Sexual Health History OSCE Station | OSCE Sup

Clinical Scenario

Candidate Briefing

Ms Laura Patel is a 23-year-old woman who has self-referred to the sexual health clinic with a 5-day history of vaginal discharge and dysuria. She has no significant past medical history.

Please take a focused sexual health history from Ms Patel. You have 10 minutes. The examiner will ask questions in the final 2 minutes.

Key Skill This station specifically tests your ability to take a sensitive, non-judgemental sexual history using appropriate language. Begin by establishing confidentiality. Use open questions. Do not assume gender of partners. Avoid clinical jargon where possible.

Opening Line A strong opening: "Before we begin, I want to let you know that everything you tell me today is completely confidential — it won't be shared with your GP or anyone else without your consent, unless I'm concerned about your safety or someone else's. Is that okay?" — This scores a mark and sets the tone.

Actor Script

Actor / Examiner Information — Do not show to candidate

Opening Appear slightly embarrassed but cooperative. If asked how you are: "A bit embarrassed to be honest, but my friend said I should come in."

Discharge Onset: 5 days ago
Character: Yellow-green, thicker than normal, quite a lot of it
Odour: Slightly unpleasant — fishy smell
Associated: Mild vulval soreness and itching

Urinary symptoms Mild dysuria — stinging when urinating. No frequency or urgency. No haematuria.

Other symptoms Mild lower abdominal discomfort. No fever, no nausea/vomiting. No rectal symptoms.

Sexual history Last sexual contact: 10 days ago
Partner: Male, met 3 weeks ago — new partner
Condom use: "We used one the first time but not the second time."
Number of partners (last 3 months): 2 — current new partner and her ex-boyfriend (ended 2 months ago)
Partner symptoms: You don't know — you haven't spoken to him since
Gender of partners: Both male (if asked — do not volunteer unless specifically asked about gender of partners)

Be slightly hesitant when asked about number of partners but provide the information if asked sensitively and non-judgementally. If candidate uses judgemental language or doesn't establish confidentiality, become more guarded.

Previous STIs Chlamydia, age 20 — treated with antibiotics. No other STIs. Last STI screen was about a year ago, all clear.

Contraception Currently on the combined oral contraceptive pill (COCP) — Microgynon. Takes it regularly.

LMP & menstrual LMP: 2 weeks ago. Regular cycle on the pill. No IMB or PCB.

Smear Last smear: 6 months ago, normal. This was her first (aged 23).

PMH / Medications No PMH. COCP (Microgynon). No other medications. NKDA.

Social history University student. Non-smoker. Drinks socially (8–10 units/week). No IVDU.

ICE Ideas: "I think I might have an infection — maybe thrush?"
Concerns: "I'm worried about what it might be — and whether I need to tell my new partner."
Expectations: "I want to be tested and get treatment as soon as possible."

History Checklist

Opening

Establishes confidentiality
Non-judgemental tone throughout
Presenting complaint in patient's own words

Discharge & Local Symptoms

Onset and duration
Colour, consistency, volume
Odour
Associated itching / vulval soreness
Dysuria (and whether external or internal)
Lower abdominal pain

Sexual History

Date of last sexual contact
Gender of partner(s) — asked without assumption
New or regular partner
Number of partners in last 3 months
Condom use (consistent?)
Partner symptoms
Sites of exposure (vaginal/oral/anal)

STI & Testing History

Previous STIs and treatment
Date of last STI screen & result
HIV status / last HIV test
Hepatitis B vaccination status

Contraception & Menstrual

Current contraception
LMP
IMB / PCB
Smear history
Pregnancy (could symptoms be pregnancy-related?)

PMH / Social / ICE

Medications & allergies
IVDU
Ideas, concerns & expectations
Explains next steps (swabs, testing, treatment, contact tracing)

Mark Scheme

Competency	Marks	Awarded
Opening
Introduces self; confirms patient identity; establishes confidentiality and its limits before starting "Everything you share with me today is confidential — it won't go to your GP unless you or someone else is at risk of harm."	2
Presenting Complaint & Symptoms
Asks about onset, duration, colour, volume and odour of discharge	2
Asks about associated symptoms: vulval soreness/itching, dysuria, lower abdominal pain	1
Asks about systemic symptoms: fever, nausea, malaise (to screen for PID)	1
Sexual History
Asks date of last sexual contact	1
Asks about gender of partner(s) without assuming — uses open/neutral language e.g. "Are your partners male, female or both?" or "What is the gender of your partner(s)?"	1
Asks whether partner is new or regular; asks number of partners in the last 3 months without judgement	1
Asks about condom use — frequency and consistency	1
Asks whether partner has any symptoms	1
Asks about sites of exposure (vaginal, oral, anal) where appropriate	1
STI & Testing History
Asks about previous STIs, treatment and dates; asks about date and result of last STI screen	1
Asks about HIV status and date of last HIV test	1
Contraception, Menstrual & General
Asks about current contraception and LMP; considers whether pregnancy could account for symptoms	1
Asks about smear history; medications and allergies; IVDU	1
ICE & Closing
Elicits ideas, concerns and expectations; addresses concern about contact tracing sensitively	2
Explains next steps — examination and swabs (HVS, endocervical, urine NAAT); advises to avoid sexual contact pending results; thanks patient	1

Total 19 marks

Examiner Questions

Based on this history, what are your differential diagnoses?

Gonorrhoea — yellow-green discharge, new partner with inconsistent condom use, previous Chlamydia (risk factor for recurrent STIs), mild dysuria and abdominal pain. Most likely given the purulent discharge.
Chlamydia — common, often co-exists with gonorrhoea; can present with discharge (though often asymptomatic). Must be tested for simultaneously.
Bacterial vaginosis (BV) — fishy odour, grey-white discharge; however, BV is not an STI and does not typically cause dysuria or abdominal pain
Trichomonas vaginalis — yellow-green frothy discharge, dysuria, fishy smell; sexually transmitted
Candidiasis (thrush) — itching and white discharge, but typically no odour and no dysuria from internal infection
PID — if lower abdominal pain and systemic features are present, must be considered

What swabs and investigations would you arrange?

High vaginal swab (HVS) — microscopy and culture (BV, Trichomonas, Candida)
Endocervical swab — culture for Neisseria gonorrhoeae (sensitivity testing essential for antibiotic resistance)
Vulvo-vaginal swab or first-void urine NAAT — for Chlamydia trachomatis and Neisseria gonorrhoeae (NAAT is more sensitive)
HIV test — offer routinely at every GUM attendance
Syphilis serology — offer routinely
Hepatitis B serology / vaccination status
Urine dipstick ± MSU — to exclude concurrent UTI
Pregnancy test — if any doubt

Ms Patel asks whether she has to tell her partners. How do you approach this?

Explain contact tracing sensitively and non-directively. The patient is not legally obligated to disclose but should be encouraged to do so. Explain that partners may have the infection without knowing and could pass it on or develop complications. Options include: informing partners themselves, the clinic contacting them anonymously (partner notification service), or a provider referral where the clinic contacts partners with the patient's consent. Emphasise this is to protect their health, not to assign blame. The sexual health clinic can help facilitate this.

What is the first-line treatment for uncomplicated gonorrhoea in the UK?

Per current BASHH guidelines: Ceftriaxone 1g IM single dose (intramuscular). Dual therapy with azithromycin is no longer routinely recommended due to azithromycin resistance. Always send a culture before treatment to guide sensitivities, as antibiotic-resistant gonorrhoea is an increasing concern (including ceftriaxone-resistant strains). Treat Chlamydia empirically if co-infection is suspected — doxycycline 100 mg BD for 7 days (or azithromycin 1g stat if compliance is a concern). Test of cure (TOC) is recommended for pharyngeal gonorrhoea and in cases of antibiotic resistance.