This weeks case highlights the challenges with having conversations about additional blood work that is recommended for STI screening. We also discussed how to approach difficult conversations when a HIV screening test is positive.

You update the patient, privately, that her HIV screen was positive. She is tearful and asks you update her family. You do so and explain that you need to confirm the test results, which will take some time (1-2 days). In the meantime, you consulted ID who agree with your confirmatory testing and has reached out to schedule a follow-up appointment with family in the next 2 days. 

You discharge her with oral metronidazole for BV, acyclovir for presumed HSV gingivostomatitis. 

Confirmatory HIV testing is negative. Patient follows up in ID clinic, as scheduled, and does not require further treatment. She is not interested in PrEP at the time. 

The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.