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Persistent unexplained postcoital bleeding in a woman aged under 25 — DFSRH MCQ

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EasyPostcoital BleedingPersistent unexplained postcoital bleeding in a woman aged under 25DFSRH

A 23-year-old woman attends a sexual and reproductive health clinic in England after three episodes of postcoital bleeding over the past 8 weeks. She has regular menstrual cycles, uses condoms and takes no hormonal contraception. She has received HPV vaccination. A urine pregnancy test is negative, and vulvovaginal NAATs for Chlamydia trachomatis and Neisseria gonorrhoeae are negative. Speculum examination shows a fully visualised, macroscopically normal cervix without ectropion, polyp, cervicitis, contact bleeding or suspicious features. Bimanual examination is normal. She asks whether she should have cervical screening early. Which is the most appropriate next management step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Refer for assessment by a gynaecologist experienced in cervical disease

Explanation lettering: B = shown as A · E = shown as B · A = shown as C · C = shown as D · D = shown as E

This patient has persistent postcoital bleeding for which pregnancy, genital infection, hormonal contraception and visible local cervical pathology have been excluded. Current NHS Cervical Screening Programme guidance states that people with postcoital bleeding unexplained by common causes are not suitable candidates for diagnostic cervical screening; they should be referred for examination by a gynaecologist experienced in cervical disease. Any subsequent symptomatic colposcopy is undertaken outside the screening programme. A is inappropriate because repeated unexplained bleeding should not simply be observed for a further 6 months once the initial assessment is unrevealing. B confuses screening with diagnosis: she is below the routine screening age, and cervical screening is not a diagnostic investigation for abnormal bleeding. C is excessive because urgent suspected-cancer referral is determined principally by a cervix whose appearance is suspicious or consistent with cervical cancer; her cervix is fully visualised and normal. E is inappropriate because NAATs are negative and there are no clinical signs of cervicitis. Empirical antimicrobial treatment would not address the need to investigate persistent unexplained bleeding.

Reference: NHS Cervical Screening Programme – Good practice guidance for sample takers (9 July 2025) — https://www.gov.uk/government/publications/nhs-cervical-screening-programme-good-practice-guidance-for-sample-takers/nhs-cervical-screening-programme-good-practice-guidance-for-sample-takers