Synopsis
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.
- Offer routine private time, explain confidentiality limits and assess competence, consent, coercion, exploitation and immediate safety without making access depend on parental attendance.
- Take a behaviour- and anatomy-based history covering last exposure, sites, condoms, contraception, pregnancy possibility, symptoms, partners, vaccination, previous infection and antimicrobial allergies.
- Use current UK Medical Eligibility Criteria and the young person's priorities to compare effectiveness, bleeding, privacy, reversibility, procedure, interactions and return to fertility.
- Long-acting reversible methods are highly effective and should be offered without pressure; condoms remain important for STI risk even when another contraceptive method is used.
- After unprotected intercourse, offer the copper intrauterine device as the most effective emergency contraception when suitable, or an oral method matched to timing, interactions, weight guidance and ongoing-method plan.
- Select NAAT and serology by anatomical exposure and window period; self-sampling can improve access, but symptoms or assault may require examination and clinician sampling.
- Treat confirmed or strongly suspected infection under current BASHH or local sexual-health protocols, arrange partner notification and retesting, and record who will communicate every result.
- Give clear advice about vomiting, missed pills, enzyme-inducing medicines, emergency help, pregnancy testing and method continuation or bridging; use a safe contact route.
Key red flags
Pain, shoulder-tip symptoms, bleeding, syncope or shock with pregnancy possibility requires urgent ectopic-pregnancy assessment regardless of reported contraception.
Fever, lower abdominal pain, cervical or adnexal tenderness, vomiting or pregnancy can indicate complicated pelvic infection needing urgent specialist care.
A large age or power imbalance, threats, inability to refuse, exchanged goods, intoxication, image-based abuse or controlling communications may indicate exploitation or assault.
Recent high-risk HIV exposure requires immediate specialist assessment because post-exposure prophylaxis is time critical and should not await routine test results.
Severe headache or neurological symptoms, chest pain, unilateral leg swelling or breathlessness during combined hormonal contraception requires urgent thrombotic assessment.
Investigation priorities
Identify current pregnancy before decisions where the result changes management.
Management branches
There is acute pain, pregnancy complication, sepsis, assault, HIV exposure or immediate exploitation concern.
- Stabilise medical needs and activate the relevant emergency, sexual-assault, HIV PEP or safeguarding pathway without avoidable delay.
- Explain confidential information sharing and preserve forensic choices while prioritising consented treatment and prevention of further harm.
- Offer time-critical emergency contraception, infection prophylaxis, vaccination or baseline testing when clinically indicated.
- Name the team responsible for results, follow-up, safety contact and partner or public-health actions.
The young person wants pregnancy prevention or menstrual benefit and no emergency precludes routine choice.
- Clarify priorities and compare all suitable methods using current UKMEC, effectiveness, bleeding, interactions, procedure and privacy.
- Assess pregnancy possibility and use quick-start or bridging principles with a clearly dated pregnancy test when criteria allow.
- Explain exact use, missed-dose or delayed-procedure advice, adverse warning symptoms and how condoms reduce STI transmission.
- Arrange insertion, supply or follow-up that does not create an avoidable gap and document a safe communication route.