LEARNING GUIDE

VENEREOLOGICAL EXAMINATION PROCEDURE

PERFORMANCE
No STEP SCALE
1 2 3 4
CLIENT ASSESSMENT
01. Great the patient respectfully with kindness
02. The patient should be given adequate explanation about the
examination & test will be carried out. Ask permission to
perform the examination.
03. Ask the patient to void before examination
04. Instruct the patient lying in lithotomy position on the examining
table
GROIN & PUBIC
05. Wash your hands then put the glove on both hands
06. Inspect and palpate the inguinal region for the presence of
lymphadenopathy. If presence note the size, consistency,
mobility and tenderness.
07. Inspect the pubic skin for any lesion and pubic hair for lice &
nits.
VULVA & URETHRA
08. Inspect the labia majora & minora for any erythema, oedema,
fissuring and other lesions such as: papules, vesicles, erosions
and ulcers.
09. The labia minora are separated and any discharge from the
introitus is noted for amount, colour and consistency.
10. Inspect the urethra and periurethra (Skene’s gland) for
erythema, oedema or any lesions and discharge. If discharge
is presence, note the amount, colour and consistency. If there
is no discharge, perform milking urethra by inserting the index
finger into the vagina then massage the urethra against the
pubic symphysis from above downward.
11. Palpate the Bartholin’s gland at 5 and 7 o’clock direction on the
face of posterior fourchet between thumb and forefinger. If
infected, the gland may be tender and pus may be seen at
inflamed duct orifice.
VAGINA & CERVIX
12. - Inserting the speculum:
- Wiped clean the introitus with gauze
- Enlarging the introitus by applying downward presure
at lower margin.
- Hold the warm speculum at an angle, then slide it
inward vertically along the posterior wall of the vagina.
 - Rotate the speculum into horizontal position, then
insert to it full length.
- Open the speculum carefully. Rotate and adjust it
until it cup the cervix and visualized well. Maitain
the open position of the speculum by tightening the
thumb screw.
13. Inspect the vaginal wall for the presence of erythema,
discharge or other lesions such as : papules, vesicles,
erosions, ulcers. If discharge is presence, note the amount,
colour and consistency.
14. Inspect the cervix for the presence of erythema, ectopy and
discharge. If discharge is presence, note the amount, colour
and consistency. The external orifice of the cervix is wiped
clean using forceps with with gauze and inspect for the
presence of papules, vesicles, erosions, ulcers.
SPECIMEN COLLECTION
15. Cleaned the exocervix to remove mucus using forcep with
gauze.
16. Neisseria gonorrhoeae :
Insert a cotton-tipped swab about 2 cm into the cervical canal.
Rotate and move the swab gently from side to side for 5 – 10
second to allow absorpsion of the exudate. Spead the smear
thinly on a microscopic slide for the Gram staining. Second
swab is done at the same way and placed into transport
medium for culture.
17. Chlamydia trachomatis :
Insert a specimen swab 2 cm. into the cervical canal and rotate
it for 10 second, gently scraping epithelials cells from the wall.
Then placed the specimen into the transport medium for
antigen/nucleic acid detection.
18. Trichomonas vaginalis :
Secretions from the posterior vaginal fornix are mixed with a
drop of saline solution and covered with cover slip. Closed the
all side of the cover slip with Vaseline.
19. Candida Spp. :
Secretions from the vaginal wall are mixed with a drop of
10% potassium hydroxide solution and covered with cover slip.
Closed the all side of the cover slip with vaseline.
20. pH determination of vaginal fluid:
Held the pH indicator paper strip with forcep then is applied to
the vaginal wall near the lateral fornix. Measure the vaginal
fluid by comparison the pH indicator paper strip with a
standardized colour scale.
 DV. 15

21. Discharge the speculum :

Withdraw the speculum slowly and closed it as it emerges
from the introitus. Rotate the speculum into vertical posision
while whithdraw from the vagina.
21. Whiff test/amine test
A drop of 10% potassium hydroxide solution is added to
vaginal fluid pooling in the speculum. The test is positif if
realising of a “fishy odour”
BIMANUAL EXAMINATION
22 Lubricate the index and middle finger of one of your gloved
hand. From standing position insert the index and middle finger
into the vagina, and another hand compressed the bladder.
Palpate the cervix moved laterally then noting the mobility and
tenderness. Normallly the cervix can be move without pain.
PERIANAL
23 The bottocks should then separated for inspection of perianal
region for any lesions.
CLOSING
24 Tell the patien that the examination is finish and let her to get
dressed.
24 Explained to her about the result of the examination and for
the definitive diagnosis she should waiting for the laboratory
result.