GENERAL DIAGNOSTIC PRINCIPLES
Many sexually transmitted infections are asymptomatic in women or are asymptomatic during the initial stages of the infection. The signs and symptoms of many STDs may be char-acterized by genital ulcers or infection of the cervix (cervicitis), ure-thra (urethritis), or both (Table 27.2). Because 20% to 50% ofpatients with one STD have a coexisting infection, when one infection is confirmed, other infections must be suspected.
Because of the variations in signs and symptoms and the asymptomatic presentation of STDs, a thorough sexual history and physical examination are essential in detecting the presence of an STD. The findings obtained through a systematic physical assessment, combined with the patient’s history, usually help make the proper diagnosis. The inguinal region should be evaluated for rashes, lesions, and adenopathy. The vulva, perineum, and perianal areas should be inspected for lesions or ulcerations, and palpated for thickening or swelling. The Bartholin glands, Skene ducts, and urethra should be evaluated, as these are frequent sites of gonorrheal infection. In patients with urinary symp-toms, the urethra should be gently milked to express any discharge. The vagina and cervix should be inspected for lesions and abnormal discharge. If a patient engages in anal intercourse, the rectum should be considered a potential site for infection. For completeness, the oral cavity as well as the cervical and other lymph nodes should be evaluated, if appropriate, based upon the patient’s modes of sexual expression.