SCA practice case · Video consultation
“I’ve got painful blisters and ulcers down below and I’m terrified — does this mean I’ll have it forever?”
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Lauren Hicks · 26 years · female
Setting
Video consultation, then a same-day face-to-face appointment for the chaperoned examination and swab — painful genital ulceration, first episode.
Past history
- No relevant history recorded
Medication
- None recorded
Allergies
Not recorded
Recent notes
No recent consultations.
Reason for contact
“Painful sores down below. Stings to pass urine.”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
A FIRST EPISODE of genital herpes (HSV) presents with PAINFUL grouped VESICLES progressing to shallow ULCERS on the genitals, DYSURIA, tender INGUINAL lymphadenopathy and flu-like SYSTEMIC symptoms — first episodes being more painful and systemic than recurrences — and should be distinguished from other causes of genital ulceration (other STIs, aphthous/Behçet’s, fixed drug eruption). Diagnosis is clinical after a chaperoned face-to-face examination, supported by an HSV SWAB/PCR from the base of a lesion (BASHH 2024), and GUM/sexual-health services should ideally be involved for confirmation, a FULL STI screen including HIV and syphilis, support with telling partners (BASHH 2024: partner notification is not required as a public health measure, but telling partners is recommended) and expert counselling. Treat promptly with an oral ANTIVIRAL without waiting for the swab (BASHH 2024: within 5 days of onset or while new lesions form; aciclovir 400 mg three times daily for 5 days preferred, valaciclovir/famciclovir alternatives, dose per BNF), most effective started EARLY in a first episode, plus symptomatic care (analgesia, saline bathing, topical anaesthetic for dysuria, fluids), warning about URINARY RETENTION from severe dysuria (occasionally needing admission/catheter — the suprapubic route is considered) and advising against sexual contact while lesions are present. Critically, lead with compassionate, DESTIGMATISING counselling: genital herpes is COMMON and MANAGEABLE, a lifelong infection (the virus persists) but with RECURRENCES that are usually MILDER and SHORTER and often less frequent over time, and it does NOT mean the patient is "dirty" or promiscuous — directly addressing shame and the "forever" fear. Counsel transmission and risk reduction (asymptomatic SHEDDING means transmission can occur without lesions; condoms reduce but do not eliminate risk; partner disclosure; SUPPRESSIVE antiviral therapy for frequent recurrences and to reduce transmission) and — after asking whether she could be pregnant now — the importance of disclosing a herpes history in any future PREGNANCY because of neonatal-herpes implications (BASHH/RCOG 2024). The hidden agenda is shame and fear about relationships and the future; the skill is accurate diagnosis and early antivirals AND compassionate destigmatising counselling with GUM involvement — not a brisk prescription.
The guidance behind it
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