The Teenager Who Asks You Not to Tell Her Mother

Handling the confidential request:

• Assess capacity. She is 16, articulate, and understands the implications of testing. In a jurisdiction that permits minors to consent to confidential sexual health services, she can consent to testing and to confidentiality for those services.
• Be clear about the limits of confidentiality up front. Explain that her sexual health information will be kept private, but that there are limits: if you believe she is at risk of serious harm, or if a reportable situation arises, you may need to act. Do not promise absolute secrecy you cannot guarantee.
• Offer the appropriate testing - a urine or self-collected vaginal swab for NAAT for chlamydia and gonorrhea, and discuss HIV and syphilis testing, pregnancy testing, and vaccination status (including HPV and hepatitis B).
• Discuss safe sex practices and offer condoms and emergency contraception information.
• Confirm how she wants to receive results and ensure the method is private (a mobile phone she controls, not a shared family account). Verify that the number is hers alone.

When the mother returns:

• Do not disclose. A neutral, truthful statement that protects confidentiality: "We've completed the examination and I've discussed some private health matters with your daughter. Those details are confidential, but I can tell you that she is well and I've given her some information to review."
• Do not lie. Avoid saying "everything is fine" if it implies no concerns; instead, redirect to what can be shared.
• Offer the mother a general conversation about adolescent health, and give the daughter the opportunity to decide what she wants to share.
• Document the confidentiality discussion, the limits explained, the tests ordered, and the conversation with the mother.

Treatment:

• Treat the patient according to local guidelines (for example, a single dose of azithromycin or a seven-day course of doxycycline, depending on current guidance and pregnancy status). Confirm she is not pregnant before choosing doxycycline.
• Offer treatment for gonorrhea if testing is positive or if empiric treatment is indicated per guidelines, and test for other STIs including HIV and syphilis.
• Arrange a test of cure if recommended, and schedule a follow-up.

Partner notification:

• Discuss with the patient how her partner will be notified. Options include patient referral (she tells him), provider referral (the clinic notifies him without naming her), or a hybrid approach.
• Support her choice while emphasizing the importance of partner treatment to prevent reinfection.
• Do not notify her mother without her consent unless the jurisdiction requires it or there is a safeguarding concern.

Public health reporting:

• Chlamydia and gonorrhea are typically reportable to public health authorities in most jurisdictions. Explain this to her in advance so it is not a surprise, and explain that reports are usually de-identified and used for surveillance and partner services.
• Follow the specific legal requirements of the jurisdiction; if you are unsure, consult the local public health unit rather than guessing.

Safeguarding:

• Assess for coercion or abuse. A 16-year-old in a sexual relationship warrants a brief screen for exploitation, coercion, or an age gap that may indicate a legal issue. If concerns arise, follow safeguarding procedures, which may override confidentiality.
• Document the diagnosis, treatment, counselling, partner notification plan, and reporting actions.