I’d not seen Peter before. He worked as a carer for young adults with learning disabilities. Like many male patients, his medical file was very thin, and as I scrolled through the correspondence I could see his last contact with the NHS was an A+E attendance some years previously for a twisted ankle, sustained whilst playing football.

But I knew his wife reasonably well as she had consulted several time recently. She had explained they were keen to conceive, as they had no children. But she was worried that there might be an infertility problem. We had talked through all the usual stuff; attention to weight, stopping smoking, optimal sexual frequency and so on. She had read around the subject too and, at 38, she was concerned about running out of time.

The GMC’s Good Medical Practice 2013 states “Confidentiality is central to trust between doctors and patients. Without assurances about confidentiality, patients may be reluctant to seek medical attention or to give doctors the information they need in order to provide good care.”

Peter got straight to the point. He was worried about having contracted HIV. Over the last 3 years he had had numerous sexual partners, often involving prostitutes. He had heard rumours about one particular prostitute, who was a drug addict, being HIV positive.

I advised him that attending a specialist clinic was the best way of ensuring an accurate and speedy diagnosis of all potential STDs, not just HIV. But he was having none of it.

“Just do the tests, doctor. No way am I attending one of those clap clinics.”

I agreed and set about counselling him about the tests, especially the implications of both positive and negative results, and arranged follow up.

His screen for gonorrhoea, syphilis, chlamydia and hepatitis B were all negative. But he was HIV positive. We had a long follow up consultation about how to manage his HIV status. This of course included informing his wife (and any other sexual partners.)

“There is no way I can tell my wife. She would be devastated and it would destroy our marriage.” He went on “of course doctor this is all between just the two of us, isn’t it?”

If you were the doctor, how would you proceed?