Sexual identity and practices relating to the spread of sexually transmitted diseases.

All sexually transmitted diseases are behaviorally correlated. A thorough understanding of the behaviors involved in the spread of sexually transmitted disease will increase the physician's ability to suspect, properly identify, and treat the disease. An appreciation of the common sexual behavior in contemporary American society will allow the physician to more effectively address patients' concerns about their sexuality and sexual behavior and identify areas for which further professional counseling is appropriate. Physicians are the most trusted source of health information, often counsel their patients on intimate subjects, and therefore are in a unique position to promote individual behavioral and perceptual changes for limiting the spread of sexually transmitted disease. Physicians must, therefore, be aggressive in taking sexual histories, especially for young, sexually active patients, whether heterosexual, homosexual, or bisexual. Clinicians must deliberately cultivate a comfortable, sympathetic attitude and provide an environment in which a complete and honest sexual practices history will freely flow. Once the patients at risk for STDs are identified, the physician should attempt to counsel them to reduce their risk through safer sexual practices. If little office time is available for these sensitive educational issues, then the physician should identify individuals within the office or appropriate programs in the community for referral. Representative data on the sexual behavior of all Americans will be relevant not only to the AIDS crisis but also to other national sex-related problems such as the growing incidence of chlamydia, other sexually transmitted diseases, and the costly multigenerational impact of epidemic teenage pregnancy. Comprehensive, well-designed studies of contemporary sexual behavior are needed now.