History Taking · Foundation · Urology

Urethral Discharge in a Young Man

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

Clinical scenario

You are an FY2 doctor in general practice. Mr Kevin Lu, a 26-year-old man, has come to see you with urethral discharge and dysuria for the past four days. Please take a focused sexual history and discuss STI screening, empirical treatment, and referral to sexual health services.

Background notes: PMH: Healthy, no previous STIs, routine vaccinations up to date

What this station tests

  • Sensitive sexual history using the partners, practices, protection framework
  • Distinguishing gonococcal from chlamydial urethritis: purulent yellowish discharge suggests gonorrhoea, mucopurulent suggests chlamydia
  • Dual empirical therapy: IM ceftriaxone plus oral azithromycin to cover both gonorrhoea and chlamydia
  • Partner notification: explaining the need and offering GUM clinic support for anonymous notification
  • Full STI screen: offering HIV, syphilis, and hepatitis B testing alongside gonorrhoea and chlamydia

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

Urethral discharge in a young man is urethritis until proven otherwise, and the candidate must take a sensitive sexual history, arrange appropriate testing, provide empirical treatment, and discuss partner notification. Mr Lu is 26, presenting with 4 days of yellowish urethral discharge and dysuria. He is embarrassed and worried about confidentiality. Open with: 'Mr Lu, thank you for coming in. Everything we discuss is confidential. Tell me about the symptoms you have been experiencing.'

Core approach

Characterise the discharge. Yellowish, purulent, noticed on underwear, worse in the morning, with dysuria. No testicular pain, no systemic symptoms. This presentation, purulent urethral discharge with dysuria, strongly suggests gonococcal urethritis. Mucopurulent or clear discharge would suggest chlamydial or non-specific urethritis.

Take a sexual history sensitively but thoroughly. Use the framework: partners (number, gender, timing), practices (vaginal, oral, anal intercourse), protection (condom use), previous STIs. He had unprotected vaginal intercourse with a new partner approximately 10 days ago. Condom was not used. This is a plausible transmission window for both gonorrhoea (incubation 2 to 5 days) and chlamydia (7 to 21 days).

Testing: urethral swab or first-void urine for NAAT (nucleic acid amplification test) for gonorrhoea and chlamydia. Offer full STI screen: HIV, syphilis, hepatitis B (blood tests). He may be reluctant; explain: 'These tests are standard when we suspect one STI, because infections can occur together.'

Partner notification: he will need to inform the partner he had unprotected sex with. This is uncomfortable but essential for public health. Offer support: the GUM clinic can assist with anonymous partner notification if he prefers.

Closing and safety netting

Empirical treatment before results return. For suspected gonococcal urethritis: IM ceftriaxone 1g single dose PLUS oral azithromycin 1g single dose (dual therapy to cover gonorrhoea and concurrent chlamydia). If gonorrhoea is excluded and chlamydia confirmed: doxycycline 100mg BD for 7 days.

Refer to GUM (genitourinary medicine) clinic for definitive management, contact tracing, and follow-up test of cure. Abstain from sexual intercourse until treatment is complete and partner is treated.

Address his embarrassment: 'STIs are very common and very treatable. You have done the right thing by coming in.' Address confidentiality: 'This will not appear on any records that your employer or others can see. GUM clinics operate with strict confidentiality.' Safety net: 'If symptoms are not improving within a week of treatment, or you develop testicular pain, come back.' Follow-up with GUM.

How examiners mark this station

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

Scores well: Discharge characterised (purulent, yellowish). Sexual history taken (partners, practices, protection, timing). Full STI screen offered. Testicular examination or symptoms checked. Transmission window estimated.

Costs marks: No sexual history. Not characterising discharge. Not offering full screen. Not checking for epididymitis.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Dual empirical therapy (ceftriaxone plus azithromycin). GUM referral arranged. Partner notification discussed. Abstinence advice. Test of cure planned. Full STI screen.

Costs marks: Monotherapy. No GUM referral. No partner notification. No full screen.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Confidentiality established at outset. Non-judgmental about unprotected sex. Normalising STIs as common and treatable. Addressing embarrassment. Supporting partner notification sensitively.

Costs marks: Judgmental about sexual behaviour. Not establishing confidentiality. Not normalising. Making partner notification feel punitive.

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 taking a sexual history. Urethral discharge requires a sexual history. Candidates who diagnose 'urethritis' and prescribe antibiotics without asking about partners, practices, and protection miss essential diagnostic and public health information.
  2. Not offering a full STI screen. A patient with one STI is at risk of others. Candidates who test only for gonorrhoea and chlamydia without offering HIV, syphilis, and hepatitis B provide incomplete care.
  3. Not discussing partner notification. The recent sexual partner needs testing and treatment. Candidates who treat the patient without addressing partner notification fail the public health aspect of STI management.

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 should I structure the urethritis history in this PLAB 2 station?

Urethral discharge in a young man is urethritis until proven otherwise, and the candidate must take a sensitive sexual history, arrange appropriate testing, provide empirical treatment, and discuss partner notification. Mr Lu is 26, presenting with 4 days of yellowish urethral discharge and dysuria. He is embarrassed and worried about confidentiality.

What are examiners marking in this urethritis station?

Marks are won for: Discharge characterised (purulent, yellowish). Sexual history taken (partners, practices, protection, timing). Full STI screen offered. Testicular examination or symptoms checked. Marks are lost for: No sexual history. Not characterising discharge. Not offering full screen. Not checking for epididymitis.

What is the most common mistake candidates make in this urethritis station?

Not taking a sexual history. Urethral discharge requires a sexual history. Candidates who diagnose 'urethritis' and prescribe antibiotics without asking about partners, practices, and protection miss essential diagnostic and public health information.

How do I prepare for this station if I have not managed urethritis in clinical practice?

This station rewards process over personal experience. The skill being assessed: Distinguishing gonococcal from chlamydial urethritis: purulent yellowish discharge suggests gonorrhoea, mucopurulent suggests chlamydia. 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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