Examination should include the genital area, and the oral and perianal areas, as indicated by the patient's history.
For women with a suspected STI, a vaginal examination using a speculum should be undertaken.
Where a woman declines to have a vaginal examination or it is culturally inappropriate, a self-obtained low vaginal swab (SOLVS) can be used to test for chlamydia or gonorrhoea in an asymptomatic woman. (See Specimen collection in women who are examined and STI self testing card (PDF 346KB).)
It should be recognised that examination is not just for obtaining swabs, and is best practice.
Rationale: A thorough physical examination is necessary to accurately diagnose and treat a patient with a suspected STI/HIV. This applies to all STIs, including chlamydia and donovanosis.
- Special care should be exercised to avoid contact with infectious materials. Wearing gloves is essential and eye protection should be worn when there is risk of material splashing.
- In all patients with anorectal pain or discharge, proctoscopy should be performed to exclude anal canal or lower rectal disease.
- For vaginal examination, always use a vaginal speculum, warmed to body temperature, to visualise the cervix. Bimanual pelvic examination should be performed in patients with lower abdominal symptoms. If there is extensive disease with donovanosis or herpes, a vaginal examination may be painful and may have to be temporarily deferred.