CONTENTS
Chapters
- The Toll of STDs
- Reducing the Toll of STDs
- Managing STDs
- Diagnostic and Treatment Tips
- Getting Services to the People
- Getting People to Services
- Promoting Prevention—Condoms and Monogamy
HIGHLIGHTS
Population Reports is published by the Population Information Program, Center for Communication Programs, The
Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland
21202-4012, USA
Volume XXI, Number 1
June, 1993 |
The Physical Examination
The physical exam allows providers to confirm the symptoms
described by patients and, if possible, to check for signs of
STDs. The extent of the exam depends on the space, equipment, and
time available to the provider and on the patient's willingness
to be examined. Lacking a private space, gloves, or time, many
providers cannot examine patients at all. Also, patients may
refuse to be examined even after counseling about what will
happen and why it is important. Fear of a physical exam, like
fear of questions about sexual behavior, keeps some people away
from care. To avoid raising anxiety, providers may decide not to
do a physical exam or to observe patients rather than perform a
more invasive exam.
The physical exam can be conducted at several levels, each
providing more information for a diagnosis:
- Syndromes only. Providers without gloves simply observe
patients. Providers with gloves can examine patients
more thoroughly. Many primary care providers using the
syndromic approach are limited to this level of exam.
- Syndromes plus signs from a physical exam. For women,
the exam comprises an abdominal exam, a pelvic exam
with speculum, and a bimanual exam. To perform a pelvic
exam, a provider needs a private space, a table, a
lamp, a spec~u~lum, and gloves. The speculum should be
disinfected after each use—for example, by boiling it
in water or by immersing it in bleach and then rinsing
with sterile water. For men, a complete exam comprises
examining the penis and the groin and feeling the
testicles and epididymis.
- Syndromes and signs plus simple tests—for example, microscopy
and testing the acidity (pH) of vaginal discharge (see Chapter
4.3, Vaginal Discharge). Providers take specimens during
the exam: samples of fluid from genital ulcers, a urethral swab, or
swabs from the vagina and cervix (185, 283).
- Syndromes, signs, and simple tests, plus blood tests
and culture of specimens from genital ulcers or
discharges. Generally, only providers at STD referral
clinics have the laboratory facilities to perform
cultures. Such providers need not take the time to test
samples from all STD patients, however. National STD
management guidelines can help providers decide when
microscope or laboratory analysis is advisable.
The provider's time may determine the extent of the physical
exam. Managing an STD patient can take 5 to 15 minutes. In
Zimbabwe, for example, health care providers spend 5 to 6 minutes
with each STD patient in a visit that includes a medical and
sexual history, examination, diagnosis, treatment, counseling,
and condom distribution. A speculum exam for women takes longer
(162). In a one-year pilot project in Maputo Province,
Mozambique, STD visits in 20 health centers averaged 15 minutes
for women and 10 minutes for men, not including waiting time
(22). |