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Consulting the doctor

When diagnosed and treated early, most STD can be completely cured. This is why it is very important to consult a doctor as soon as symptoms develop or you gave reason to suspect that you may have contracted STD.

When to suspect STD

The following are some of the more common symptoms of STD that you should specifically look out for. However, they are not diagnostic and you should always consult a doctor to confirm whether they are STD related or not. 

Symptoms Common STD causes
Genital discharge Gonorrhoea, nonspecific genital infection including chlamydial infection, trichomoniasis,candidiasis, nonspecific vaginitis.
Pain or discomfort on urination (dysuria) Gonorrhoea, nonspecific genital infection including chlamydial infection.
Genitla ulcer or sore Syphilis, genital herpes, chancroid, granuloma inguinale
Blisters in the genital area Genital herpes
Itching in the genital area Candidiasis, trichomoniasis, pediculosis pubis
Abdominal pain Pelvic inflammatory disease (PID) due to gonorrhoea or chlamydial infection
Growth in the anal or genital area   Warts, molluscum contagiosum
Rashes Syphilis
Swollen lymph glands in the groin Syphilis, chancroid, genital herpes, lymphogranuloma venereum (LGV). 

Unfortunately, the problem is complicated by the fact that some infected persons, particularly women are completely asymptomatic. Therefore, it may be prudent for those with multiple partners to go for reglar STD checks every 3 months or so or each time they start a relationship with a new partner.

What to do when you suspect STD

Stop all sexual activities. You do not want to spread infection to others.

Consult a doctor immediatly. The symptoms of STD may subside even without treatment. This usually means that infection has spread deeper and complications may develop. Do not self-medicate. You may take the wrong medicine or insufficient amounts of it. Some medicines can cause serious side effects. Partial treatment also makes it more difficult for the doctor to detect infection.

Get your sex partner(s) to see a doctor. They may not know they are infected and may develop complications and they may spread infection to others or reinfect you when you ghave sex with them.

Who to consult

Most doctors, including GP (General Practitioner) treat STD. Doctors who are specialised in the area of STD are known as STD specialists or venereologists. In countries such as Singapore and Malaysia, most dermatologists (skin specialists) are also trained STD specialists. STD specialists can be found in private practice as well as in government run STD clinics. If you have difficulty finding a STD specialist, contact your local hospital. Alternatively, ask your GP to refer you to a specialist.

What to expect at the clinic

All clinics will need to register the patient. This allows the clinic to contact the patient when the laboratory tests are abnormal and the patient fails to keep his appointment. If you are worried about phone calls and letters reaching the wrong person, request the clinic not to contact you but come personally for the results. All information obtained in the clinic is strictly confidential.
Diagnsoing STD is not a simple task. The doctor relies heavily on the information you give him, his examination and tests. Let us examine each of these to give you an idea of what to expect when you consult a STD specialist.

History taking
The doctor usually begins by asking what your complaint is, when it started and for how long. He will also ask questions pertaining to the timing of sexual intercourse, with whom and whether any of these have symptoms and also the type of sexual activity that took place. He needs this information to help him decide which tests are appropriate and which sites are at risk of infection. You should be totally honest with him. He will also ask about the treatment you have received, allergies to medicines and whether you have had STD before. In female patients, he will also enquire about menstruation (period), pregnancies, abortions and previous Pap (cervical cancer) smears.

Physical examination
The doctor will examine the entire area between the umbilicus and the mid-thigh, paying special attention to the genital area and the lymph glands in the groin. Other parts of the body may be examined, if appropriate.

Men
This involves retracting (pulling back) the foreskin (prepuce) in the uncircumcised person and examining the penis, testes and the umbilicus to mid-thigh area. After examination, the doctor will take some discharge from the urethra for tests. If there is no discharge, he will pass a platinum or disposible loop 1 - 2 cm long into the urethra to obtain a specimen. In homosexual men admitting to passive anal sex, the rectum will also be examined by passing an instrument known as the proctoscope into the anus. A swab is then inserted into the rectum and a sample taken. He may also take a swab from the throat if this site is at risk of infection. After this, the doctor may ask the patient to pass the first portion of urine into a glass and part of the remainder into a second glass. This test, known as the two glass urine test helps the doctor determine whether infection is confined to the urethra and has spread higher up the genitourinary tract. He usually finishes by taking some blood for tests (see below). 
Women
This is a little more involved. As in the male, the doctor begins by examining the genitla area and the surrounding regions. Then he does an internal examination by inserting an instrument calkled the vaginal speculum into the vagina. This allows the doctor to see inside the vagina and check the vagina and cervix for any abnormalities. At the same time, it allows him to take samples from different areas inside the vagina and from the cervix. A Pap smear may also be taken from the cervix to detect early cancer. He then withdraws the speculum and takes a swab from the urethra. There is very little discomfort except for a ticklish feeling when he takes these specimens. The doctor then inserts one or two fingers into the vagina, places his other hand on the lower abdomen and feels the insides between them. This is known as the bimanual examination and is useful for detecting any abnormal swelling or areas of tenderness that might indicate pelvic inflammatory disease (PID). The doctor may also insert a swab into the rectum to obtain a specimen. A throat swab may be taken if the throat is at risk of infection. 

Finally, he may take blood from one arm. He puts a tourniquet above the elbow and asks the patient to make a fist. This cause the veins to bulge out. He then cleans the area with an alcohol swab and introduces a hypodermic needle into the vein. A small amount of blood is withdrawn for tests. The hand is relaxeed and the tourniquet is removed. He then asks the patient to double up the arm for a few minutes. After this, the arm is straightened and the wound covered with a small elastoplast.

The examinations described above may appear frightening but they actually involve very little discomfort and are over in a few minutes. You will naturally be nervous the first time but do try to stay relaxed because this actually reduces the discomfort. The next time you go through this will seem like nothing. You may notice that several specimens as well as blood are obtained. This is so that the doctor can test you for several STD. The reason is that a person may have more than one STD.

There is no single test to detect all STD. The table below shows some of the tests that are used to help diagnose STD:-

STD Helpful diagnostic tests Specimens required
Syphilis VDRL, TPHA or FTA-ABs tests
Darkground examination
Blood
Gonorrhoea Smear
Culture
Discharge
Discharge
Nonspecific genital infection Smear
Culture for chlamydial trachomatis
Discharge
Discharge
Genital herpes Tzanck smear
Culture
Scrapings
Scrapings
Human immuno deficiency virus and AIDS ELISA, Western Blot tests Blood
Candidiasis Smear
Culture
Discharge
Discharge
Trichomoniasis Smear
Culture
Discharge
Discharge
Nonspecific vaginitis Smear
Amine (sniff) test
Discharge
Discharge
Genital warts Examination  
Molluscum contagiosum Examination  
Hepatitis B Hepatitis B surface antigen Blood
Chancroid Culture  Discharge
Lymphogranuloma venereum LGV-CFT
Culture for chlamydial trachomatis
Blood
Pus from bubo
Granuloma inguinale Smear Tissue
Pediculosis pubis Examination for nits
Microscopy of nits or louse
 
Scabies Examination
Microscopy for scabies mites
Scrapings
NB Blood tests for herpes infections are generally not useful for diagnosis.

After the tests, your doctor will usually require yoy to wait a few minutes for some of the results. Some tests are read immediately and treatment can be given straightaway. Others take a few days to weeks to return. Some tests have to be repeated in order to increase the accuracy. In the meantime, your doctor will advise you to abstain from sex.

Treatment

Each STD is treated differently. Some STD require injections but others respond only to tablets or applications. Soo do not insist on injections.

A special note about treatment
Once treatment is prescribed, there are still other precautions that you should observe. You should:-

1.  Take all medication according to the doctors instructions.

2.  Avoid sex while being treated or until follow up tests are negative.

3.  Notify all recent sexual partners, including spouses and be sure they consult a doctor.

4.  Return on the specified date/s for follow up tests to ensure that the infection has been completely cured.

Ensuring that your sexual partners are examined is important for 3 main reasons:-

1.  They may not know they are infected and may develop complications.

2.  They may cause ping-pong reinfection. This refers to the situation where a couple is infected but only one partner receives treatment so infection continues to spread from the untreated to the treated person repeatedly.

3.  They may infect other people and ecourage the spread of infection.

The reason that ping-pong reinfection occurs is that some stages of infection are asymptomatic and the person may unknowingly transmit infection to others.

There are different methods of getting your sexual contacts to see a doctor. Some clinics provide patients with contact slips which they can personally give to their sexual contacts or post to them. Alternatively, a health worker from the Department of Health may pass these on to their sexual partners. The doctor and health worker will workl out with your help the best possible way to do this so as not to cause any social upheavals. The contact slips contain your clinic reference number (but not your name) and the diagnosis or the diagnosis code. Thsi provides the dodcotr examining your sexual partners with valuable information on which to decide on appropriate tests.