Sexually transmitted infection screening and management — formative SAQs

SAQ 1 — Confidential screening in an asymptomatic 16-year-old (10 marks)

A 16-year-old female presents for a "routine check." She is sexually active with a male partner and uses condoms inconsistently. Her mother waits in the corner and offers to answer questions. [5] [1]

Questions

1. Outline how you would conduct this visit, including time alone, confidentiality, history and the tests you would offer. (6 marks) [5]
2. Justify your choice of test sites and your pregnancy-testing step before treatment. (4 marks) [2] [3]

Model answer

Conduct of the visit (6). Greet the young person first, set a joint agenda, then ask the mother to step out to create private time as standard adolescent care. State conditional confidentiality with clear limits (serious harm to self/others, abuse, legal duties). Take a 5 P's history: Partners, Practices, Protection, Past STI, Pregnancy intention, plus a respectful coercion question. Offer universal chlamydia and gonorrhoea screening, HIV testing, and syphilis by risk; integrate contraception. [5] [1] [2]

Test sites and pregnancy testing (4). Sample by disclosed practices: vaginal and urine NAAT cover vaginal exposure, and self-collection is acceptable and improves uptake. Add pharyngeal and rectal NAAT when oral or anal exposure is reported, because urogenital-only testing misses extragenital infection. Perform a urine pregnancy test before any treatment because doxycycline is contraindicated in pregnancy and syphilis treatment differs by pregnancy status. [2] [3]

SAQ 2 — Positive result, treatment, partners and rescreening (10 marks)

The 16-year-old's chlamydia NAAT is positive. She is not pregnant. Separately, you are counselling a young man who has sex with men about a recurrent positive gonorrhoea result. [2] [6]

Questions

1. Describe your treatment, partner-services and follow-up plan for the chlamydia-positive young woman. (5 marks) [2] [7]
2. Explain why you rescreen at about three months and how you would address the MSM patient's gonococcal recurrence and prevention. (5 marks) [6] [3]

Model answer

Treatment, partners and follow-up (5). Treat per current guideline; verify the exact local dose. For the non-pregnant adolescent the standard first line is doxycycline 100 mg by mouth twice daily for 7 days (confirm current regimen). Counsel abstinence until therapy completed plus seven days and until symptoms resolve. Arrange partner treatment — expedited partner therapy where lawful, otherwise provider or patient referral. Book rescreening at about three months and safety-net for after-hours help. [2] [7]

Rescreening and the MSM recurrence (5). Reinfection, not relapse, is the usual cause of a recurrent positive test, because of untreated partners and high incidence in the year after an STI; rescreen at about three months rather than relying on test-of-cure. For the MSM patient, re-screen at three anatomical sites (urethral, pharyngeal, rectal), add syphilis and HIV, send gonococcal culture for resistance surveillance given falling cephalosporin susceptibility, ensure partner treatment, and offer HIV PrEP and prevention counselling. [6] [3] [8]