From the Guidelines
A comprehensive physical exam for suspected sexually transmitted infections (STIs) should include a visual inspection of the external genitalia, pelvic examination for females, and urethral examination for males, as recommended by the most recent guidelines 1. When performing the physical exam, it is essential to begin by examining the skin for rashes, lesions, or warts that might indicate herpes, syphilis, or HPV.
- For females, a speculum exam should be performed to visualize the cervix and vaginal walls for discharge, inflammation, or cervical friability, as suggested by the American Academy of Pediatrics 1.
- Collect cervical and vaginal swabs for gonorrhea, chlamydia, and trichomoniasis testing.
- For males, examine the penis for discharge, lesions, or inflammation and milk the urethra to check for discharge.
- In all patients, palpate inguinal lymph nodes for enlargement or tenderness.
- Perform a bimanual exam in females to check for cervical motion tenderness or adnexal tenderness suggesting pelvic inflammatory disease.
- Examine the perianal area for warts, lesions, or discharge.
- For patients reporting oral or anal sex, inspect the oropharynx and perform anoscopy as indicated. It is crucial to maintain a non-judgmental approach and explain each step of the examination to ensure patient comfort and cooperation, as emphasized by the American Academy of Pediatrics 1. The physical exam components help identify visible signs of STIs, though many infections remain asymptomatic, making laboratory testing essential even with a normal physical exam, as noted in the 1993 sexually transmitted diseases treatment guidelines 1.
From the Research
Physical Exam Tests for Diagnosing Sexually Transmitted Infections (STIs)
To diagnose a possible STI, several physical exam tests should be performed, including:
- A thorough evaluation for otic, ophthalmic, and neurologic symptoms, especially in patients with syphilis 2
- Screening for syphilis, gonorrhea, and chlamydia, which can be performed using nucleic acid amplification tests or serology 3
- A cervical Papanicolaou test for women 4
- Screening for rectal gonorrhea and chlamydia in men who report receptive anal intercourse with men 4
- Screening for oropharyngeal gonorrhea in men who report receptive oral intercourse with men 4
Special Considerations
Certain populations may require more frequent or specialized screening, including:
- Men who have sex with men, who may require screening at 3- to 6-month intervals 4
- Pregnant women, who should receive empiric treatment and close follow-up care to prevent serious complications 5
- Adolescents and young adults, who are at higher risk for STIs and should be screened regularly 6
Diagnostic Tests
The following diagnostic tests can be used to diagnose STIs: