Abstract: Objective: Describe sexual history completion among U.S. Veterans with a sexually transmitted infection (STI) and its association with number of ordered STI laboratory tests and offer of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP). Methods: We assembled a retrospective cohort of Veterans with a STI seen at five sites in the southern United States and excluded those with diagnosis of HIV. We conducted a systematic chart review of sexual history using Centers for Disease Control and Prevention's five ‘Ps.’ The outcome was STI testing and PrEP offer. Charts were reviewed between December 2021 and May 2022. Results: No sexual history was documented in 43 % of the 278 encounters with differences across sites ( p < 0.001). Missing documentation occurred for: partners (67 %); practices (93 %); protection (75 %); pregnancies (24 %, 14/58 females) and prior STIs (78 %). No association was observed between sexual history and complete STI testing ( p = 0.42) but a positive association between sexual history components and individual STI tests, except HIV, was present ( p ≤ 0.001). PrEP was offered to 1.4 % (4/278) of Veterans. Conclusions: Low sexual history documentation were associated with less STI tests ordered. PrEP referrals were low. Improvements in sexual history taking and PrEP offerings are essential.