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[physical][pelvic][anoscopy][stool blood][sigmoexam][vaccines][travel][impotence][lab tests][HIV test][research]


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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.


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.


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.


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). If you have already had the 23-valent Pneumovax, your next pneumonia vaccine should be the 13-valent "pediatric" pneumococcal vaccine, Prevnar-13. We anticipate having Prevnar-13 in stock after our Sutter Pacific Medical Foundation (SPMF) integration on February 2, 2015.

We recommend herpes zoster (shingles) vaccine to persons 50 and over who are not immune compromised. Because of special refrigeration requirements to store this vaccine, we do not currently carry it in our office but can provide a prescription for certain retail pharmacies where herpes zoster vaccine is administered. We anticipate receiving the special refrigerator needed to store Zostavax after February 2, 2015, once our office suite renovation is complete

For young gay men who have never been sexually active or have been minimally active, we recommend the series of human papillomavirus (HPV) vaccines (Gardisil). Although we do not carry this vaccine, it may be obtained through the Travel Clinic at the San Francisco Department of Public Health, 101 Grove Street, San Francisco, CA 94102.


travel services

We offer vaccinations against most infections recommended by the CDC, except for yellow fever, and depending on availability. Other vaccinations may be obtained through the Travel Clinic at the San Francisco Department of Public Health, 101 Grove Street, San Francisco, CA 94102.

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, Cialis, and Stendra, 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, Cialis, and Stendra work by enhancing the effect of nitric oxide. Cialis has a longer duration in which the drug is active than Viagra or Levitra. Stendra has a more rapid onset, 15 minutes, when taken on an empty stomach.

Side effects of Viagra, Levitra, Cialis, and Stendra 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, Cialis, or Stendra because dangerously low blood pressure may occur with the combination.

We can 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, Cialis, and Stendra do not cause an erection by themselves. Sexual stimulation is still required.

We can also prescribe and instruct men in use of the Osbon ErecAid Vacuum Penile Therapy System.

laboratory tests

Although we do not perform most laboratory tests in our office, we are conveniently located to several laboratories, including Sutter Health's California Pacific Medical Center (CPMC) Davies Campus lab, LabCorp, and Quest Diagnostics. Routine screening for gay men, such as syphilis serology and gonorrheal and Chlamydial smears, can be performed at these laboratories.

As of early 2015, when our Sutter Pacific Medical Foundation (SPMF) Epic electronic health record (EHR) has its "go live" date, we are temporarily unable to order laboratory tests at Quest Diagnostics laboratory. However, we understand that SPMF and Quest are working on an interface that should be up and running later in 2015. At that time, you may once again use Quest Diagnostics laboratory, if you prefer.

While Sutter Health did not have an interface with our previous EHR, athenahealth, SPMF has a full interface with the Epic EHR. Therefore, you may utilize the laboratory and imaging services of any Sutter Health facility, including the CPMC Davies Campus laboratory.

HIV/AIDS tests and postexposure prophylaxis (PEP)

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.

preexposure prophylaxis (PrEP)

The iPrex study was a clinical trial of 2,499 sexually active HIV negative men who have sex with men (MSM) that took place at sites in San Francisco, California, Lima, Peru, and other cities in Brazil, Ecuador, South Africa and Thailand. Trial participants were randomized to receive either tenofovir-emtricitabine (Truvada) or placebo. At the end of the trial, there was a reduction of 44% in the number of new HIV infections among the participants receiving Truvada as compared to those receiving placebo. The FDA has now approved Truvada for preexposure prophylaxis (taking one Truvada pill a day every day) for sexually active people at risk for HIV.

If you are a sexually active gay or bisexual man (or a heterosexually active man or woman at risk for HIV) and would like information about PrEP, please consult Dr. Owen or Carl Stein at your next visit to our office to determine if you might be a good candidate for PrEP and to discuss the risks and benefits.

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. Here is a link to an online search for the HIV clinical trials in the San Francisco Bay Area that are open to enrollment. For more information about these research organizations, please follow the links below.
In collaboration with The Buncke Clinic, an internationally renowned group of microsurgeons at the Davies Campus of CPMC, we are pleased to be the first practice to participate in a pilot study of for treating HIV related facial lipoatrophy (wasting) through stimulating the body's own stem cell response. Volunteers for this trial must either never have been treated previously for facial lipoatrophy or may have been treated with Sculptra, with the last treatment occurring at least 3 months ago. Volunteers should know that they are likely to have facial asymmetry for at least 6 months, as it is important to know if the treatment is effective by injecting only one side of the face and using the untreated side for comparison. Effectiveness will be judged by both ultrasound measurements of the face and by serial photographs. Contact Dr. Bill Owen or Carl Stein, PA-C, for further information about this trial.
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. 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.

[physical][pelvic][anoscopy][stool blood][sigmoexam][vaccines][travel][impotence][lab tests][HIV test][research]

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Last modified: February 01, 2015