Adolescent STI encounter OSCE — confidentiality, site-based testing and safety

Station objectives

1. Negotiate private time and explain conditional confidentiality. [5]
2. Take a 5 P's sexual history with inclusive, non-judgemental language. [2]
3. Choose test sites by disclosed anatomy and exposure. [3]
4. Apply pregnancy-aware treatment and partner services. [2] [6]
5. Assess PID severity and disposition. [4]

Candidate brief

You are the paediatric doctor in adolescent clinic. You have 10 minutes for Station A (confidential screening with a reluctant parent) and 12 minutes for Station B (return visit with pelvic pain). Examiners score process, safety and partnership language. [5] [2]

Station A — Parent resists leaving

Setup: A 16-year-old and her mother attend for a check-up. The mother says "we have no secrets in this family." [5]

Expected actions:

• Greet the young person first; set a joint agenda. [5]
• Explain that private time is standard adolescent care, not suspicion. [5]
• State conditional confidentiality with clear limits (harm, abuse, legal duties). [5]
• Take a 5 P's history in private, including a coercion question. [2]
• Offer universal chlamydia/gonorrhoea screening plus HIV and syphilis by risk; offer self-collection. [1]
• Sample by disclosed practices — add pharyngeal/rectal NAAT when oral or anal exposure is reported. [3]

Station B — Pelvic pain, fever and cervical motion tenderness

Setup: Two weeks later the young person returns with bilateral lower abdominal pain, fever and tenderness on bimanual examination; a recent chlamydia NAAT was positive and only partially treated. [4]

Expected actions:

• Recognise pelvic inflammatory disease and assess for features in serious illness (FIRH): fever, rigors, peritoneal signs, vomiting, haemodynamics. [4]
• Send a urine pregnancy test before deciding treatment (doxycycline contraindicated in pregnancy). [2]
• Apply inpatient criteria: systemic toxicity, pregnancy, intolerance, non-adherence risk or diagnostic uncertainty. [4]
• Arrange parenteral therapy, analgesia and gynaecology liaison; exclude ectopic pregnancy and appendicitis. [4]
• Plan partner treatment and rescreening at about three months. [6]

Marking anchors

Clear pass: secures private time, correct confidentiality limits, structured 5 P's history, site-based testing, pregnancy test before treatment, correct PID severity assessment and disposition, non-judgemental and safeguarding-aware language. [5] [2] [4] Borderline: good rapport but incomplete site testing, omitted pregnancy test, or vague follow-up and partner plan. [3] [6] Fail: no private time; absolute secrecy promise; urine-only testing despite disclosed anal exposure; oral outpatient therapy for severe PID with toxicity; judgemental language. [5] [4]

Debrief pearls

• Screening waits for no symptoms: universal CT/GC for sexually active females under 25. [1]
• Test by exposure, not gender; add extragenital sites when relevant. [3]
• Pregnancy-test before any tetracycline; severe PID needs inpatient parenteral care. [2] [4]
• Treat partners and rescreen at about three months; layer condoms, HPV vaccine and PrEP. [6] [8]