History Taking · Intermediate · O&G

Vaginal Discharge and Sexual Health Concerns

Practise this PLAB 2 history taking station on Suspected Gonorrhoea/Chlamydia. 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 Amina Mensah, a 26-year-old woman, presents with vaginal discharge that concerns her. Please take a comprehensive sexual history and discuss investigations and management options for possible sexually transmitted infection.

Background notes: PMH: Nil significant

What this station tests

  • Discharge colour as diagnostic clue: yellow-green (gonococcal), white (candida), thin grey fishy (BV)
  • NAAT testing for gonorrhoea and chlamydia: the standard diagnostic test
  • Full STI screen: HIV, syphilis, hepatitis B offered alongside targeted testing
  • Partner notification and treatment: both partners must be treated to prevent reinfection
  • PID safety netting: lower abdominal pain or fever suggests ascending infection

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

Vaginal discharge with STI concern requires a sensitive sexual history, appropriate testing, and non-judgmental communication. Ms Mensah is 26, in a new relationship (3 months), presenting with vaginal discharge for 10 days. She is worried about gonorrhoea or chlamydia. Open with: 'Ms Mensah, everything we discuss is confidential. Tell me about the discharge and what has concerned you.'

Core approach

Characterise the discharge. Colour (yellow-green suggests gonococcal, white suggests candida, thin grey with fishy smell suggests BV), consistency, odour, volume. Associated symptoms: dysuria, intermenstrual bleeding, dyspareunia, lower abdominal pain. Her discharge is yellow-green, with dysuria, raising suspicion for gonorrhoea or chlamydia.

Sexual history using the framework: partners (new boyfriend 3 months, one previous partner), practices (vaginal, oral), protection (condoms initially, now inconsistent), previous STIs (none). Last menstrual period and contraception. Any partner symptoms?

Testing: endocervical or self-taken vulvovaginal swab for NAAT (gonorrhoea and chlamydia). Offer full STI screen: HIV, syphilis, hepatitis B. High vaginal swab if BV or candida suspected concurrently. Microscopy if available in the clinic.

Closing and safety netting

Empirical treatment if high clinical suspicion: IM ceftriaxone 1g plus oral azithromycin 1g (covers gonorrhoea and chlamydia) or doxycycline 100mg BD for 7 days if chlamydia alone suspected. Partner notification: boyfriend needs testing and treatment. Abstain until both treated.

Reassure: 'STIs are extremely common and very treatable. Having one does not say anything about you as a person.' Address her embarrassment directly and normalise. GUM clinic referral for specialist follow-up and contact tracing. Safety net: 'If you develop lower abdominal pain or fever, come back urgently as this could indicate the infection has spread.' Follow-up with results.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for suspected gonorrhoea/chlamydia. 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: Discharge characterised. Sexual history taken sensitively. Full STI screen offered. LMP and contraception checked. Partner symptoms asked.

Costs marks: Not characterising discharge. No sexual history. Incomplete screen.

Domain 2 (Primary focus)

Scores well: Appropriate testing (NAAT). Empirical treatment if indicated. Partner notification. PID safety netting. GUM referral.

Costs marks: No testing. No partner notification. No PID warning.

Domain 3 (Primary focus)

Scores well: Non-judgmental throughout. Confidentiality established. Normalising STIs. Addressing embarrassment.

Costs marks: Judgmental. Not establishing confidentiality. Making her feel ashamed.

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 offering full STI screen: a patient with one STI may have others
  2. Not discussing partner notification: treating the patient without the partner allows reinfection
  3. Being judgmental: any hint of moral judgment will prevent future health-seeking behaviour

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 suspected gonorrhoea/Chlamydia station?

Vaginal discharge with STI concern requires a sensitive sexual history, appropriate testing, and non-judgmental communication. Ms Mensah is 26, in a new relationship (3 months), presenting with vaginal discharge for 10 days. She is worried about gonorrhoea or chlamydia.

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

Strong performances show: Discharge characterised. Sexual history taken sensitively. Full STI screen offered. LMP and contraception checked. Partner symptoms asked. Weak performances: Not characterising discharge. No sexual history. Incomplete screen.

What is the biggest pitfall in this suspected gonorrhoea/Chlamydia station?

Not offering full STI screen: a patient with one STI may have others. Another frequent error: Not discussing partner notification: treating the patient without the partner allows reinfection.

How should I prepare for suspected gonorrhoea/Chlamydia if I have never seen it in practice?

Structure beats experience here. Focus on nAAT testing for gonorrhoea and chlamydia: the standard diagnostic test. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

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