Personal Details:

Name: Jessica Green

Age: 25

Medical Record:

Past medical history: None.

Regular medication: None.

Allergies: None known.

Notes:

Jessica attended the GUM clinic a few days ago with symptoms of vaginal discharge and itching. A high vaginal swab was taken. She is here for the results.

Investigation Results: Swab test - Positive for Trichomonas vaginalis.

Task:

1. Break the news of the diagnosis.

2. Take a sensitive sexual history and address her concerns about her partner.

3. Discuss management for her and her partner, and provide safe sex advice.

Opening Sentence: “Hi, Doctor, you asked me to come back to get my test results.”

Open History (to give freely): “I’m really hoping you can give me something to clear this up. The discharge is horrible, it’s yellowy-green and smells really fishy. It’s so embarrassing.”

Cues to give: “My boyfriend and I just broke up last week.”

ICE (Ideas, Concerns, Expectations):

Ideas: “I think it’s just a bad case of thrush, but the creams didn’t work.”

Concerns: “Is my partner cheating on me? How did I get this?”

Expectation: “I just want some antibiotics to get rid of it.”

How to Act: You are upset, embarrassed, and suspicious. You become angry and tearful when you hear the diagnosis.

More History (only if asked): You were in a stable relationship for two years. You broke up last week after an argument. You don’t use condoms with him because you thought you were both exclusive. You have never had a cervical smear test. Your ex-partner doesn’t have any symptoms.

Social History: You work as a hairdresser. You have been staying with a friend since the breakup.

Questions to ask:

“So he definitely cheated on me? That’s the only way I could have got this?”

“Do I have to tell him? I never want to speak to him again.”

“Will this affect me having kids in the future?”

Setting the Scene:

Hi Sarah, thanks for coming in. We have the results of the tests you did last week. Before I give you the results, how have you been since we last saw you?

Breaking the News (Warning Shot): Most of your results have come back negative, which is great. However, one of the tests has come back positive. It shows you have an infection called Trichomonas vaginalis. (Pause and allow for reaction)

Sexual History & Relationship Context: I know this must be distressing. Can you remind me about your current relationship status? How long have you been with your partner?

ICE (Ideas, Concerns, Expectations):

What are your initial thoughts on hearing this result?

What is your biggest worry right now?

What were you hoping we could do to help you with this?

Explain the test results:

Thanks for coming in, Jessica. I have the result of the swab we took. It shows that the discharge is being caused by an infection called Trichomonas vaginalis, or TV for short. This is a very common sexually transmitted infection (STI), and it is easily treated with a course of antibiotics.

Addressing and answering the patient’s ICE:

I can see that this news is a shock. You’re asking if this means your partner has been cheating on you. TV is an STI, which means it is passed through unprotected sex. It is possible for the infection to be present for a long time without causing any symptoms, so it’s not always possible to know exactly when or from whom it was caught. However, it does mean that your ex-partner will also have the infection, even if he has no symptoms, and he will need treatment.”

Next Steps:

I am going to prescribe you a course of an antibiotic called Metronidazole (500 mg twice a day for 7 days). It’s really important you take all the tablets as prescribed and avoid drinking alcohol while you’re on them, as it can make you feel very sick. The most important thing is that your ex-partner also gets treated. If he doesn’t, he could pass the infection back to you or on to someone else. You should also avoid having sex until you have both completed treatment.”

We can help you with telling him. We have something called a ‘contact slip’ which you can give him. It’s a note that explains the diagnosis and advises him to attend a GUM clinic for treatment, without having your name on it. Alternatively, we can try to contact him for you, with your permission. I know it’s a difficult conversation, but it’s really important for his health and to stop the infection from spreading.

This infection doesn’t cause long-term harm or affect your future fertility as long as it’s treated properly. While you’re here, it would be a good opportunity to do a full screen for other STIs and to talk about contraception and safe sex for the future. You also mentioned you’ve never had a smear test; we can arrange that for you too.

Addressing ideas, concerns, and expectations: Break the news sensitively. Explain what TV is. Address her concerns about infidelity carefully, without making definitive accusations. Manage her expectation that she doesn’t have to tell her ex-partner.

Prescribe Metronidazole for the patient. Explain the critical importance of partner treatment and offer practical, confidential methods for contact tracing. Offer a full STI screen and cervical smear.

What is scenario testing? This case tests the candidate’s ability to break bad news, manage a patient’s emotional distress (anger, betrayal), and handle the complexities of partner notification for an STI. It requires a non-judgmental attitude, clear communication about treatment and public health responsibilities, and the ability to provide holistic sexual health advice.