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Practice case P2-05 · Face-to-face · simulated patient

A positive swab result at the sexual health clinic

A 28-year-old woman returns for her swab results. One is positive.

Reviewed and kept current

Station family: Explaining a result / partner notification · 8-minute station · 1 min 30 s reading · Last editorial review: 19 September 2026.

Candidate instructions

Read this as you would outside the room

You have 1 minute 30 seconds to read, then 8 minutes. Candidates: everything below this section is folded away — leave it closed until you have finished the station.

	Information
Your role	Foundation Year 2 doctor in an integrated sexual health clinic. A health adviser and a nurse are available in the clinic.
Patient	Ms Chloe Bennett, 28, retail supervisor
Background	Attended five days ago with a week of yellow vaginal discharge and stinging on passing urine. Self-taken vulvovaginal swab and bloods were sent. She was asked to return for the results.
Results in front of you	Vulvovaginal NAAT: Neisseria gonorrhoeae detected (confirmed on a second target). Chlamydia trachomatis not detected. HIV and syphilis serology negative. Urine pregnancy test (five days ago) negative. No culture has been taken yet.
Records	Combined oral contraceptive pill. No other medication. Allergy recorded: penicillin — no details.

Your task

•

Take the brief, focused history you need before treatment is given.

•

Explain the result to Ms Bennett.

•

Discuss treatment and what she needs to do afterwards.

•

Discuss partner notification.

•

Address her concerns. You are not required to examine her.

Folded away

For the actor and the examiner

1 · Actor script — role player only

Candidates: do not open until you have consulted.

Persona and manner

Chloe Bennett, 28, retail supervisor. With your boyfriend Ryan for six months. You live with your parents.
Embarrassed and on edge, arms folded. When you are frightened it comes out as anger.

Opening line — say this verbatim

“Just tell me — is it bad news?”

Volunteer freely if given the space

The discharge and the stinging are still there — about two weeks now.
You have never had anything like this before. You have never had a sexual health test before this one.

Only if asked

Sex: vaginal and oral sex with Ryan; no condoms since you started the pill four months ago. No anal sex.
Other partners in the last three months: one — your ex, Jamie, once, about ten weeks ago after a night out. No condom. Ryan does not know. (Disclose this only if asked about other partners without judgement, or if invited to add anything.)
No partners from abroad and you have not travelled.
No lower tummy or pelvic pain, no pain deep inside during sex, no bleeding between periods or after sex, no fever, no sore throat, no joint pains or rash.
Last period two weeks ago, on time. You take the pill reliably.
The penicillin allergy: “I came out in a rash when I was about seven. No swelling, no trouble breathing, I’ve never been in hospital with it.”
Ryan has no symptoms that you know of.
Your smear test is up to date.

Impact on daily life — home and work (only if asked)

You have been making excuses to avoid sex with Ryan for two weeks and he has noticed.
You cannot concentrate at work; you have been snappy with your team.
You live with your parents and are terrified a letter or a text from the clinic will turn up at home.

Ideas, concerns and expectations

Idea: thrush, or a urine infection.
Concerns: “Has he cheated on me?” “Will my mum find out — she works at my GP surgery.” “Can I still have children?”
Expectation: a course of tablets, and for nobody to know.

Cues to deliver, timed

If you have not been told the result by minute 2: “Please — just tell me what it shows.”
When you hear the word gonorrhoea: shocked silence, then angry — “So he’s cheated on me.”
Minute 3–4: “Does this go on my record? My mum works at my doctor’s.”
When an injection is mentioned: “A needle? Can’t I just have tablets?”
If partner notification is put as an order: “You can’t make me tell anyone.” — name Jamie only if he has already come up.

If the doctor summarises and asks whether you want to add anything

If Jamie has not come up: look at the floor — “There is something. My ex — Jamie. It was only the once.”
If he has: “Will you have to tell Ryan about Jamie?”

How to respond to the doctor

If the doctor explains that nobody can say who gave it to whom, or when — because many people carry it for weeks or months with no symptoms — you calm down.
If the doctor explains confidentiality in concrete terms (clinic records are separate from your GP record; your GP is not told without your consent; no letters home; texts only if you agree; partners can be told anonymously by the health adviser without your name being given): visibly relieved. You agree to tell Ryan yourself and to let the clinic contact Jamie anonymously.
If told “you must tell all your partners — it’s the law”: “Is it? Then I’m leaving.”
If the doctor explains why the injection is the recommended treatment and that your childhood rash does not rule it out: you accept it.
If the doctor does not mention avoiding sex, ask: “So once I’ve had the injection I’m clear — that’s it?”
If fertility is explained honestly — treated promptly, it is very unlikely to have done harm; the risk comes from leaving it untreated: “OK. That’s what I really needed to know.”

Do not

Volunteer Jamie unless asked about other partners in the last three months or invited to add anything.
Report pelvic pain, fever or bleeding — you have none.

2 · Examiner mark sheet — generic scheme plus the key facts for this case

Domain marks — with the key facts that earn a 4 at this station

Domain (GMC wording) · key facts for this case	1	2	3	4	Score
1 · Data gathering, technical and assessment skills Confirms identity and privacy; finds out what she is expecting from today Sexual history without judgement: partners in the last 3 months, sites of exposure, condom use, contraception and pregnancy risk, travel Red flags: pelvic pain, deep dyspareunia, intermenstrual or post-coital bleeding, fever (PID); joint pain or rash (disseminated infection) ICE — blame, secrecy, fertility — and impact on her relationship, home and work; clarifies what the “penicillin allergy” actually was	☐	☐	☐	☐	/4
2 · Clinical management skills Recap and check, then the diagnosis in plain words: gonorrhoea — confirmed, fits her symptoms, easily cured; thrush, urine infection and chlamydia excluded, and why Today: culture and throat swabs first, then ceftriaxone 1 g IM once — safe because her penicillin reaction was a mild childhood rash, not anaphylaxis No sex at all until 7 days after she and her partner(s) are treated; partners from the last 3 months notified — by her or anonymously via the health adviser Safety-net: pelvic pain, fever, pain during sex or abnormal bleeding → clinic the same day (NHS 111 out of hours); not settling in a few days → review · Follow-up: test of cure at 2 weeks; health adviser call about partners; repeat HIV and syphilis tests after the window period	☐	☐	☐	☐	/4
3 · Interpersonal skills Unembarrassed, non-judgemental language; normalises Handles anger and blame honestly — nobody can say who infected whom, or when Confidentiality made concrete: separate records, GP not told without consent, nothing sent home Negotiates partner notification rather than ordering it; checks understanding	☐	☐	☐	☐	/4
Station total					/12

Examiner's overall judgement (standard-setting only — it does not decide your result): ☐ Unsatisfactory ☐ Borderline ☐ Satisfactory ☐ Good

Marks are 1 to 4 in each domain; the generic descriptor for each mark is on the mark scheme page, and the structure of the eight minutes is on the 8-minute station page. The full standard for this case is in section 3 and the GMC feedback statements, with examples from this case, are in section 4.

3 · Expanded station-specific marking standard — what earns 4, 3, 2 and 1 here

The top row is the full picture of what a competent F2 could do at this station, including the working diagnosis with its justified differentials, the safety-net and the follow-up; lower rows describe how performance falls away. It is a debriefing aid, not a checklist to recite: nobody says every line in eight minutes, and a 4 is a judgement that the essentials — the italic key facts on the mark sheet — were done well, in plain language and at the patient’s pace. Acumen training standard — the GMC does not publish station mark sheets.

Mark	Domain 1 · Data gathering, technical and assessment skills	Domain 2 · Clinical management skills	Domain 3 · Interpersonal skills
4	Confirms identity and that the room is private; asks what she is expecting from today before giving the result Sexual history taken matter-of-factly: number of partners in the last three months, type of sex and sites of exposure, condom use, contraception, last period and pregnancy risk, partners from or travel abroad Red flags for complicated infection: lower abdominal or pelvic pain, deep dyspareunia, intermenstrual or post-coital bleeding, fever (pelvic inflammatory disease); joint pain or rash (disseminated infection) Clarifies the recorded penicillin allergy — what happened, how old she was, any swelling, breathing difficulty or hospital admission ICE: thought it was thrush or a urine infection; fears he has cheated, that her mother and GP will find out, that her fertility is damaged; expects tablets and secrecy Impact on daily living: avoiding sex with Ryan, distracted at work, living with her parents and fearing post or texts from the clinic	Summarises why she came and what was tested, and checks whether she wants to add anything Working diagnosis with justified differentials: gonorrhoea — a confirmed positive test that fits two weeks of discharge and stinging. Thrush would cause itching and a white discharge and would not give a positive test; a urine infection would not cause discharge; chlamydia was looked for and is negative; there are no features to suggest the infection has spread to the womb and tubes Before treatment: a swab for culture (antibiotic sensitivities) and a throat swab, because throat infection is usually silent Treatment: ceftriaxone 1 g by intramuscular injection, once, today — explains why an injection; her childhood rash with penicillin is not a reason to avoid it; checks with a senior if any doubt No sex at all — including oral sex and sex with condoms — until seven days after she and her partner(s) have been treated Partner notification: all partners in the last three months (Ryan and Jamie) need testing; she can tell them herself or the health adviser can do it without naming her; it is strongly advised, not a legal duty Honest answers to her questions: treated promptly, fertility is very unlikely to be affected; condoms and future testing Safety-net: lower abdominal or pelvic pain, fever, pain during sex, bleeding between periods, a painful swollen joint or a rash → contact the clinic the same day (out of hours: NHS 111); symptoms not settling within a few days, or sex with an untreated partner → return for review and re-testing. Follow-up: test-of-cure NAAT booked for two weeks after treatment (BASHH still recommends it when antibiotic sensitivity is not yet known — the clinic will cancel it only if the culture shows a ceftriaxone-sensitive infection, her throat swab is negative and her symptoms have gone); the health adviser telephones, on the number and at the time she chooses, to confirm Ryan and Jamie have been reached; results by text only with her consent; repeat HIV test 45 days, and syphilis serology three months, after her last unprotected sex; condoms discussed.	Matter-of-fact, unembarrassed language; normalises (“this is one of the commonest infections we see”) Stays calm when she is angry; is honest that nobody can tell who infected whom, or when Explains confidentiality in concrete terms: separate clinic record, GP not informed without consent, no post to her home, texts only with consent Negotiates partner notification — offers options — rather than issuing an instruction Responds to the fertility fear directly and honestly Checks understanding: asks her to say what she will do this week
3	Sexual history and ICE elicited; one of the PID screen, the allergy detail or the impact on home and work missing.	Correct diagnosis, treatment and abstinence advice; partner notification covered; one of culture/throat swab, the allergy reasoning, the specific safety-net or the test-of-cure plan missing.	Non-judgemental and clear; one concern (blame, secrecy or fertility) not fully addressed.
2	Partial sexual history (current partner only); red flags not screened; concerns picked up only when she raises them.	Treatment correct but partner notification vague or limited to the current partner; no abstinence advice; no reasoning about other causes; follow-up vague.	Polite but clinical; answers “did he cheat?” with a guess or avoids it; confidentiality stated but not explained.
1	Gives the result with almost no history; no look-back period; judgemental or embarrassed questioning. Or unsafe: no relevant history; or allergy not checked before treatment is offered.	Outdated or wrong treatment (oral tablets alone, or “ceftriaxone plus azithromycin”); no partner notification; no safety-net. Or unsafe: withholds ceftriaxone solely because the notes say “penicillin allergy” and offers nothing effective; breaches or threatens to breach confidentiality (“we will have to tell your GP / your partner”); tells her she is legally obliged to inform partners.	Judgemental tone or visible embarrassment; lectures about condoms. Or unsafe: moralising, or discloses / threatens to disclose without consent.

4 · GMC feedback statements — where underperformance was identified — with case-specific examples

A feedback statement marks where underperformance was identified in the consultation. With PLAB 2 results the GMC may attach any combination of the ten statements to a station — none, one or several. The right-hand column shows what each one looks like at this station. Record the statements that applied in the practice log.

GMC feedback statement	Underperformance it signals (generic)	Case-specific examples
1 · Consultation	Disorganised or unstructured consultation	Blurts the result with no warning or check of what she expects — or withholds it through a full sexual history while she keeps asking “is it bad news?”; partner notification squeezed into the last seconds.
2 · Issues	Key issues or priorities not recognised	Treats it as “give an antibiotic and go” — misses that the station is about partner notification, abstinence and confidentiality as much as the injection.
3 · Time	Poor time management	A long, detailed sexual and gynaecological history; treatment and partner notification reached only as the bell goes.
4 · Findings	Abnormal findings or results, or their implications, not identified	Does not notice that no culture has been taken, that the throat has not been tested, or that “penicillin allergy — no details” must be clarified before ceftriaxone.
5 · Examination	Physical examination or use of instruments not competent	No examination is required — but fails to ask the questions that would show whether she needs one today (pelvic pain, fever, deep dyspareunia, bleeding).
6 · Diagnosis	Working diagnosis or differential diagnoses not correct	Calls it “an infection” without naming gonorrhoea; or cannot explain why this is not thrush or a urine infection; does not consider pelvic inflammatory disease.
7 · Management	Management plan not reflecting current best practice	“Ceftriaxone plus azithromycin”, or oral tablets alone; ceftriaxone refused because of a childhood rash; no advice to avoid sex for seven days; only the current partner mentioned; no test-of-cure plan; no safety-net for pelvic pain or fever.
8 · Rapport	Rapport and sensitivity to the patient’s feelings and concerns not shown	Visible embarrassment; “you really should have used condoms”; no response to “has he cheated on me?” or to her fear about fertility.
9 · Listening	Verbal and non-verbal cues not used; poor active listening	Misses “my mum works at my GP surgery”; misses the hesitation that signals another partner; does not offer the chance to add anything.
10 · Language	Language or explanations not understandable; understanding not checked	“You have a positive NAAT for GC; we’ll give IM ceftriaxone, do PN with a three-month look-back and a TOC” — no plain-English version and no check of what she has understood.

5 · Examiner points of fact and guidelines

Points of fact the examiner should have to hand

BASHH 2025: first-line treatment for uncomplicated anogenital and pharyngeal gonorrhoea is ceftriaxone 1 g intramuscularly as a single dose. Dual therapy with azithromycin is no longer recommended.
Everyone with gonorrhoea should have a culture for antibiotic sensitivities before treatment, and BASHH 2025 now recommends pharyngeal testing for everyone with urogenital gonorrhoea.
Penicillin allergy: third-generation cephalosporins show negligible cross-allergy. Ceftriaxone is suitable unless there is a history of severe hypersensitivity (for example anaphylaxis) to any beta-lactam (BASHH 2025).
Advise no sexual intercourse until seven days after the patient and partner(s) have completed treatment.
Partner notification look-back: all partners in the preceding three months (two weeks before symptom onset applies only to symptomatic penile urethral infection). Contacts seen within 14 days of exposure may be offered treatment on epidemiological grounds; after 14 days, treat on a positive test.
Test of cure is no longer routine after ceftriaxone for a ceftriaxone-sensitive anogenital infection, but is still recommended when sensitivity is unknown, for pharyngeal infection, persistent symptoms, any other regimen, or pregnancy — by NAAT at least two weeks after treatment (BASHH 2025).
About half of women with cervical infection have no symptoms; over 90% of men with urethral infection do, usually within two to five days; throat and rectal infection is usually silent. “I cannot tell you who gave it to whom, or when” is the accurate answer.
Untreated infection can ascend: pelvic inflammatory disease was reported in about 14% of women with gonorrhoea in one UK clinic study, with later risks of ectopic pregnancy and infertility. Treated promptly, fertility is very unlikely to be affected.
Sexual health clinics hold records separately from the GP record and do not inform the GP without consent. There is no legal duty on a patient to notify partners. GMC guidance permits disclosure to a sexual contact only in limited circumstances to protect them from serious harm, after trying to persuade the patient — in practice this concerns infections such as HIV.
Chlamydia, HIV and syphilis tests have been done, but her negative blood tests do not cover recent exposure: a fourth-generation HIV test is conclusive 45 days after the last risk, and syphilis serology at three months — book repeat tests then (BHIVA/BASHH/BIA HIV testing guidelines 2020; BASHH syphilis guideline 2024). Discuss hepatitis B vaccination and condoms according to risk.

Where candidates lose marks at this station

“You must tell all your partners — it’s the law.”
Answering “did he cheat on me?” with a guess.
Forgetting the culture and the throat swab before the injection.
Refusing ceftriaxone because the notes say “penicillin allergy”.
No mention of avoiding sex for seven days — including oral sex.

Guidelines for this station

6 · MLA content map tags for this case

MLA content map	This station
Domain 1 · Areas of clinical practice	Sexual health · Infection
Domain 3 · Clinical and professional capabilities	Communication with patients, relatives and carers · Capacity, consent and confidentiality · Safe prescribing · Health promotion and disease prevention
Domain 5 · Patient presentations	Vaginal discharge · Urinary symptoms
Domain 6 · Conditions	Gonorrhoea · Pelvic inflammatory disease
Station family	Explanation, counselling and breaking bad news — Explaining a result / partner notification

7 · My marks and reflection — practice log form

Record your three domain marks, your station total, the GMC feedback statements that applied (where underperformance was identified), and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.

Record my marks and reflection for P2-05

Revision link for this case: acumenprimarycare.com/plab-2-osce/case-05-positive-swab-result

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Independence & scope. Independent, formative training material from MD Acumen Ltd. Not affiliated with, endorsed by, or delivered on behalf of the General Medical Council. The GMC does not publish its station mark sheets: every mark scheme and descriptor on these pages is an Acumen training tool calibrated to the GMC's published marking domains, feedback statements and the MLA content map. Practice scores are not a prediction of examination performance. Clinical content reflects UK guidance at the date of editorial review — always check the current guideline. All patients are fictional.

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