Cases/Sexual Health

17-year-old Attending for Her Swab Results, Which Show Chlamydia — Free SCA Practice Case

17-year-old attending for her swab results, which show chlamydia

Station Timer

12:00

Golden Minute

Initial Introduction

•Introduce yourself

•Ask an open question — "How can I help you today?"

•Listen — don't interrupt

•Catch early cues

Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

12:00

Golden Minute

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Amber Slade

Age

17 years

Consultation Type

Video

Age

Situation

Video Consultation, booked to discuss swab and urine results.

Reason for Encounter

"I've come to go through my swab results."

Medical Records

●PMH: None recorded.
●Medications: Combined oral contraceptive pill (taken consistently).
●Allergies: NKDA.
●Recent notes (3 days ago, nurse practitioner): Five-day history of vaginal discharge with dysuria. Pelvic examination performed with verbal consent and a chaperone present: purulent vaginal discharge observed. High vaginal and endocervical swabs taken. Urinalysis: leucocytes 2+, nitrites negative. Plan: review results at follow-up.
●Results: Chlamydia trachomatis NAAT — POSITIVE. Neisseria gonorrhoeae NAAT — negative. Bacterial vaginosis — not detected. Candida — not detected. Trichomonas vaginalis — not detected. MSU culture — no significant growth.

Patient Script

For the friend playing the patient role

Character Overview: You are Amber, a 17-year-old college student studying for A-levels. You booked this appointment to get your swab results. For just over a week you have had an unusual, unpleasant-smelling vaginal discharge and burning when you pass urine; these symptoms are still present. You are otherwise well, your periods are regular, and your last period was two weeks ago. You take the contraceptive pill reliably. You have had more than one sexual partner in the last few months and think you may have picked something up after sex without a condom with someone you met at a party about two weeks ago; your partners have all been around your own age and nothing has ever happened that you were unhappy about. You live at home with your parents and do not want them to find out — you are worried about their reaction. You are quiet and a bit embarrassed but will engage if the doctor is calm and non-judgemental.

Opening Sentence: "Hi Doctor. I've come to go through my swab results, please. I've still got the discharge and the burning when I wee, so I'm guessing something showed up?"

History if Asked (Data Gathering Phase)

●Current symptoms: "The discharge and the burning are still there — about the same, maybe slightly worse."
●How she is otherwise: "Fine in myself. No temperature, no feeling unwell."
●Her periods and contraception: "Periods are regular, last one two weeks ago. I take the pill every day, I'm good with it."
●Her worry about her parents: "The main thing is my parents can't find out. They'd hit the roof."
●What she wants: "I want to know what it is and how to get rid of it."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

●Ideas: Amber thinks it is probably a sexually transmitted infection, though she wonders if it could be a urine infection. "I think it's probably an STI, but I did wonder about a water infection."
●Concerns: Her stated concern is her parents finding out; when explored, she is also worried about what this means for her health and whether it could affect having children one day. "The main thing is my parents. But… could this affect me having kids later on?"
●Expectations: She wants the results explained and to be treated. "I want to know what it is and get it sorted."

If Asked — Complications, Sexual Health, and Safeguarding Screen

The patient answers these only when directly asked, and more openly if the candidate signposts sensitively before personal questions.

●If asked about pelvic or lower abdominal pain, deep pain during sex, fever, or feeling unwell (pelvic inflammatory disease): "No pelvic pain, no pain during sex, no fever — I feel well apart from the discharge and the burning." (Reassuring against PID.)
●If asked about abnormal bleeding (between periods or after sex): "No, no bleeding in between or afterwards."
●If asked about the possibility of pregnancy: "I'm on the pill and I take it properly, and my period was normal two weeks ago."
●If asked about the timing of the last sexual contact and number of partners in recent months: "About two weeks ago. There have been a few partners over the last few months."
●If asked about condom use: "Usually, but not that time."
●If asked about the age of her partners — safeguarding: "They've all been around my age, 17 or 18." (No age-disparity concern.)
●If asked, sensitively, whether she has ever been pressured, coerced, or made to do anything she was not happy with: "No, nothing like that — it's always been my choice." (Safeguarding screen negative.)
●If asked about alcohol or drugs in a sexual context: "I don't really drink much and I don't take anything."
●If asked about previous STIs or testing: "I've never been tested before and never had an infection."
●If asked about home and school: "Home is fine apart from this. College is going okay — I'm doing my A-levels."
●If asked about who she could talk to / a trusted adult: "My older cousin, maybe. Not my parents."
●If asked about her partner(s) being told: "I could message the one from two weeks ago. I'm dreading it though."

Responses to Management (The Negotiation Phase)

●If the Doctor gives the positive chlamydia result clearly: "So it's chlamydia. Is that serious? Can it be cured?" (The tested point is giving a positive STI result clearly and calmly, and reassuring appropriately.)
●If the Doctor explains treatment: "A week of antibiotics? Will it interfere with my pill?" (The tested point is correct treatment and accurate advice about contraception.)
●If the Doctor explains abstaining from sex during treatment: "So no sex for a week, and not until my partners have been treated too?"
●If the Doctor raises partner notification — key: "I have to tell them? That's mortifying. Do I have to do it myself?" (The tested point is explaining partner notification and the help sexual health services can provide, including anonymous contact tracing.)
●If the Doctor addresses confidentiality — key: "But you won't tell my parents, will you?" (The tested point is explaining confidentiality and its limits honestly to a competent young person.)
●If the Doctor explains complications and re-testing: "So if it's treated properly it shouldn't affect me having children? And I need another test in three months?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 20 indicators checked+0−0

Positive (0/10)

Negative (0/10)

Domain 2: Clinical Management and Medical Complexity

0 / 18 indicators checked+0−0

Positive (0/9)

Negative (0/9)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Giving a Positive STI Result

●Give the result clearly, calmly, and without judgement, check the person's reaction, and reassure appropriately — chlamydia is common and curable. In a young person, a non-judgemental approach is what keeps them engaged with treatment, partner notification, and future testing.

Treatment

●First-line treatment for uncomplicated genital chlamydia is doxycycline 100 mg twice daily for 7 days; azithromycin is the alternative where doxycycline is contraindicated (for example in pregnancy). Advise on side effects including photosensitivity, and note that doxycycline does not reduce the effectiveness of combined hormonal contraception.

Abstinence and Reinfection

●Advise no sexual contact until 7 days of treatment are complete and partners have been treated — otherwise reinfection is likely.

Partner Notification

●Recent sexual partners require testing and treatment, using the appropriate look-back period. Sexual health services can undertake contact tracing, including contacting partners anonymously — offering this transforms a task the patient may find impossible into something achievable.

Confidentiality in Under-18s

●A competent young person is entitled to confidentiality. Explain this honestly, including its limits — information would be shared only where there is a serious safety or safeguarding concern, ideally with their involvement. Assess competence (Gillick/Fraser) and encourage, without forcing, the involvement of a trusted adult.

Safeguarding Screen

●In any young person presenting with sexual health needs, screen for exploitation: the age of partners (significant age disparity is a concern), coercion or pressure, alcohol and drugs in a sexual context, and the wider home and school picture. Ask sensitively — asking is required whether or not concerns emerge.

Complications, Re-Testing, and Wider Screening

●Untreated chlamydia can cause pelvic inflammatory disease, ectopic pregnancy, and tubal-factor infertility; treated infection should not affect future fertility. Offer a full STI screen (HIV and syphilis serology), arrange a repeat test at 3 months, and note that a test of cure is not routinely required except in defined circumstances such as pregnancy. Screen for PID at diagnosis.

Common Candidate Mistakes in This Case

●Mishandling confidentiality: promising absolute secrecy, or failing to address her overriding fear about her parents.
●Omitting the safeguarding screen: not asking about partner age or coercion in a 17-year-old.
●Neglecting partner notification: or leaving her to do it unsupported, without offering the anonymous route.
●Incorrect treatment or contraception advice: wrong regimen, or wrongly advising extra contraceptive precautions.
●Missing PID screening, complications, or re-testing: failing to check for pelvic pain/fever, address fertility fears, or arrange the 3-month repeat test.

Free MRCGP SCA practice case for GP registrars covering 17-year-old Attending for Her Swab Results, Which Show Chlamydia — Sexual Health. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.

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