CCE-CE-017

Case ID: UTI-STI-002
Case Name: Emily Dawson
Age: 22
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: U71 (Cystitis/urinary infection other), X34 (Sexually transmitted infection other)​

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Establishes a patient-centred approach
1.2 Uses active listening and questioning skills
1.4 Demonstrates empathy and sensitivity
2. Clinical Information Gathering and Interpretation2.1 Gathers a relevant and focused history
2.2 Identifies red flags and risk factors
3. Diagnosis, Decision-Making and Reasoning3.1 Formulates appropriate differential diagnoses
3.3 Considers common and serious conditions
4. Clinical Management and Therapeutic Reasoning4.1 Develops an evidence-based management plan
4.2 Uses shared decision-making in treatment options
5. Preventive and Population Health5.1 Identifies opportunities for STI and CST screening
5.3 Provides education on safe sexual practices
6. Professionalism6.2 Maintains patient confidentiality and professionalism
8. Procedural Skills8.1 Interprets relevant urine dipstick and pathology results
9. Managing Uncertainty9.1 Recognises when further investigation is needed

CASE FEATURES

  • Providing safe-sex education and discussing risk factors
  • Young female presenting with UTI symptoms
  • Hidden agenda: Concern about potential STI
  • Balancing confidentiality and patient-centred care
  • Importance of non-judgmental communication
  • Incorporating opportunistic STI screening

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face to face.

You are not required to perform an examination.

A patient record summary is provided for your information.

Perform the following tasks:

  1. Take an appropriate history
  2. Formulate a differential diagnosis.
  3. Discuss management options with the patient.
  4. Address the patient’s concerns.

SCENARIO

Emily Dawson, a 22-year-old university student, presents to the clinic complaining of dysuria, urinary frequency, and lower abdominal discomfort over the past three days. She describes a burning sensation when passing urine and a constant feeling of needing to urinate. She denies fever or back pain but mentions feeling a little “off.”

Emily attributes her symptoms to not drinking enough water but appears slightly uncomfortable when discussing her history.

PATIENT RECORD SUMMARY

Patient Details

Name: Emily Dawson
Age: 25
Gender: Female
Gender Assigned at Birth: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

None known

Medications

None

Past History

Nil significant

Social History

  • University student, studying law

Family History

  • No known significant illnesses

Smoking

  • Never smoked

Alcohol

  • Drinks socially (1-2 times per week, 2-3 standard drinks)

Vaccination and Preventative Activities

  • Childhood immunisations up to date

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

Opening Line:

“Hi Doctor, I think I might have a UTI. It’s been really uncomfortable when I pee, and I feel like I need to go all the time.”

General Information

(Freely Given if Asked Open-Ended Questions):

  • You first noticed the burning sensation three days ago.
  • You feel like you constantly need to urinate, but only pass small amounts each time.
  • You have some lower abdominal discomfort but no fever, back pain, or nausea.

Specific Information

(To Be Given Only If Asked Directly):

Background Information

  • You haven’t noticed any unusual vaginal discharge or odour.
  • You’re feeling a little bit run down lately, but you’re not sure if that’s related.
  • You think it could be from not drinking enough water because you’ve been busy with uni.

Urinary Symptoms:

  • The pain is sharp and burning, and it happens right at the end of urination.
  • You’ve been going to the toilet at least every 30-40 minutes, even at night.
  • You haven’t noticed any blood in your urine, but it does look slightly cloudy.
  • You haven’t had anything like this before.
  • You’ve tried drinking more water, but it hasn’t really helped.
  • You don’t feel feverish or shivery, and you haven’t had any back pain.

Sexual History

(Revealed Only If the Doctor Asks About It):

  • You had unprotected vaginal and oral sex with a new partner about a week ago.
  • You’ve had three sexual partners in the past six months.
  • Your partner hasn’t mentioned any symptoms, but you haven’t asked them directly.
  • You’ve never had an STI test before, but you’ve been meaning to get one.
  • You don’t usually use condoms unless your partner suggests it.
  • You’re not on any hormonal contraception; you usually just rely on condoms or the withdrawal method.
  • You had your first sexual experience at 18 and haven’t had any previous issues.
  • You’re worried about what an STI test involves—“Is it painful?”
  • You feel a bit embarrassed asking for an STI check and didn’t know if it was something you could just ask for during a normal consult.

Menstrual and Gynaecological History:

  • Your periods are regular, about every 28 days, and you’re not due for another week.
  • You haven’t noticed any unusual vaginal discharge, itching, or odour.
  • No abnormal bleeding between periods or after sex.
  • You’ve never had a Pap smear before but know you should get one soon.

Patient’s Concerns and Expectations:

  • You think you have a UTI, but you’re also wondering if it could be an STI.
  • You’re feeling embarrassed about asking for an STI test, but you know it’s probably a good idea.
  • You’re worried about confidentiality—“If I get tested, will anyone else find out? Will it go on my record?”
  • You don’t want to have to tell your partner unless you have to.
  • You’re unsure whether you really need antibiotics and are wondering if it will go away on its own.
  • You’re concerned about whether it’s safe to have sex while you have these symptoms.

Emotional and Behavioural Cues:

  • Initially, you seem a bit embarrassed and hesitant to talk about the possibility of an STI.
  • You look down or fidget when discussing your sexual history.
  • If the doctor reassures you and normalises the conversation, you relax and become more open.
  • You seem relieved when the doctor explains confidentiality.
  • You may laugh nervously or make self-deprecating jokes to deflect embarrassment.
  • You appear slightly anxious when asking about what an STI test involves.

Potential Questions for the Candidate:

  1. “Could this actually be an STI instead of a UTI?”
  2. “How do you test for STIs? Is it painful?”
  3. “Do I have to tell my partner if I have an STI?”
  4. “Will this go away if I just drink lots of water?”
  5. “Can I still have sex while I have this?”
  6. “If I get tested, will anyone else find out? What if my parents somehow see it on my Medicare record?”
  7. “What happens if I do have an STI? Does it mean my partner cheated on me?”
  8. “If I get an STI test today, when will I get the results?”
  9. “Do you think I should get a Pap smear while I’m here?”
  10. “How do I stop this from happening again?”

Additional Notes for Role-Player:

  • If the doctor asks about your feelings regarding the STI test, express that you’re worried about the stigma and nervous about the process.
  • If the doctor doesn’t bring up STI screening, continue focusing on your UTI symptoms but drop subtle hints like:
    • “I don’t usually get sick like this. Could it be something else?”
    • “I was reading online, and it said that some STIs can have no symptoms.”
  • If the doctor brushes off the STI concern, persist slightly but remain hesitant, saying something like:
    • “I just want to be sure… I’ve never been tested before.”
  • If the doctor provides reassurance and clear explanations, express relief and gratitude.
  • If the doctor is judgmental or dismissive, act more withdrawn and hesitant to disclose further information.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including risk factors for STIs and UTIs.

The competent candidate should:

  • Use open-ended questions to establish rapport and gather a detailed history.
  • Elicit UTI-related symptoms, including dysuria, urinary urgency, frequency, haematuria, and suprapubic pain.
  • Inquire about systemic symptoms (fever, flank pain) to assess for pyelonephritis.
  • Explore hydration status, recent antibiotic use, and previous UTI history.
  • Perform a sexual health history using a sensitive, non-judgmental approach:
    • Last sexual encounter (timing, partner details).
    • Number of partners in the past six months.
    • Use of barrier protection.
    • Any previous STIs.
    • Partner symptoms (urethral discharge, dysuria, genital ulcers).
  • Assess for gynaecological symptoms, including vaginal discharge, abnormal bleeding, or dyspareunia, which may indicate an STI or another pelvic pathology.
  • Address patient concerns by exploring her hidden agenda regarding STI testing.

Task 2: Formulate a differential diagnosis and explain your reasoning.

The competent candidate should:

  • List UTI (cystitis) as the most likely diagnosis based on dysuria, frequency, and urgency.
  • Consider differentials:
    • STI-related urethritis (Chlamydia, Gonorrhoea)—risk factors include unprotected sex, multiple partners.
    • Vaginitis (Candida, Bacterial Vaginosis, Trichomoniasis)—if there is abnormal discharge, odour, or itching.
    • Pelvic inflammatory disease (PID)—if associated with pelvic pain, fever, or dyspareunia.
    • Interstitial cystitis—if recurrent dysuria without infection.
  • Justify the need for urine dipstick, microscopy and culture, and STI screening (first-void urine NAAT and high vaginal swab if indicated).

Task 3: Discuss management options with the patient, including treatment and follow-up.

The competent candidate should:

  • UTI Management:
    • Empirical antibiotics (trimethoprim or nitrofurantoin, as per Therapeutic Guidelines Australia).
    • Analgesia options include paracetamol and urinary alkalinisers.
    • Increase fluid intake and voiding post-intercourse to reduce recurrence.
  • STI Considerations:
    • If STI is suspected, treat empirically for Chlamydia (azithromycin or doxycycline).
    • Offer contact tracing and partner notification.
    • Discuss safe sex practices and the importance of condom use.
  • Arrange follow-up in 48 hours if symptoms persist or if urine culture/STI results require modification of treatment.
  • Reinforce confidentiality and provide reassurance regarding stigma and privacy.
  • Opportunistically suggest Cervical Screening and explain
    • Self-collection in the first instance
    • A low probability that a formal speculum sample will be required if HPV is detected
      • Detection of 16/18 HPV -> Colposcopy
      • Detection of non-16/18 -> formal collection for LBC

Task 4: Address the patient’s concerns in a sensitive and non-judgmental manner.

The competent candidate should:

  • Acknowledge the patient’s embarrassment and concerns about confidentiality.
  • Normalise STI screening as a routine part of healthcare.
  • Provide clear and factual information about UTIs and STIs, correcting misconceptions.
  • Offer supportive and non-judgmental discussion regarding safe sexual practices.
  • Allow the patient to express any further concerns and provide reassurance.

SUMMARY OF A COMPETENT ANSWER

  • Takes a detailed UTI and STI-focused history, including sexual health risk factors.
  • Provides a well-reasoned differential diagnosis, considering both infectious and non-infectious causes.
  • Explains management clearly, including appropriate antibiotic therapy, STI screening, and partner notification.
  • Addresses patient concerns empathetically, normalising STI screening and ensuring confidentiality.
  • Uses patient-centred communication, engaging in shared decision-making.

PITFALLS

  • Failing to explore STI risk factors, missing the hidden agenda.
  • Overlooking alternative diagnoses like PID or interstitial cystitis.
  • Not offering STI testing despite risk factors.
  • Providing incorrect or incomplete treatment, such as using an inappropriate antibiotic.
  • Failing to address patient concerns, particularly around stigma and confidentiality.
  • Not arranging appropriate follow-up, particularly for STI results and unresolved symptoms.

REFERENCES

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations of healthcare and the full impact of their illness experience on their lives.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers a relevant and focused history.
2.2 Identifies red flags and risk factors.

3. Diagnosis, Decision-Making and Reasoning

3.1 Formulates appropriate differential diagnoses.
3.3 Considers common and serious conditions.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan.
4.2 Uses shared decision-making in treatment options.

5. Preventive and Population Health

5.1 Identifies opportunities for STI screening.
5.3 Provides education on safe sexual practices.

6. Professionalism

6.2 Maintains patient confidentiality and professionalism.

8. Procedural Skills

8.1 Interprets relevant urine dipstick and pathology results.

9. Managing Uncertainty

9.1 Recognises when further investigation is needed.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD