Action
Obtain:
- History of present illness
- Past medical history
- Sexual history
Perform:
- Physical examination (Appendices 1 and 2)
- External genital examination and/or pelvic examination (Appendix 3)
Decision
Suspicion for STI?
Background
STIs have manifestations that can be both local and systemic, so a full physical examination is indicated. A chaperone should be utilized during any intimate examination, regardless of whether the patient and the clinician are of the same gender. Tachycardia, hypotension, and fever should raise concern for possible sepsis and/or PID in women. In patients with vaginal bleeding or lower abdominal pain, the pelvic examination continues to play a vital role in the diagnosis of many STIs. UTIs and STIs can cause similar symptoms, so a pelvic examination, along with a clean-catch urine specimen, will reduce misdiagnosis. Appendices 1, 2, and 3 detail physical examination findings, by body system, that are seen in common STIs.
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