History Taking · Intermediate · Infectious Diseases

Genital Warts in a 26-Year-Old Woman

Practise this PLAB 2 history taking station on Genital Warts. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a sexual health clinic. Miss Yasmin Kassem, a 26-year-old woman, has come to see you with anogenital warts that have appeared over the past two months. She is embarrassed but keen to understand treatment options and has questions about HPV vaccination. Please take a focused sexual history and discuss management.

Background notes: PMH: Regular menses, On combined oral contraceptive pill

What this station tests

  • Distinguishing HPV types: 6/11 (warts, low-risk) from 16/18 (cervical cancer, high-risk), the critical reassurance point
  • Partner discussion: HPV dormancy means warts do not necessarily indicate infidelity
  • Treatment options: patient-applied (podophyllotoxin, imiquimod) versus clinic-based (cryotherapy, excision)
  • Natural history: most people clear HPV within 2 years, recurrence common but decreasing over time
  • Cervical screening advice: warts do not change screening schedule, different HPV types

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, confirm identity, open question. 'What's brought you in today?'
  • 1-4 min — Systematic History: Presenting complaint detail (SOCRATES for pain, timeline, severity). Systems review. PMH, medications, allergies.
  • 4-6 min — Context and ICE: Social history (smoking, alcohol, occupation, living situation). Family history. Ideas, Concerns, Expectations.
  • 6-7 min — Summary and Plan: Summarise findings back to patient. Share differential/working diagnosis. Outline investigation and management plan.
  • 7-8 min — Closing: Safety netting with specific red flags. Arrange follow-up. Check for questions.

Consultation approach

The opening

Genital warts counselling requires a sensitive, non-judgmental approach covering diagnosis, treatment, partner implications, and the HPV-cervical cancer link. Miss Kassem is 26, presenting with anogenital warts for 2 months. She is embarrassed and worried they might be cancer. Open with: 'Miss Kassem, thank you for coming in. I know this can be difficult to discuss. Tell me what you have noticed.'

Core approach

Characterise the lesions. Small, flesh-coloured, soft, fleshy bumps around the vulva for 2 months. Painless. No bleeding. No ulceration. Her partner noticed them. These are consistent with condylomata acuminata (genital warts) caused by HPV types 6 and 11 (low-risk, non-oncogenic types).

Address the cancer concern immediately. 'Genital warts are caused by HPV types 6 and 11. These are different from the HPV types (16 and 18) that can cause cervical cancer. Having genital warts does not mean you are at increased risk of cervical cancer.' This distinction is the most important message.

Partner discussion. Her boyfriend may have given her the warts, she may have given them to him, or both may have been infected by previous partners (HPV can be dormant for months to years). This does not necessarily indicate infidelity. He should be examined but treatment of asymptomatic partners is not recommended. Condoms reduce but do not eliminate HPV transmission (skin-to-skin contact).

Check: is she up to date with cervical screening? Has she had HPV vaccination?

Closing and safety netting

Treatment options. Topical self-treatment: podophyllotoxin cream (patient-applied, twice daily for 3 days, 4-day break, repeat for up to 4 cycles) or imiquimod cream (immune modulator, applied 3 nights per week for up to 16 weeks). Clinic-based: cryotherapy (freezing), surgical excision for larger warts. Treatment removes visible warts but does not clear the virus. Recurrence is common (30% within 3 months).

Reassure: 'Most people clear HPV from their body within 2 years without any intervention. The warts may recur but they do become less frequent over time.' Cervical screening should continue as normal. Address relationship impact: 'HPV is extremely common. Most sexually active people will have HPV at some point.' Safety net: 'If warts change rapidly, bleed, or become painful, come back.' GUM clinic referral for specialist management if needed.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for genital warts. Domain 1 (Data Gathering) carries the most weight: expect marks for systematic coverage of presenting complaint, red flags, PMH, medications, social and family history. Domain 2 (Clinical Management) requires a clear differential, appropriate investigations, and a safe management plan with safety netting. Domain 3 (Interpersonal Skills) is assessed throughout: genuine exploration of ICE, active listening, empathic responses, and clear communication without jargon.

Domain 1: Data Gathering, Technical and Assessment Skills (Supporting)

Scores well: Lesions characterised. Sexual history taken sensitively. Cervical screening status checked. HPV vaccination history. Partner symptoms assessed.

Costs marks: Not checking screening. Not asking about partner. Not taking sexual history.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: HPV types distinguished (6/11 vs 16/18). Treatment options presented (patient-applied and clinic-based). Recurrence warned. Cervical screening continued. GUM referral offered.

Costs marks: Not distinguishing HPV types. Not knowing treatment options. Not warning about recurrence.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Non-judgmental. Cancer fear addressed immediately. Infidelity concern handled sensitively. Normalising HPV prevalence. Empowering with self-treatment option.

Costs marks: Judgmental. Not addressing cancer fear. Implying infidelity. Making her feel abnormal.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Use a consistent framework for every history. After covering the presenting complaint, systematically move through PMH, drug history, social history, family history, and ICE. Keep a mental checklist.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Reserve the final 2 minutes to summarise your findings, share your working diagnosis with the patient, and outline your investigation and management plan including safety netting.

Common mistakes in this station

  1. Not distinguishing HPV types. She is terrified of cervical cancer. Candidates who do not explain that wart-causing HPV (6/11) is different from cancer-causing HPV (16/18) leave her with the wrong fear.
  2. Implying infidelity. HPV can be dormant for years. The warts may be from a previous partner, not necessarily from the current relationship. Candidates who imply she or her partner has been unfaithful cause unnecessary relationship damage.
  3. Not mentioning recurrence. Wart treatment removes visible warts but does not clear the virus. Recurrence in 30% within 3 months is expected. Candidates who present treatment as curative create false expectations.

Resitting PLAB 2?

If you have previously struggled with history taking stations, focus on building a consistent systematic framework that you apply to every case. Practise structuring your history into clear phases (presenting complaint, systems review, PMH, social, ICE) so that even under pressure, you cover all domains. Many resitters lose marks not on knowledge but on organisation and time management.

Example opening

Good morning/afternoon, my name is Dr [Name], I'm one of the doctors here today. Could I confirm your name and date of birth please? Thank you. So, what's brought you in to see me today?

Frequently asked questions

How do I approach the consultation in this genital warts station?

Genital warts counselling requires a sensitive, non-judgmental approach covering diagnosis, treatment, partner implications, and the HPV-cervical cancer link. Miss Kassem is 26, presenting with anogenital warts for 2 months. She is embarrassed and worried they might be cancer.

What does a strong performance look like to the examiner in this station?

Strong performances show: Lesions characterised. Sexual history taken sensitively. Cervical screening status checked. HPV vaccination history. Partner symptoms assessed. Weak performances: Not checking screening. Not asking about partner. Not taking sexual history.

What is the biggest pitfall in this genital warts station?

Not distinguishing HPV types. She is terrified of cervical cancer. Candidates who do not explain that wart-causing HPV (6/11) is different from cancer-causing HPV (16/18) leave her with the wrong fear.

How should I prepare for genital warts if I have never seen it in practice?

This station rewards process over personal experience. The skill being assessed: Partner discussion: HPV dormancy means warts do not necessarily indicate infidelity. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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