GUM - Examination

Question 1

What observations should be made on general inspection of a male patient in a sexual exam?

Answer 1

Observe:

• Mouth
• Joints
• Eyes
• Skin - rash of secondary syphilis; scabies; HIV infection

Question 2

After observation what comes next?

Answer 2

1) Inspect the patients inguinal glands for significant enlargement and lymphadenopathy
2) Check the skin around the scrotum and groin for warts and tinea cruris
3) Next check the pubic area for crab louse
4) The scrotal contents can be palpated for abnormal masses or tenderness (epidiymo-orchitis)

Question 3

What features of the penile skin should be examined?

Answer 3

Retract the pupice (if present)
Inspect for any genital warts and ulcers.
Be aware of normal anatomical features such as coronal papillae, or prominent sebaceous or parafrenal glands.
Check the urethral meatus for discharge.

Question 4

How should the perianal area and rectum be examined?

Answer 4

Check the peri-anal area for warts (in both MSM and heterosexual men).
Examine the rectum in MSM practicing receptive anal intercourse using a protoscope looking for proctitis.

Question 5

What investigations for STIs should be undertaken in heterosexual men?

Answer 5

First void urine is the specimen of choice for the combined NAAT for gonorrhoea and chlamydia.

Alternatively, for gonorrhoea, a urethral swab placed directly on chocolate agar or a selective medium can be cultured for antimicrobial sensitivities.

Syphilis serology - e.g. enzyme immunoassay for antitreponemal immunoglobulin (IgG) antibody

HIV screening

Question 6

What investigations for STIs are important in men who have sex with men?

Answer 6

FVU,* and pharyngeal and rectal swabs for combined NAAT for gonorrhoea and chlamydia.
STS (repeat testing may be necessary in the event of negative test results in the first few weeks following exposure).
Serological tests for hepatitis A/B (with a view to vaccination if seronegative).
HIV test.

Question 7

Outline a female clinical examination

Answer 7

1) Observe - as per men
2) Abdomen - masses or tenderness
3) Inguinal glands - enlargement
4) Pubic area - crab louse
5) Labia majora and minora - ulcers, vulvitis, warts
6) Perineum and perianal skin - warts, ulcers
7) Vagina and cervix (using speculum) - abnormal discharge, warts, ulcers, inflammation, in women with lower abdo pain perform bimanual examination for adnexal masses/ tenderness (PID)

Question 8

Which individuals are particularly at risk of STIs?

Answer 8

Sex workers, male and female
Clients of sex workers
Men who have sex with men
Injecting drug users (sex for money or
drugs) and their partners 
Frequent travellers