Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Provide confidential, non-judgemental contraception and sexually transmitted infection care for young people, exclude urgent pregnancy or infection complications, assess competence and coercion, choose effective methods with current eligibility guidance, and secure treatment, partner and safeguarding follow-through.
Young people should be able to access respectful sexual-health care without assumptions about identity, behaviour or parental support. Begin privately, outline confidentiality and ask what outcome matters today. Assess decision-specific competence and whether sexual activity is consensual. For someone under 16 seeking contraception, explore understanding of advice, likely continuation of sexual activity, ability to involve a parent or trusted adult and physical or mental welfare; these Fraser considerations support care but do not replace a full safeguarding assessment. Age alone, a partner's age alone or a single checklist cannot settle safety.
Contraceptive choice is shared and non-directive. Explain typical-use effectiveness, duration, bleeding changes, privacy, procedure, reversibility, effect on acne or pain, interactions and practical access. Intrauterine contraception and the implant offer high effectiveness without daily action, but declining them must not become a barrier to pills, injection, condoms or continued counselling. Apply current UKMEC to migraine with aura, thrombosis risk, hypertension, medicines, liver disease, postpartum state and other relevant conditions. Check blood pressure before combined hormonal contraception and body mass index where it changes eligibility; intimate examination is not required for most non-intrauterine methods.
The young person identifies the relative importance of effectiveness, bleeding control, privacy, daily action, procedure avoidance and rapid return to fertility.
Lower abdominal pain, deep dyspareunia, abnormal bleeding or discharge with pelvic tenderness raises concern and treatment should not await every result.
Pressure, fear, a power imbalance, gifts, accommodation, drugs, threats, online control or inability to negotiate condoms indicates a safeguarding need.
New severe neurological, chest, leg or abdominal symptoms, pregnancy concern, missing intrauterine threads or significant infection symptoms require targeted urgent review.
Recent high-risk exposure, ongoing partner risk or repeated emergency presentations should trigger timely PEP or PrEP pathway assessment and baseline testing.
Confirm interaction and weight guidance, explain that later intercourse is not covered, provide immediate ongoing-method advice and a timed pregnancy test, and refer pain or abnormal bleeding urgently.
Review severe asthma treated with oral glucocorticoids, breastfeeding advice, enzyme inducers and recent progestogen exposure; explain the five-day hormonal-method delay and arrange a pregnancy test.
Long-acting methods should be available and explained, but reproductive autonomy includes choosing, declining or removing a method without punitive barriers.
A negative urine sample cannot exclude pharyngeal or rectal infection after exposure at those sites.
They reduce infection transmission even when another method provides much stronger pregnancy prevention, so dual-method discussion remains useful.
Before sampling, agree whether a voicemail, text, portal notification or clinic name could expose the young person or trigger harm.
Frequent emergency contraception or infection does not justify judgement; it prompts method-access, coercion, partner, HIV prevention and safeguarding review.
Requiring parental permission automatically before offering a competent young person contraception or STI testing.
Offering only long-acting contraception or making STI care conditional on accepting a contraceptive method.
Testing urine alone despite oral or anal exposure and then providing false reassurance about infection at other sites.
Giving oral emergency contraception without explaining ongoing contraception, later intercourse, vomiting and the pregnancy-test date.
Treating an STI but failing to communicate the result, arrange partner notification or address reinfection and safeguarding.
Assuming reported condom use excludes pregnancy, infection, coercion or a method failure requiring assessment.
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A competent 17-year-old presents after unprotected intercourse and wants the most effective emergency contraception plus ongoing contraception. There is no contraindication. Which option should be offered?
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Emergency contraception is time dependent. A copper intrauterine device is the most effective method and can provide ongoing contraception when inserted within the eligible interval after unprotected intercourse or estimated ovulation. Ulipristal acetate and levonorgestrel are oral alternatives selected according to timing and individual factors. Hormonal contraception start or restart timing differs after ulipristal because immediate progestogen can reduce its effect; provide condoms or abstinence advice and a pregnancy-test date. Oral emergency contraception does not protect later intercourse in the same cycle.
STI testing follows anatomy, exposure and time. Chlamydia and gonorrhoea NAAT samples may include urine or self-taken vaginal, rectal and pharyngeal specimens; blood tests assess HIV, syphilis and hepatitis when indicated. Explain window periods and that a test from one site does not exclude infection elsewhere. Symptoms such as pelvic pain, testicular pain, ulcers or systemic illness require examination and urgent pathways. Vaccination, including HPV and hepatitis B for eligible risk groups, and HIV pre-exposure or post-exposure prophylaxis assessment are part of prevention, not optional extras after testing.
Close the loop. Agree how results can safely be communicated, whether messages may name the clinic, and what happens if contact fails. Treat under the current guideline and check allergy, pregnancy and interactions. Partner notification can be patient-led or supported by the sexual-health service without disclosing the index patient unnecessarily. Arrange retesting when recommended, complete vaccination, review contraception after emergency use and revisit safety because disclosure of coercion may occur only after rapport develops.