"This is mortifying" — taking a sexual history

PLAB 2 & PRES 3 · sexual health / history taking · medium · 10 minutes

Candidate brief

You are an FY2 doctor in a GP surgery. Mr Josh Adeyemi, 26, attends with four days of penile discharge and discomfort passing urine. He is visibly embarrassed and says: "Sorry, this is mortifying. I've never had anything like this before." Please take a sexual health history, examine as appropriate, and agree a management plan with him.

What examiners look for

The sexual history is a clinical instrument, not a confession. Every question in the BASHH sequence exists because it changes a test, a site sampled, a window period or a notification: last contact and its details set the incubation arithmetic; sites of exposure set the swabs; the 3-month lookback sets the notification list. Say the reason as you ask — "I'm asking when, because it tells us which infections are even possible" — and intimate questions become what they are: differential diagnosis. Tone is technique. Matter-of-fact, unshockable, unhurried: the patient calibrates his honesty to your eyebrows. He came in apologising for his own symptoms; the doctor who treats discharge like a sore throat gets the whole history, including the partner he "forgot" and the HIV fear he was saving for the door handle. Incubation periods are where sexual health histories earn their keep. Purulent discharge 10 days after an unprotected contact fits gonorrhoea; chlamydia's longer, quieter course may belong to an earlier partner — so the honest sentence is "the tests will tell us; more than one infection, from more than one point in the last few months, is possible", and partner notification follows the evidence, not the patient's guilt-driven guess about who "gave him" something. Window periods must leave the room with him. An HIV test 10 days after an exposure is a baseline, not an answer; the conclusive 45-day test is planned before he stands up. The doctor who says "we'll test you for everything today, all clear" has manufactured either false peace or a delayed panic — both are clinical errors wearing reassurance's coat. And end with the practical triad rehearsed: tests done today, no sex until treated and cleared, partners told with help available. If he can say those three back, the mortifying consultation has done its work.

Guideline references

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