Female Age: 16

Background:

Candace, age 16, is healthy and extroverted. During a regular checkup, she avoids eye contact and is quiet. As is your policy, you speak with her alone for part of the checkup. You ask Candace’s mother to step into the reception area, which she does unwillingly.

Candace reports being sexually active and is worried about getting an infection. She denies any cramping or abdominal pain or any change in her discharge. You discuss available testing and potential treatments.

When you review condom use, Candace says she’s worried that her boyfriend is flirting with someone else. You confirm that Candace thinks her boyfriend has other sexual partners. You explain how that would increase her risks for infections that could cause health problems for her. Candace then admits that her boyfriend said he recently was treated for chlamydia and told her to get checked and treated. Candace wants to be tested, but refuses a pelvic exam today. She agrees to self-collect a wet prep and gonorrhea/chlamydia swab and allow blood work for HIV and syphilis. Her abdominal exam is benign. She does not want her mother to know about her situation.

After the checkup, Candace’s mother wants to come back to the exam room to discuss how her daughter is doing.