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STI testing with dysuria — DFSRH MCQ

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ModerateSTI diagnosis and managementSTI testing with dysuriaDFSRH

A 19-year-old woman attends with dysuria and intermenstrual bleeding after a new partner. Urine dipstick shows trace leucocytes, pregnancy test is negative, and pelvic examination shows no tenderness. What is the most appropriate investigation?

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Correct answer: A — Vulvovaginal NAAT for chlamydia and gonorrhoea

The sexual history and intermenstrual bleeding make STI NAAT testing the best investigation, even with urinary symptoms. A urine culture alone can miss cervicitis, and cervical screening is not used to investigate acute STI risk. Progesterone and MRI do not address the likely cause. The pearl is that chlamydia can mimic cystitis in young sexually active patients.

Reference: BASHH Guidelines; NICE CKS: Chlamydia