Written by Vivian Lei
Pelvic examination added little to clinical judgment when evaluating for sexually transmitted infections (STIs) in young women.
Why does this matter?
STIs are rampant, and diagnosis is often based on a combination of historical features and physical exam findings. This study examined whether the pelvic examination continues to be a useful “test” in evaluating adolescent patients for suspected cervicitis or pelvic inflammatory disease.
Drop the speculum
Investigators enrolled 288 women aged 14 to 20 years who presented to an academic pediatric ED with a complaint of vaginal discharge or lower abdominal pain. Each patient provided a urine sample for STI testing. A standardized history was obtained from each patient to assess for cervicitis or pelvic inflammatory disease and a pelvic examination was performed. Of the 288 patients, 79 tested positive for an STI (overall prevalence 27.4%; 22.6% chlamydia, 6% gonorrhea, 3.5% trichomonas, and 4.5% coinfection). Before the pelvic examination, 127 patients were thought to have cervicitis or pelvic inflammatory disease. After the pelvic examination, management changed in 71 cases. However, 35 of those cases correlated with a positive urine STI test and 36 did not, meaning that any information obtained by the pelvic examination did not consistently redirect the clinician to better identify an STI.
Of course, there are other clinically important reasons for performing a pelvic exam. However, this study supports that there is little clinical or diagnostic benefit of a routine pelvic exam in a pediatric ED setting when evaluating for STI. Additionally, the authors comment that adolescent women may be less likely to engage in healthcare if a routine pelvic exam is expected.
The Additive Value of Pelvic Examinations to History in Predicting Sexually Transmitted Infections for Young Female Patients With Suspected Cervicitis or Pelvic Inflammatory Disease. Ann Emerg Med. 2018 Dec;72(6):703-712.e1. doi: 10.1016/j.annemergmed.2018.05.004. Epub 2018 Jul 2.
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Reviewed by Clay Smith