Physical examination

We recommend a full physical examination at the time of the initial visit, or as soon thereafter as practicable. This includes completion of a comprehensive health history data base, and the obtaining of vital signs by our medical assistant, followed by a review of the health history form with the practitioner, and an examination.

Pelvic exam

For women, we highly recommend referral to a gynecologist for routine breast, pelvic and rectal examinations, Pap smears and mammograms.

Digital rectal examination

We recommend digital rectal examinations, including an examination of the prostate, for all male patients as part of the physical examination or more frequently if indicated.

Anoscopy

For men who have engaged in unprotected anal sex in the past with other men, or who have anal and rectal complaints, we often recommend examination with a small scope.

Colonoscopy

For people over age 50, the American Cancer Society recommends colon cancer screening. Although, many years ago, we performed rigid sigmoidoscopy in the office, we now refer to gastroenterologists for colonoscopy, which should be performed every 10 years or more frequently if there are polyps found on the exam or if there are risk factors for colon cancer, including family history.

Stool occult blood testing

In following the guidelines of most major preventive medicine organizations, we recommend testing for fecal occult blood annually after age 50 if you have not had a screening colonoscopy.

Vaccinations

For gay men and others at high risk for hepatitis infection, we recommend testing to assess previous exposure to hepatitis A and B. If these tests show no evidence of exposure, we can administer the appropriate hepatitis vaccines. For a brochure that explains the importance of hepatitis A and B vaccines for gay men, click here. We offer routine vaccinations against influenza (September through December), Streptococcus pneumoniae pneumonia, diphtheria, tetanus (lockjaw) and pertussis (whooping cough). We also test for tuberculosis exposure (TB skin test). We recommend herpes zoster (shingles) vaccine to persons 60 and over who are not immune compromised. Because of special refrigeration requirements to store this vaccine, we do not carry it in our office but can provide a prescription for certain retail pharmacies where herpes zoster vaccine is administered.

 

Travel services

We offer vaccinations against most infections recommended by the CDC, except for yellow fever.

Male sexual dysfunction

We recommend an evaluation, including a comprehensive physical examination, as well as lab tests, to investigate specific causes of erectile difficulties, e.g., diabetes mellitus, vascular disease, and testosterone deficiency.

	We prescribe Viagra, Levitra, and Cialis, orally administered treatments for erectile dysfunction (ED, sometimes referred to as impotence). Viagra is supplied as 25 mg, 50 mg, and 100 mg tablets, Levitra as 2.5 mg, 5 mg, 10 mg and 20 mg tablets, and Cialis as 5 mg, 10 mg and 20 mg tablets. The medication should be taken approximately one hour before sexual activity. Viagra should not be taken for at least two hours after a fatty meal, because fat will interfere with absorption of the medication. Erection of the penis involves release of nitric oxide during sexual stimulation. Viagra, Levitra, and Cialis work by enhancing the effect of nitric oxide. Cialis has a longer duration in which the drug is active than Viagra or Levitra. Side effects of Viagra, Levitra, and Cialis include headache, flushing, upset stomach, and a temporary difficulty with distinguishing blue from green colors. Inhaled nitrites ("poppers") should not be used with Viagra, Levitra, or Cialis, because dangerously low blood pressure may occur with the combination.

We can also instruct men in use of the MUSE system, in which an erection may be obtained after inserting a tiny pellet of a hormone, alprostadil, into the penis. Unlike the MUSE intraurethral prostaglandin suppository system, and unlike local injections of prostaglandins and/or papaverine into the penis, Viagra, Levitra, and Cialis do not cause an erection by themselves. Sexual stimulation is still required.

Laboratory tests

Although we do not perform most laboratory tests in our office, we are conveniently located to several laboratories, including the Davies campus of California Pacific Medical Center, LabCorp, Quest Diagnostics and Hunter Laboratories. Routine screening for gay men, such as syphilis serology and gonorrheal and Chlamydial smears, can be performed at these laboratories.

HIV/AIDS tests

We recommend routine testing for HIV if you are at risk. Tests must be ordered on the record and may be billed to your insurance company. The results come back in 3 to 5 days and we require that HIV test results be given to you in person, rather than over the telephone. If you have had a possibly high-risk exposure to HIV, due to unprotected anal or vaginal sex, a broken condom, ejaculation in the mouth or blood contact, please call us as soon as possible (preferably less than 72 hours after contact) to discuss your exposure. Depending on the nature of the exposure, we may recommend that you begin post-exposure prophylaxis (PEP), to reduce your risk of HIV disease.

Clinical research

	Our patients participate in a number of studies, particularly in HIV drug expanded access trials, some of which are conducted through our office. Most of the trials to which we refer patients, however, are conducted through university, hospital-based and independent clinical research organizations. We keep a current list in our office of the HIV clinical trials in the San Francisco Bay Area that are open to enrollment, provided by HIVCare at St. Francis Memorial Hospital. For more information about these research organizations, please follow the links below.
	Dr. Jay Lalezari has been at the forefront in investigating a number of cutting-edge therapies for HIV disease and opportunistic infections in recent years, through Quest Clinical Research.
	The Community Consortium of Bay Area HIV/AIDS Providers, founded by Dr. Donald Abrams, includes most of the providers providing HIV care in the San Francisco Bay Area. The Community Consortium has a number of trials involving both antiviral and immunological research, many of which are national trials sponsored by the Community Programs for Clinical Research in AIDS network (CPCRA).
	San Francisco General Hospital is a world-renowned site for many of the AIDS Clinical Trials Group (ACTG) national trials, directed by Dr. Diane Havlir, along with a number of industry-sponsored trials, led by Dr. Annie Luetkemeyer.
	We are also fortunate to have a second ACTG site in the Bay Area at Stanford University Medical Center under the direction of Dr. Andrew Zolopa. Stanford is also a well-known and respected center for HIV/AIDS research.
	Dr. Fritz Bredeek is relatively new to our community but has an HIV research background in Southern California and in Tucson, AZ. He also offers several open clinical trials at Metropolis Medical Group.

Send mail to bill at owenmed dot com or carl at owenmed dot com with questions or comments.
Last modified: July 06, 2010