History Taking · Intermediate · O&G

Genital Ulceration and Sexual Health Assessment

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

Clinical scenario

You are an FY2 doctor in a sexual health clinic. Ms Maria Schneider, a 24-year-old woman, presents with painful genital ulcers. She is clearly distressed and worried. Please take a detailed sexual and medical history and discuss your differential diagnosis and management plan.

Background notes: PMH: Nil significant, Good general health

What this station tests

  • Primary herpes presentation: multiple painful vesicles/ulcers with systemic symptoms and lymphadenopathy
  • HSV typing: HSV-2 recurs more genitally than HSV-1, affects counselling
  • Aciclovir within 5 days of onset: most effective when started early
  • Transmission despite condoms: skin-to-skin contact, asymptomatic shedding
  • Urinary retention as a complication of severe primary herpes: requires urgent management

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 herpes causes significant distress because of the recurrent, incurable nature. The candidate must diagnose, treat, counsel about recurrence and transmission, and address the emotional impact. Ms Schneider is 24, a student, with painful genital ulcers for the first time. She is very distressed. Open with: 'Maria, I can see you are really upset. Tell me about the sores and I will help you understand what is happening.'

Core approach

Classic primary genital herpes. Multiple painful vesicles and ulcers on the vulva, tender inguinal lymphadenopathy, systemic symptoms (fever, malaise). Painful urination (dysuria from urine on ulcers). First episode is typically the most severe. She has a new boyfriend (2 months). HSV can be transmitted from asymptomatic shedding, so her boyfriend may not have known he carried the virus.

Confirm diagnosis: viral swab from an active vesicle or ulcer (PCR is most sensitive). Type the virus (HSV-1 versus HSV-2) as this affects recurrence counselling: HSV-2 recurs more frequently than HSV-1 genitally.

The hardest part of the consultation is the 'lifelong' message. HSV establishes latency in sensory ganglia and can reactivate. First episode is worst; recurrences are typically milder and less frequent over time. Some people have very few recurrences.

Closing and safety netting

Treatment: oral aciclovir 400mg TDS for 5 days (or valaciclovir 500mg BD). Start as soon as possible. Pain management: lignocaine gel topically, salt water bathing, paracetamol. Passing urine in the bath or shower can reduce dysuria. If recurrent (>6 episodes per year): suppressive therapy with daily aciclovir reduces outbreaks by 70 to 80%.

Transmission counselling: condoms reduce but do not eliminate transmission (skin-to-skin contact). Avoid sexual contact during outbreaks. Asymptomatic shedding occurs. Her boyfriend should be told but this does not mean infidelity: HSV can be dormant for years.

Address her distress. 'I know this diagnosis feels overwhelming right now. Genital herpes is extremely common, it is manageable, and most people find it has very little impact on their lives after the first episode.' Herpes Viruses Association for support. Safety net: if urinary retention develops (severe dysuria preventing urination), seek urgent care. Follow-up in 1 to 2 weeks.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for genital herpes. 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 (Primary focus)

Scores well: Classic presentation identified. Viral swab sent for typing. Sexual history taken. Urinary symptoms assessed.

Costs marks: Not swabbing. Not taking sexual history. Not assessing urinary retention risk.

Domain 2 (Primary focus)

Scores well: Aciclovir prescribed correctly. Pain management. Suppressive therapy for frequent recurrence. Transmission counselling. Urinary retention safety netting.

Costs marks: No treatment. No pain management. No transmission counselling.

Domain 3 (Primary focus)

Scores well: Addressing her distress. Normalising herpes as very common. Not implying infidelity. Providing hope about reducing impact. Support resources.

Costs marks: Being insensitive. Implying infidelity. Not normalising. Cold delivery of lifelong diagnosis.

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. Being insensitive about the lifelong nature: this needs careful framing, not blunt delivery
  2. Not offering pain management: salt baths, lignocaine gel, and urinating in the shower are practical and valued
  3. Implying infidelity: HSV can be dormant, the boyfriend may not have known he carried it

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

What is the best way to take a genital herpes history in PLAB 2?

Genital herpes causes significant distress because of the recurrent, incurable nature. The candidate must diagnose, treat, counsel about recurrence and transmission, and address the emotional impact. Ms Schneider is 24, a student, with painful genital ulcers for the first time.

Where are marks won and lost in this genital herpes station?

Examiners reward: Classic presentation identified. Viral swab sent for typing. Sexual history taken. Urinary symptoms assessed. Candidates are penalised for: Not swabbing. Not taking sexual history. Not assessing urinary retention risk.

Where do candidates most often go wrong in this station?

Being insensitive about the lifelong nature: this needs careful framing, not blunt delivery. Another frequent error: Not offering pain management: salt baths, lignocaine gel, and urinating in the shower are practical and valued.

Can I do well in this station without real-world experience of genital herpes?

Structure beats experience here. Focus on hSV typing: HSV-2 recurs more genitally than HSV-1, affects counselling. 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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