Sexually transmitted infection screening and management — branching viva

Stem

The examiner will test whether you can run a confidential, risk-stratified adolescent STI visit under pressure. [5] [1]

Branch 1 — Opening and history

Examiner: How do you start this STI visit? [5]

Strong answer: Greet the young person first, set a joint agenda, create private time, and state conditional confidentiality with clear limits. Then take a 5 P's history — Partners, Practices, Protection, Past history, Pregnancy intention — with a respectful coercion question. [5] [2]

Branch 2 — Site-based testing

Examiner: She reports vaginal and oral practices. Which sites do you sample, and why not urine alone? [3]

Strong answer: Sample by disclosed exposure: urine or vaginal NAAT for vaginal exposure, and add pharyngeal NAAT for oral exposure. Urogenital-only testing misses extragenital infection, so test the anatomy that was exposed. Self-collection is acceptable and improves uptake. [3] [1]

Branch 3 — Pregnancy-aware treatment

Examiner: Chlamydia NAAT is positive. Give your treatment plan. [2]

Strong answer: First confirm she is not pregnant with a urine hCG, because doxycycline is contraindicated in pregnancy. For the non-pregnant adolescent the standard first line is doxycycline 100 mg by mouth twice daily for 7 days — verify the exact current local dose before prescribing. Counsel abstinence until therapy completed plus seven days. [2]

Branch 4 — Partner services

Examiner: How do you stop reinfection? [6]

Strong answer: Arrange partner treatment. Where lawful, expedited partner therapy delivers treatment to the partner without a clinic visit and reduces reinfection; where unlawful, use provider or patient referral. Then rescreen at about three months because reinfection, not relapse, is the usual cause of recurrence. [6]

Branch 5 — Red-flag interrupt

Examiner: She returns with severe lower abdominal pain, fever and cervical motion tenderness. What now? [4]

Strong answer: This is pelvic inflammatory disease with possible systemic toxicity. Exclude pregnancy and ectopic, check for features in serious illness, and admit for parenteral therapy, analgesia and gynaecology liaison. Review at 48–72 hours and rescreen at about three months. Do not send her home on oral therapy if she meets inpatient criteria. [4]

Branch 6 — Prevention and HIV

Examiner: Her HIV test is negative and she remains at risk. What do you offer? [8]

Strong answer: Layer prevention: consistent condom use, HPV vaccination and catch-up, contraception, and referral for HIV PrEP given the grade-A USPSTF recommendation for those at increased risk. Discuss syphilis screening by risk and book ongoing preventive review. [8] [7]

Examiner extras

• Universal chlamydia and gonorrhoea screening is for sexually active females under 25 precisely because most are asymptomatic. [1]
• Test by disclosed anatomy and practices, never by assumed gender. [3]
• Rescreen at about three months for reinfection; reserve test-of-cure for pregnancy, failure or resistance. [2]
• Severe PID, pregnancy with STI, suspected coercion and treatment failure are same-day escalation triggers. [4] [5]