Cases/Sexual Health

Man Whose Partner Has Tested Positive for Gonorrhoea — Free SCA Practice Case

Man whose partner has tested positive for gonorrhoea

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

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Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Dexter Quarshie

Age

25 years

Consultation Type

Telephone

Age

Situation

Telephone Consultation. Routine appointment booked by the patient.

Reason for Encounter

"My girlfriend has texted to say she has an infection from the clinic. I would like antibiotics today, please."

Medical Records

●PMH: Hay fever. Tonsillitis at 19, treated with amoxicillin.
●Medications: Cetirizine as needed.
●Allergies: NKDA.
●Social: Stock controller at a builders merchant. Shares a flat with two friends. Non smoker. Alcohol at weekends.

Patient Script

For the friend playing the patient role

Character Overview: You are Dexter Quarshie, a 25 year old stock controller at a builders merchant. You count and order stock for the trade counter and are at work from 8 until 4 on weekdays. You share a flat with two friends and have been with your girlfriend Bronwyn for about thirteen months. Last night she texted you after a clinic visit to say she has been diagnosed with gonorrhoea, had an injection, and that you need treating too. You feel fine, you are embarrassed, and you are frightened of the clinic: the queue, the time off, being seen, and what a swab will find out about you. You have a secret you have not told her. You are polite and a little jokey when nervous, then quiet and flat when you feel cornered. You assume a course of tablets will fix everything quickly and want that from your doctor today. Speak at a natural pace and answer what you are asked.

Opening Sentence: "Hi doctor. My girlfriend texted me last night to say she's got gonorrhoea and that I need treating as well. I feel completely fine, so can you just give me the antibiotics today? I really don't want to go to the clinic."

History if Asked (Data Gathering Phase)

●What Bronwyn told you: "She went to the sexual health clinic last week because she had a bit of discharge. They rang her yesterday to say the swab showed gonorrhoea. She went in the same afternoon and had an injection in her bottom. She said her other tests were clear, chlamydia and the blood ones, as far as she knows. They told her to tell me, and that we shouldn't have sex until a week after we've both been treated."
●Symptoms: "Nothing. I haven't noticed anything at all."
●Last sex with Bronwyn: "Four days ago. Nothing since, and we haven't seen each other since she got the result. We've been together about thirteen months and we stopped using condoms a few months in. Usually two or three times a week."
●Type of sex: "Vaginal and oral, both ways. Nothing else. I've only ever been with women."
●Pregnancy and contraception: "She's on the pill and had a period about two weeks ago, so she isn't pregnant as far as I know."
●Previous tests: "Never had any sexual health test, ever. I've never had an infection either."
●Her partner history: "I'm not sure about before me. She says she had a check just before we got together and it was fine."
●Other partners (volunteer nothing): "Um. Yes, there was one other person. About seven weeks ago, a woman I met through a dating app, one night after a night out. We used a condom for the sex but not for oral. I only have her first name and her number on the app. I haven't told Bronwyn and I really don't want to."

Gating note: Dexter does not mention the other woman unless the doctor asks about other partners in the last few months. If asked in a plain, non judgemental way he admits it quietly. If the doctor sounds judgemental he becomes short and says "I know, I know."

Ideas, Concerns, Expectations

Gating note: Dexter does not raise any of this himself. Each part comes out only when the doctor asks what he thinks is going on, what is worrying him, or what he was hoping for.

●Ideas: He thinks it works like a chest infection: a few tablets and it is gone. A friend told him his GP "just gave him a course" after a similar scare. He believes that with no symptoms he is probably fine and the clinic would only be a formality. "My mate's GP gave him tablets and that was that. Isn't it just a course of antibiotics?"
●Concerns: Four worries, in this order. First, the clinic itself: the nearest one is a forty minute bus ride into the town centre, people queue for hours, and he cannot leave work during the day. Second, privacy: the clinic is next to the hospital where his mum works as a ward clerk and he is afraid she will see him. He also thinks it will go on his GP record and wants to know who can see it. Third, that Bronwyn will find out about the other woman. Fourth, only if asked about the future, whether it could affect him having children. "If my mum sees me going in there, that's the end of it. And will Bronwyn find out everything?"
●Expectations: He expects a prescription for a few days of tablets today and no tests, no swabs and no clinic. "I just want something I can pick up on my way home."

If Asked: Medical History and Medications

Gating note: Dexter answers each of these plainly when the doctor asks about it.

●Other health problems: "Only hay fever. I had tonsillitis when I was 19."
●Medicines: "Cetirizine when the pollen's bad. Nothing else."
●Allergies: "None. I had amoxicillin for the tonsillitis and was fine."
●Hepatitis B vaccine and HIV test: "I don't think I've ever had either."
●Injecting drugs and chemsex: "No. I drink on Saturdays, about eight pints, and that's it. No drugs."
●Tattoos, piercings or travel: "No."

Social History and Lifestyle Impact

●Work: Stock controller at a builders merchant, 8 until 4. He can only leave during the day with his line manager's permission and does not want to explain why.
●Home: Shares a flat with two friends. Bronwyn stays most weekends, and they had planned to see each other this weekend.
●Availability to be seen: He can get anywhere after half past four today and is free all day on Saturday. A booked slot, a drop in after work, or a postal kit he could do tonight would all suit him better than a half day queue.
●Contact: He is happy to be contacted by text on his mobile. He asks that nothing is left on the flat's landline.
●Relationship: Bronwyn is the first serious partner he has had. He feels guilty about the other woman and is not sure how to tell Bronwyn any of it.
●Support: One flatmate, who he trusts, but he has told no one.

If Asked: Associated Symptoms

Gating note: Dexter answers these only when asked. Every one is negative.

●If asked about discharge, burning or stinging on passing urine, or needing to pass urine more often: "No, nothing like that."
●If asked about testicular pain, swelling, or a lump: "No, everything feels normal down there."
●If asked about a rash, sore joints, fever, or feeling unwell: "No to all of that."
●If asked about a sore throat or anything around the back passage: "No. My throat's fine and there's nothing at the back."
●If asked about a blister, sore or ulcer on the penis: "No."

Responses to Management (The Negotiation Phase)

●
If the doctor explains why he is not being given tablets, or that treatment is an injection and tests are needed first:
- ●Reaction: Surprised and pushing back. "But my mate got tablets from his GP." If told that tablets are less reliable and the infection is now resistant to many antibiotics, he asks: "So it's an injection? Do I need it if I feel fine?" He accepts when told that the clinic can test him and, because it was only four days ago, may offer the injection straight away. "Can't you do the injection here, then?" If the doctor says it is not available here, he accepts: "Right. So it has to be the clinic."
●
If the doctor talks about the clinic and confidentiality:
- ●Reaction: Anxious. "Will it go on my records? Will my mum find out? Does the surgery tell anyone?" If told that sexual health records are kept separately and are not shared with the GP or his family without his consent, and that the practice will not tell Bronwyn, his mum or his work: "Okay. That's good." If a postal kit or an evening booked appointment is offered: "I could do the kit tonight. Or a slot after half four. Where would I book?"
●
If the doctor explains what testing involves:
- ●Reaction: Puzzled about the details. "Why do I need a throat swab if my throat's fine? Is it just a wee sample? And blood tests as well?" If told the tests also look for chlamydia, HIV and syphilis: "I haven't had any of that. Fine. How long do results take?" He is told it may be a few days and agrees to a text.
●
If the doctor advises against sex until treatment is complete:
- ●Reaction: Awkward. "We were due to see each other this weekend. What do I tell her?" Asks how long and whether condoms are enough. Once told it is a week after both have finished treatment, including oral sex: "A week. Right. I'll tell her." If told Bronwyn need not know about anything else, he is relieved.
●
If the doctor raises telling the other woman:
- ●Reaction: Defensive, then worried. "Do I have to? I only have her first name and a number on the app. Can't I just leave it?" If told the clinic can contact her without giving his name, or help him word a message: "Anonymous? Okay. Will it tell Bronwyn anything?" He agrees once reassured that it will not.
●
If the doctor gives safety netting and talks about what happens if he does nothing:
- ●Reaction: Wants specifics. "What happens if I just leave it? Could it stop me having kids?" If the doctor says "come back if it gets worse": "Worse how? What would I look for?" He repeats back what to watch for and who to contact when given clear symptoms.

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 16 indicators checked+0−0

Positive (0/8)

Negative (0/8)

Domain 2: Clinical Management and Medical Complexity

0 / 22 indicators checked+0−0

Positive (0/11)

Negative (0/11)

Domain 3: Relating to Others

0 / 14 indicators checked+0−0

Positive (0/7)

Negative (0/7)

Clinical Learning Points

The Core Dilemma and the Model Plan

●Dexter is 25, has no symptoms, and his girlfriend has been diagnosed with gonorrhoea and treated. He wants antibiotics from his GP today to avoid the sexual health clinic. The station tests partner notification and contact management: testing and, if needed, treatment through sexual health services, advice to abstain, and confidentiality. Hidden in the history is a second contact, a casual partner about seven weeks ago.
●The model plan has six parts. Take a focused sexual history covering the date of last exposure, sites, symptoms and all partners in the last three months. Explain that he cannot have tablets, because the recommended treatment is an injection given once infection is confirmed or presumptive treatment is judged appropriate. Arrange a full screen and early sexual health assessment by a route he can manage. Advise no sex until treatment is complete. Plan notification of both partners. Close with specific safety netting and a clear route for results.
●Acceptable alternatives: a same or next day appointment, an evening or Saturday slot, a drop in after work, or an online postal kit with a clear path to treatment. If the practice stocks ceftriaxone and can give it after samples are taken, treating there is reasonable, provided the full screen and partner notification are still arranged. Planning a repeat test about two weeks after exposure, if he is not treated presumptively, is also sound.

Why Oral Antibiotics From the GP Are Not the Answer

●The British Association for Sexual Health and HIV (BASHH) national guideline for Neisseria gonorrhoeae (2025) recommends ceftriaxone 1 g intramuscularly as a single dose for uncomplicated anogenital and pharyngeal infection, and states that ceftriaxone remains highly effective.
●Oral options are for people who cannot have an injection. Cefixime 400 mg followed by a second 400 mg dose 6 to 12 hours later, plus azithromycin 2 g, is advised only if an injection is contraindicated and susceptibility results are available. Azithromycin alone is not suitable because resistance is too high. Ciprofloxacin is no longer first line and is used only when susceptibility is known and it is judged appropriate.
●BASHH recommends confirming gonorrhoea before treatment, with presumptive treatment of contacts the exception. Treating without samples also loses the chance to test for other infections and to monitor resistance. The UKHSA Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) depends on samples, and possible ceftriaxone treatment failures are reported to UKHSA by the treating clinic.

Contacts, the Two Week Window and Epidemiological Treatment

●A recent contact may test negative because infection is too early to detect. BASHH states that infection cannot be ruled out within two weeks of contact, and recommends repeat testing after that window if presumptive treatment is not given.
●Epidemiological treatment, meaning treatment of a contact before a result, is not needed for every contact. After 14 days from exposure, BASHH recommends treating only after a positive test. Within 14 days it recommends considering treatment after a clinical and psychosocial risk assessment and a discussion with the person. Groups to consider include people who are pregnant, contacts of pregnant people, people living remotely from clinics, and people with barriers such as homelessness, substance misuse, mental ill health, zero hours work or no childcare. For other asymptomatic contacts it may be appropriate to withhold treatment and repeat the test two weeks after exposure.
●Dexter is four days from exposure, so either route is defensible. The decision belongs to the sexual health clinician, which is why the best GP action is prompt access, not a prescription. Candidates who send him for early assessment, or plan repeat testing at two weeks, meet the standard.
●Doxycycline post exposure prophylaxis does not alter this. BASHH advises it is unlikely to prevent gonorrhoea because of tetracycline resistance, and users are managed like other contacts.

What to Test and How

●Gonorrhoea is detected with a nucleic acid amplification test (NAAT). In men the usual specimen is first pass urine. BASHH recommends pharyngeal testing for all contacts, so Dexter needs a throat swab as well, because he has had unprotected oral sex, even though his throat feels fine.
●About one in five people with gonorrhoea also have chlamydia, so he needs a chlamydia test. BASHH advises that people diagnosed with gonorrhoea are tested for chlamydia, syphilis and HIV. Bronwyn's other results being clear does not lower his risk, because he has had a second partner.
●Very recent exposure can be missed by blood tests as well as swabs. The clinic will advise whether any test should be repeated, and he should be told so that a single negative result does not give false reassurance.
●If he is treated with ceftriaxone for a susceptible anogenital infection, routine test of cure is not needed. The clinic decides who needs one.

Partner Notification, Including the Contact He Has Not Mentioned

●BASHH advises that partner notification is pursued for everyone with gonococcal infection. For asymptomatic infection, all partners in the preceding three months should be notified where possible. Bronwyn has been treated and told Dexter, but the woman from the dating app seven weeks ago falls within the look back period and does not know she may be at risk.
●A first name and a phone number are enough. Sexual health advisers can notify a contact without giving the name of the person who named her, and can help with wording if he prefers to contact her himself. Practices generally do not do this work, so the right action is to refer him to the service and agree his preference.
●Ask about other partners plainly and without comment. He will not volunteer it, and a tone that suggests judgement closes the topic.
●He is not obliged to tell Bronwyn about the other encounter, and neither the clinic nor the GP will. It is fair to say that whether to tell her is his choice, and that an adviser can talk it through.

Abstaining, Reinfection and Follow Up

●BASHH advises abstaining from sexual intercourse until 7 days after the person and their partners have completed treatment. Dexter should include oral sex. If he is carrying the infection while Bronwyn is treated, she can be reinfected.
●If he is not treated presumptively, he should avoid sex until results are back and any treatment is complete, and he should repeat the test about two weeks after exposure if the first result is negative.
●Condoms reduce risk but do not cure existing infection. Helping him find wording for Bronwyn, such as that the clinic told him to wait a week, lets him follow the advice without disclosing anything else.
●Record his preference for results by text to his own mobile, with nothing left on the shared landline.

Confidentiality and Records

●The call is confidential. GMC guidance allows disclosure without consent only in specific circumstances, such as serious harm, and none apply. Bronwyn, his mother and his employer are not told.
●Sexual health clinics treat records as especially sensitive and usually ask the patient's consent before writing to the GP. His fear of being seen by his mother near her hospital can be met with a postal kit, a different clinic or a booked slot.
●Dexter has capacity. If he still declines every route, document the advice and keep the door open. Refusal is a reason to offer more routes, not to prescribe an unsuitable antibiotic.

Consequences and Safety Netting

●Gonorrhoea can be present without symptoms. Untreated it can cause epididymitis, prostatitis and, rarely, infertility, and it can pass back and forth between partners. Explain this in proportion: complications are uncommon once treated.
●Safety net with symptoms and a disposition. Discharge, burning on passing urine, a rash, joint pain or fever need same day contact with sexual health or urgent care. A painful or swollen testicle needs same day assessment, because BASHH advises ceftriaxone 1 g IM in addition to the usual regimen for epididymo orchitis.

Common Mistakes in This Station

●Prescribing azithromycin, cefixime or ciprofloxacin to avoid the clinic, with no samples taken.
●Reassuring him because he has no symptoms, or arranging a single test with no plan for early infection or repeat testing.
●Missing the throat swab, or limiting the screen to gonorrhoea.
●Not asking about other partners, or asking in a way that sounds accusing so that he denies it.
●Telling him to attend the clinic with no route, time or check that he can go.
●Saying that condoms are enough, or not mentioning oral sex.
●Giving no confidentiality information, or implying his mother or Bronwyn could be told.
●Safety netting with "come back if it gets worse" instead of named symptoms.

Mapped to the RCGP curriculum topic: Sexual Health.

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