual history led to investigations for venereal infections. A final diagnosis of proctitis secondary to lymphogranuloma venereum was made. The patient was successfully treated with doxycycline and spared an unnecessary colectomy. Case 2 concerns a 22-year-old Caucasian woman under investigation for possible lymphoma. However, the doctor carrying out the biopsy experienced a needle stick injury and the ensuing investigations revealed the patient's HIV positive status and thus the explanation for her hitherto undiagnosed lymphadenopathy. A prior review of her sexual history could have hastened the diagnosis and prevented the need for invasive tests.