Sexually transmitted infection (STI) rates are high and rising, especially amongst young men. The problem is, as primary care physicians, we aren’t very good at providing a setting where men feel comfortable getting STI testing: one that requires trust, sensitivity and privacy.
When young men are interviewed about STI testing they describe their fears and vulnerabilities: fears of getting an erection during genital examinations and multiple vulnerabilities associated with exposing the male body in a clinical setting. Men also report they may be unwilling to fully disclose sensitive items.
So let’s take some of the mystery out of what a visit will be like for sexually transmitted infection testing and solutions to problems you may have.
1) Your primary care doc will examine the genital area for enlarged nodes, pubic hair infestations (scabies, lice) and the penis will be inspected for sores or discharge from the urethra.
2) You should be prepared to tell us: any symptoms, history of previous sexually transmitted infections, the gender of your sexual partners, sites of exposure (rectum, mouth, penis) whether receptive or insertive and frequency of condom use.
Here are specifics about what you may be dealing with:
Men with sexually transmitted infections commonly have discharge, pain with urination or urethral tingling or itching. In this case we can send the discharge for cultures and/or send urine for cultures and just go ahead and treat you. Urine tests for gonorrhea and chlamydia have made it so the dreaded urethral swab is not always needed.
Sores (Ulcers) on the penis:
Several STIs may be present with a sore. Herpes and syphilis are the most common. Direct testing of the sore can be done for Herpes (or blood tests, which aren’t as helpful) and is the recommended method for diagnosis. Syphilis usually causes only one sore that is painless and can be diagnosed on a blood test (RPR.)
Papules or warts on your Penis
It may surprise you that the most common STI that gives papules or warts is molluscum contagiosum. Human papilloma virus (HPV) also causes genital warts. Remember too that there are pearly penile papules that are NORMAL and not an STI, and your doctor can find out on exam if that’s the case. For both molluscum and HPV there are treatments you apply at home that work well to get rid of the lesions. Imiquimod 5% cream (Aldara) can be prescribed and used 3 times a week. Podophyllotoxin (Podophyllin 0.5% gel) is also used 3 times a week, or your doctor may use cryotherapy with liquid nitrogen in the office.
If you have no symptoms but want to have STI testing prior to being with a new sexual partner, what should you ask for?
- Urine DNA test for gonorrhea and chlamydia
- Test for rectal infection with gonorrhea and chlamydia in men who have had receptive anal intercourse during the previous year.
- Blood test for Hepatitis B, HIV, and RPR (Syphilis)
- Dr. O
Editor's note: This article is part of our Men's Health Week series, happening June 11th-June 15th, 2012. Celebrate with us by visiting the DailyStrength Men's Health Week special page, and don't forget to check out Sharecare's videos and tips just for men!
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