ND Department of Health - Know Your Risk

myth

You can't get an STD from oral sex.

1. What state do you live in?*

2. What is your zip code?*

3. What is your age?*

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myth

If you have an STD, you'll see it and know it.

4. What race do you consider yourself to be? (check all that apply)*

White

Black / African American

Hispanic or Latino

American Indian / Alaskan Native

Asian

Hawaiian or Pacific Islander

Other, Unknown, Refused

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myth

Only cheating guys and dirty girls get STDs.

5. What is your yearly income?*

$0 - $8,374.99

$8,375 - $33,999.99

$34,000 - $82,399.99

$82,400 - $171,849.99

$171,850 - $373,649.99

$373,650+

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6. What is the highest level of education you have completed?*

Never attended school or only attended kindergarten

Grades 1 through 8 (Elementary)

Grades 9 through 11 (Some high school)

Grade 12 or GED (High school graduate)

College 1 year to 3 years (Some college or technical school)

College 4 years or more (College graduate)

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myth

You only can get herpes when your partner is having an outbreak that you can see.

7. Have you ever been in jail?*

Yes

No

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8. With which gender do you identify yourself with?*

Male

Female

Transgender Male to Female

Transgender Female to Male

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myth

The Pill prevents STDs.

9. My sex partners are:*

Male

Female

Both

Not sexually active

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10. Do you participate in anal,
oral, or vaginal sex?

Vaginal Sex

Anal Sex

Oral Sex

Not sexually active

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myth

If you have sex in the pool or hot tub, the chlorine will kill anything and everything.

10a. In regards to anal sex, do you:

Give

Receive

Both

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myth

I don't have to use a condom. I can tell my partner doesn't have an STD.

11. How many sex partners have you had during your lifetime?*

0

1-5

6-10

11-20

20+

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12. Where do you meet your partners?*

Adult Book Store / Cinema

Bars

Cruising in Automobile

Dance Halls

Escort Services

Baths / Spas / Resorts

Place of Worship

Home

Chat Rooms/Lines/E-mail/Internet

Jail/Prison

Clubs

Beach

Motel/Hotel

Shopping Mall

Project/Shelter

School

Gyms/Health Clubs

Partner's Home

Street

Circuit Party

Cruise (Boat)

Work

Park/Rest Area

Not sexually active

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myth

If you don't have a condom, you can use plastic wrap.

13. Have you ever had sex with someone you didn't know?*

Yes

No

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14. Have you ever had unprotected oral, anal or vaginal sex?*

Yes

No

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myth

2 condoms are better than 1.

15. Have you ever been told you have an STD?*

Yes

No

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15a. Check which STDs you've been diagnosed with:

Chlamydia

Gonorrhea

Syphilis

HIV

Genital Warts

Herpes

Trichomonas

Hepatitis B

Hepatitis C

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myth

You need more than skin to skin contact. You only can get an STD from semen.

16. Have you ever injected drugs?*

Yes

No

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16a. Have you ever shared needles or drug works?

Yes

No

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myth

Chlamydia and gonorrhea are no big deal and will go away on their own.

17. Have you ever had sex with someone who has ever injected drugs?*

Yes

No

Unknown

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18. Have you ever had sex while under the influence of drugs or alcohol?*

Yes

No

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19. Have you ever had sex in exchange for money, drugs or alcohol?*

Yes

No

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20. Have you ever shared sex toys?*

Yes

No

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21. Have you ever been a victim of sexual assault?*

Yes

No

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22. Have you ever been bullied about your sexual orientation?*

Yes

No

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23. Where did you hear about this survey? (check all that apply)*

TV

Friends

Radio

Billboard

Internet

Posters

Brochures

Other

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23a. Specify Other:

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North Dakota Department of Health Anonymous STD Risk Assessment Questionnaire

myth

1. What state do you live in?*

2. What is your zip code?*

3. What is your age?*

myth

4. What race do you consider yourself to be? (check all that apply)*

myth

5. What is your yearly income?*

6. What is the highest level of education you have completed?*

myth

7. Have you ever been in jail?*

8. With which gender do you identify yourself with?*

myth

9. My sex partners are:*

10. Do you participate in anal, oral, or vaginal sex?

myth

10a. In regards to anal sex, do you:

myth

11. How many sex partners have you had during your lifetime?*

12. Where do you meet your partners?*

myth

13. Have you ever had sex with someone you didn't know?*

14. Have you ever had unprotected oral, anal or vaginal sex?*

myth

15. Have you ever been told you have an STD?*

15a. Check which STDs you've been diagnosed with:

myth

16. Have you ever injected drugs?*

16a. Have you ever shared needles or drug works?

myth

17. Have you ever had sex with someone who has ever injected drugs?*

18. Have you ever had sex while under the influence of drugs or alcohol?*

19. Have you ever had sex in exchange for money, drugs or alcohol?*

20. Have you ever shared sex toys?*

21. Have you ever been a victim of sexual assault?*

22. Have you ever been bullied about your sexual orientation?*

23. Where did you hear about this survey? (check all that apply)*

23a. Specify Other:

10. Do you participate in anal,
oral, or vaginal sex?