Assessment on Sexually Transmitted Disease
Assessment of Sexually Transmitted Infections (STIs/STDs)
Sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs), are infections transmitted predominantly through sexual contact (vaginal, anal, and oral intercourse). Certain STIs may also be transmitted via blood, shared needles, or from mother to child. Etiological agents include bacteria, viruses, parasites, protozoa, and rarely fungi. Manifestations may involve the genitals, urethra, anus, rectum, pharynx, conjunctiva, or skin; many infections remain asymptomatic for extended periods.
A systematic, non-judgmental, and patient-centered approach is essential when assessing individuals for possible STIs.
• Comprehensive sexual & medical history
• Physical examination
• Diagnostic investigations
• Patient education and counseling
Common Clinical Presentations
- Abnormal genital, urethral, vaginal, or rectal discharge
- Dysuria (burning or pain on urination)
- Genital sores, ulcers, vesicles, blisters, warts, or rashes
- Genital or perianal pruritus
- Lower abdominal or pelvic pain (especially in females)
- Scrotal pain, swelling, or tenderness
- Dyspareunia
- Intermenstrual or post-coital bleeding
- Enlarged/tender lymph nodes
- Pharyngeal discomfort or exudates
- Systemic symptoms (fever, rash, arthralgia)
Note: Many STIs (e.g., chlamydia, gonorrhea in women, HPV) are asymptomatic; screening is indicated in high-risk groups even without symptoms.
Comprehensive Sexual and Medical History
Key elements to cover confidentially and empathetically:
- Presenting complaint and timeline of symptoms
- Number and gender of sexual partners (past 6–12 months and lifetime)
- Types of sexual practices (oral, vaginal, anal; insertive/receptive)
- Consistency of condom/barrier use
- Symptoms or known STIs in partner(s)
- Date of last sexual contact and last unprotected exposure
- Previous STI history and treatment completion
- Drug use (especially stimulants linked to high-risk behavior)
- History of sexual assault or coercion
- Contraceptive method, last menstrual period, pregnancy history (women)
- Cervical screening and vaccination status (HPV, Hep A & B)
- Travel history and general medical/medication history
Physical Examination
General Examination
- Vital signs, weight, pallor, jaundice
- Skin and mucous membranes (rashes, lesions)
- Lymph node palpation (cervical, axillary, inguinal)
- Oral and pharyngeal inspection
Genitourinary & Anorectal Examination
- Inspection: External genitalia, urethral meatus, retraction of foreskin (males), speculum exam (females when tolerated), perianal region
- Palpation: Inguinal nodes, bimanual pelvic exam, Bartholin/Skene glands, scrotal contents, digital rectal exam if indicated
Important: Defer speculum/bimanual exam in suspected sexual assault or when severe pain/ulceration is present.
Diagnostic Investigations
- Serology: HIV Ag/Ab (4th gen), syphilis (RPR/VDRL + TPHA/FTA-ABS), hepatitis B & C
- NAAT (preferred): First-void urine or vaginal/rectal/oropharyngeal swabs for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium
- Lesion swabs: HSV PCR, syphilis PCR/dark-field
- Other: Wet mount, Gram stain, Pap smear/HPV co-test, pelvic ultrasound (if PID suspected)
Patient Education and Counseling
- Consistent and correct condom use (male/female condoms, dental dams)
- Reduction in number of sexual partners or mutual monogamy
- Regular STI screening, especially <25 years or with new/multiple partners
- Completion of full treatment course and abstinence until cured
- Partner notification and simultaneous treatment
- Vaccination: HPV (up to age 45 where indicated), hepatitis A & B
- Avoid vaginal douching and unnecessary antibiotics
- Offer PrEP or doxy-PEP where guidelines recommend
- Psychosocial support and referral as needed
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