GP CCE Cases · sexual-health-and-gender-diversity
Asymptomatic MSM quarterly screen — CCE clinical encounter
CCE-style clinical encounter: a 31-year-old man on HIV PrEP attends for a routine script renewal. The candidate must take a non-judgemental sexual history, order site-specific STI testing, deliver results and treatment with partner notification, and counsel on PrEP limits.
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Prompt
A 31-year-old man attends for his PrEP (tenofovir/emtricitabine) three-monthly review. He feels well. He has had four partners since his last visit — receptive anal sex, no condoms with two of them; he does not want 'a big deal' made of testing.
Objectives
- Take a brief, normalised sexual history that establishes sites of exposure without judgement. [1]
- Order site-specific screening (urine, throat, rectum NAAT; HIV/syphilis serology) and explain why urine alone is inadequate. [1]
- Manage a positive result: doxycycline-first chlamydia therapy, treatment on the day, and partner notification including expedited partner therapy where lawful. [2] [3]
- Reinforce PrEP adherence and its scope — HIV only. [3]
- Arrange three-monthly retesting rhythm aligned to PrEP reviews. [1]
References3ShowHide
- [1]Aaron KJ, Gaydos CA, Hook EW 3rd, et al. Chlamydia and Gonorrhea Infections in Genital and Extragenital Samples Among Men and Women Sex Transm Dis, 2025.PMID 40772619
- [2]Lau A, Kong FYS, Fairley CK, et al. Azithromycin or Doxycycline for Asymptomatic Rectal Chlamydia trachomatis N Engl J Med, 2021.PMID 34161706
- [3]Golden MR, Kerani RP, Stenger M, et al. Uptake and population-level impact of expedited partner therapy (EPT) on Chlamydia trachomatis and Neisseria gonorrhoeae: the Washington State community-level randomized trial of EPT PLoS Med, 2015.PMID 25590331