Examination: Male Genitalia

Although it is unlikely you will be asked to do this on a real patient in an OSCE, you may be asked to perform the examination on a model and so is important you know the steps to take.

OSCE Scenario: You have been asked to examine the external genitalia of this gentleman who has presented with penile discharge.


Introduction
  • Introduce yourself
  • Wash your hands
  • Explain to the patient that you need to perform a genital examination and ask permission to do so
  • Offer a chaperone
  • Expose patient: from waist down
  • Position patient lying flat to begin with
  • Ask if patient has any pain/is comfortable as they are
  • Don gloves

Inspection
  • Inspect from base to tip of penis (ensure to lift penis up to inspect shaft and scrotum fully)
  • Inspect the prepuce (foreskin) – pull back and inspect prepucial area
  • Inspect the meatus
  • Inspect the scrotum
  • Inspect the general groin area
  • What you are looking for/comment on:
    • Rashes
    • Redness
    • Sores
    • Lumps
    • Discharge
    • Symmetry
    • Structural abnormality

Palpation
  • Palpate for inguinal lymph nodes bilaterally
  • Scrotal palpation:
    • Start with normal side, then go on to abnormal side
    • Testes: gently palpate using thumb and two fingers
    • If swelling felt then examine standing (examine as per lump and hernia exam)

Further examinations/investigations
  • Full history including sexual and travel history
  • Abdominal examination, PR, and throat examination if suspecting STI
  • If any discharge seen: urethral swab for microscopy, culture and NAT
  • Ultrasound if testicular lump felt

Finishing Exam
  • Thank patient
  • Inform them they can get dressed

Notes on penile discharge:

Gonococcal urethritis
  • Caused by Neisseria gonorrhoea – Gram negative kidney shaped diplococcic
  • Typically inside neutrophils
  • Features:
    • Urethral pus
    • Dysuria
    • Tenesmus, proctitis and rectal discharge if MSM
  • Diagnosis:
    • Urethral swab for Gram stain
  • Complications:
    • Local – prostatitis, epididymitis
    • Systemic – septicaemia, Reiter’s syndrome, endocarditis, septic arthritis
    • Obstetric – opthalmia neonatorum
    • Long-term – uretral stricture, infertility
  • Treatment:
    • Ceftriaxone 250mg IM single dose OR cefixime 400mg PO
    • Co-treat for Chlamydia

Non-gonococcal urethritis
  • Commoner than GC
  • Features:
    • Thinner discharge
  • Organisms:
    • Chlamydia
    • Ureaplasma urealyticum
    • Mycoplasma gentialium
    • Herpes Simplex Virus
    • Candida
  • Treatment:
    • Azithromycin 1g PO stat or doxycycline for 7 days
    • Avoid intercourse during rx and alcohol for 4 weeks

written by: naina_mccann, first posted on: 15/02/2016; 14:01

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