CCFP priority topic 88 of 105
Sexually Transmitted Infections on the CCFP exam
8 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 22, 2026.
What the exam tests
Key features
The CFPC’s 8 key features for Sexually Transmitted Infections. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 8
Prevention talk
Use any visit with a patient who has sex, or soon may, to talk about safer sex, testing and harms.
CFPC skill Patient-centred approach, clinical reasoningPhase TreatmentSources Public Health Agency of Canada, Canadian Task Force on Preventive Health Care, Public Health Agency of Canada / NACI
On the exam
A 16-year-old comes in for acne and mentions a new partner. Expect a short menu (pick several from a list) of things to raise.
Pick what to raise at this visit.
Common mistakes
Treating the acne and leaving sex for another visit. Or a talk about condoms alone, with no test offered and no vaccine check.
Approach
- Raise sexual health yourself. Say you offer testing to everyone, so it feels routine.
- Many sexually transmitted infections (STIs) cause no symptoms. Left alone, they can do serious harm later. Say so plainly.
- Under 30 and has had oral, vaginal or anal sex: offer a chlamydia and gonorrhea test once a year.
- Check the human papillomavirus (HPV) vaccine. It is advised for everyone aged 9 to 26.
- Talk about condoms, and about privacy. Fear of others finding out keeps people from testing.
- Ongoing risk may mean testing more often.
Key feature 2 of 8
Hidden STI
When symptoms are vague, such as burning on urination, keep an STI on the list and test for it.
CFPC skill Selectivity, clinical reasoningPhase Hypothesis generation, investigationSources Public Health Agency of Canada, Canadian Task Force on Preventive Health Care, Public Health Agency of Canada 2025
On the exam
A woman has her third “bladder infection” this year, and her cultures grew nothing. Expect a short menu (pick several from a list) of questions and tests.
Pick the history and the tests.
Common mistakes
A third course of antibiotics for “cystitis” with no sexual history taken. A culture with no growth points away from a bladder infection, not away from an STI.
Approach
- Take a sexual history in anyone with burning, discharge, or vaginal symptoms that keep coming back.
- Ask about new partners, condom use and the type of sex. The answers pick the sites to test.
- Test for chlamydia and gonorrhea together, on one urine or swab sample.
- The gene test, a nucleic acid amplification test (NAAT), is the most sensitive test for chlamydia. Chlamydia culture is no longer routinely available in Canada.
- One STI found or suspected: screen for the others too. They share risks and often come together.
Key feature 3 of 8
Screen higher risk
Test people at higher risk who feel well, and give them ways to stay safe.
CFPC skill Clinical reasoning, patient-centred approachPhase Treatment, investigationSources Public Health Agency of Canada / NACI, Canadian Task Force on Preventive Health Care, Public Health Agency of Canada
On the exam
A 22-year-old man has had new partners since his last negative screen, and has no symptoms. Expect a short menu (pick several from a list) of tests and vaccines.
Pick the tests and vaccines today.
Common mistakes
A hepatitis B booster after a full school series. One HPV dose at 22, or three, which are for weak immune systems. Hepatitis A for sex with women alone.
Approach
- Offer hepatitis B vaccine if not already immune. Who: new partners without condoms, more than one partner in 6 months, a past STI, or men who have sex with men.
- A full hepatitis B series protects for the long term. Routine boosters are not advised when the immune system is normal.
- The Canadian Task Force on Preventive Health Care's yearly screen is for people at average risk. Higher risk follows public health advice, and may mean testing more often.
- Test the sites the patient exposes, as the history and risk call for: throat, genitals or rectum.
- HPV doses depend on age and the immune system. People living with HIV, the virus that attacks the immune system, get three doses. See the table below.
- Past HPV infection, warts or an abnormal Pap test are not reasons to skip the HPV vaccine.
- Hepatitis A vaccine is for men who have sex with men and people who use drugs, among others. Sex with women alone is not on the list.
| Who | Doses | Spacing |
|---|---|---|
| Age 9 to 20, normal immune system | 1 | A second dose may be considered, at least 24 weeks later |
| Age 21 to 26, normal immune system | 2 | At least 24 weeks apart |
| Age 27 and older, ongoing risk | 2, by shared decision | At least 24 weeks apart |
| Weak immune system or living with HIV, any age | 3 | At 0, 2 and 6 months |
Key feature 4 of 8
Treat before results
When risk is high and symptoms fit, treat at the visit instead of waiting for results.
CFPC skill Clinical reasoning, selectivityPhase TreatmentSources Public Health Agency of Canada
On the exam
A man has discharge from the penis a week after a new partner. Expect one best answer for what to do today.
Pick today's plan.
Common mistakes
Sending him home to wait for results. He may not come back, and he can pass it on meanwhile. Treating before taking any samples is wrong too.
Approach
- Take the samples first, then treat at the same visit.
- Do not wait when symptoms fit and risk is high, or when the patient may not come back.
- Cover the likely causes of the symptom pattern. Take the drug and dose from current Canadian treatment advice.
- Test for the other infections too. STIs share risks and often come together.
- Ask for no sex until the patient and partners are treated.
- Start partner care now, not after the result.
Key feature 5 of 8
Asked for a test
When someone asks to be tested, learn why, weigh the risk, and fit the advice to it.
CFPC skill Clinical reasoning, patient-centred approachPhase Hypothesis generation, treatment, history, diagnosisSources Public Health Agency of Canada
On the exam
A 22-year-old man asks for “the full panel”. His screen in August was negative. Expect a short menu (pick several from a list) of history questions.
Pick the questions that change the tests.
Common mistakes
A full lifetime sexual history, or questions on allergies, contraception or whether his family knows. None of these change which tests he needs today.
Approach
- Ask why now: a new partner, a partner's diagnosis, symptoms, or worry.
- Ask what has happened since the last negative test. Those exposures set today's tests.
- A recent negative result says nothing about exposures since it, and may miss very recent ones before it.
- Ask about the type of sex: oral, vaginal, anal. The answer picks the sites to sample, as the risk calls for.
- For HIV, counsel on its risk apart from other STIs: how it spreads and how to lower the risk.
- Fit the advice to the risk: condoms, vaccines, and testing more often if the risk goes on.
Key feature 6 of 8
Partners and public health
After a confirmed infection, arrange care for partners and bring in public health to reach them.
CFPC skill Clinical reasoningPhase Treatment, follow-up
On the exam
His chlamydia test is positive, and he will not tell his partners himself. Expect one best answer for partner care.
Pick the partner plan.
Common mistakes
Waiting until partners get symptoms, or dropping it to respect his privacy. Most partners feel nothing, and untreated partners infect him again.
Approach
- Report the infection to public health.
- Every recent partner needs testing and treatment, even with no symptoms.
- If he will not tell them, public health can notify partners without naming him.
- Handing him prescriptions for his partners still means he tells them himself. They also miss their own tests.
- Treat partners without waiting for their results.
- Plan a repeat test for him later, to catch a new infection.
Key feature 7 of 8
Right sample, right site
Choose and collect the right sample from each body site the patient has exposed.
CFPC skill Procedure skills, clinical reasoningPhase Investigation, physicalSources Public Health Agency of Canada, Canadian Task Force on Preventive Health Care, Public Health Agency of Canada 2025
On the exam
A man with no symptoms and several new partners reports oral and vaginal sex, no anal sex. Expect a short menu (pick several from a list) of samples.
Pick the samples to collect.
Common mistakes
Urine alone misses the throat. A Gram stain (a quick slide test) of urethral discharge needs discharge, and he has none. A rectal swab with no anal sex is not needed.
Approach
- Match sites to the history: throat for oral sex, genitals for vaginal sex, rectum for anal sex.
- Genital site: a urine sample or a vaginal swab. Either can be self-collected.
- Offer swabs patients take themselves. They make testing easier to accept.
- Run chlamydia and gonorrhea on one sample. A NAAT can find both from a single sample.
- Add blood tests, such as HIV and syphilis, as the risk calls for.
| Exposure | Sample | Know this |
|---|---|---|
| Oral sex | Throat swab, if the risk calls for it | Often no symptoms. Urine will not find it. |
| Vaginal or penile sex | Urine, or a vaginal swab | The patient can take the swab. |
| Receptive anal sex | Rectal swab | The patient can take the swab. |
Key feature 8 of 8
Negative test, strong story
When the story points hard at an STI, do not let one negative result end the search.
CFPC skill Selectivity, clinical reasoningPhase Diagnosis, investigationSources Public Health Agency of Canada
On the exam
A woman with pelvic pain and a new partner has a negative chlamydia and gonorrhea test. Expect one best answer for the next step.
Pick the next step.
Common mistakes
Calling it “not an STI” because the test came back negative. The sample may be from the wrong site, taken too soon, or simply missed it.
Approach
- Ask what the test could miss: a site not sampled, an exposure too recent, a sample poorly taken.
- Treat when the picture is strong, even with a negative result.
- Repeat the test, or test other sites, rather than closing the case.
- When you treat on suspicion, still bring in her partners.
Flashcards
Answer it first, then check.
KF 1Who should be offered a yearly chlamydia and gonorrhea screen?
People under 30 who have had sex, men included. Oral sex counts. Source: Canadian Task Force on Preventive Health Care
KF 2Burning on urination, a new partner, and a urine culture with no growth. Next test?
A chlamydia and gonorrhea test. Burning with a new partner can be an STI. Source: Public Health Agency of Canada
KF 3He finished hepatitis B shots in grade 6 and has new partners. Booster?
No. Routine boosters are not advised after a full series when the immune system is normal. Source: Public Health Agency of Canada / NACI
KF 3A healthy 22-year-old wants the HPV vaccine. How many doses?
Two, at least 24 weeks apart. One dose is for ages 9 to 20. Source: Public Health Agency of Canada / NACI
KF 5Negative screen in August, new partners since. What sets today's tests?
The exposures since that screen. The old result does not cover them.
KF 6Chlamydia, and he will not tell his partners. What now?
Ask public health to notify them. They do not give his name.
KF 7No symptoms, oral and vaginal sex only. Which samples?
A urine sample, and a throat swab if public health advice calls for it. No rectal swab without anal sex. Source: Public Health Agency of Canada
KF 8A strong story for an STI, but the test is negative. Is it ruled out?
No. Check for missed sites and early testing. Treat if suspicion stays high.
FAQ
Which screening advice does the exam follow: the Task Force or public health?
Both, for different people. The Task Force's yearly chlamydia and gonorrhea screen is for people under 30 at average risk. People at higher risk follow public health advice, and may test more often.
Do I need the lab result before I treat?
Not when symptoms fit and risk is high, or the patient may not return. Take the samples first. With mild symptoms and a patient who will come back, waiting is reasonable.
Does a past HPV infection or an abnormal Pap test mean no HPV vaccine?
No. The vaccine does not treat an infection that is already there. It still protects against the HPV types the person has not met yet.
Does oral sex count when deciding who to screen?
Yes. The Task Force counts oral, vaginal or anal sex. Oral sex can also call for a throat swab, by risk. A urine test cannot find a throat infection.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 22, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- STBBI screening and diagnostic testingPublic Health Agency of Canada
- Published prevention guidelinesCanadian Task Force on Preventive Health Care
- Canadian Immunization GuidePublic Health Agency of Canada / NACI
- Chlamydia and LGV guide: Screening and diagnostic testingPublic Health Agency of Canada · 2025