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]}