Appendix A. Online Risk Assessment Tool - AHRQ National ...

Infectious disease (continued)# Question Prereq Sub-Question Options Script(s) Programming NotesHave any of your sexualpartners beenPlug in "have had asexual partner that5bdiagnosed with a STI? Yes At risk for STI had an STI."5b Have any of your sexual partners been diagnosed with a STI?No5b5c5c Have any of your sexual partners had syphilis or herpes?No5c5d5d5d5e5e5e5f"Male" or"Both" toQuestion3 inHealthPromotionHave any of your sexual partners been diagnosed with a STI?Don'tknow At risk for STIHave any of your sexualpartners had syphilis orherpes? Yes At risk for STIHave any of your sexual partners had syphilis or herpes?Don'tknowAt risk for STIHave any of your malesexual partners had sexwith men? Yes At risk for STI"Male" or "Both" to Question 3 in HealthNoPromotion Have any of your male sexual partners had sex with men?"Male" or "Both" to Question 3 in HealthPromotion"Male" or"Both" toQuestion3 inHealthPromotionHave any of your male sexual partners had sex with men?Don'tknowAt risk for STIHave any of your sexualpartners had HepatitisC? Yes Hep C (at risk)"Male" or "Both" to Question 3 in HealthNoPromotion Have any of your sexual partners had Hepatitis C?"Male" or "Both" to Question 3 in HealthPromotion Have any of your sexual partners had Hepatitis C?5f Have you ever used illicit drugs (street drugs)? This includes marijuana.NoDon'tknowHep C (at risk)Have you ever usedillicit drugs (streetdrugs)? This includesmarijuana. Yes At risk for STISkip to 4iPlug in "may havehad a sexual partnerthat had an STI."Plug in "had a sexualpartner who hadsyphilis or herpes."Plug in "had a sexualpartner who hadsyphilis or herpes."Plug in "have hadmale sexual partnerwho has had sex withmen." Also, if yes toquestion and girl hasnot had hepatitis Bvaccine then use HepB at risk. (PartnerQuestion)Plug in "may havehad male sexualpartner who has hadsex with men."Also, ifyes to question andgirl has not hadhepatitis B vaccinethen use Hep B atrisk. (PartnerQuestion)Plug in "may havehad a sexual partnerwho had hepatitis c."Plug in "have had asexual partner whohad hepatitis c."Plug in "have usedstreet drugs." Also, ifyes to question andgirl has not hadhepatitis B vaccinethen use Hep B atrisk.Source: Adapted from Jack BW, Culpepper L, Babcock J, Kogan MD, Weismiller D. Addressing Preconception Risks Identifiedat the Time of a Negative Pregnancy Test. A Randomized Trial. J Fam Pract. 1998;47(1)33-38. Reviewed by Dean V. Coonrod,MD, MPH; Mona R. Prasad, DO, MPH; Shanna N. Cox, MSPH.17