• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Does Pelvic Exam Provide Any Additional Benefit When Diagnosing STDs in Adolescents and Young Women?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE: 

  • In the US, STDs caused by gonorrhea and chlamydia are highest in adolescents and young women 15-24 years of age  
  • Farrukh et al. (Annals of Emergency Medicine, 2018) sought to determine the additive value of pelvic exam for predicting sexually transmitted infection (STI) with suspected cervicitis or pelvic inflammatory disease in a pediatric emergency department (ED)

METHODS: 

  • Prospective observational study (blinded) 
  • Participants 
    • Female patients 14 to 20 years  
    • Chief complaint of vaginal discharge or lower abdominal pain (regardless of pregnancy status)  
    • Exclusion: Pulse rate >110 bpm or systolic BP <90 mm Hg | Needs critical care management | Refuses testing | Never had a pelvic examination 
  • Practioners 
    • Pediatric ED attending physician | Emergency medicine or pediatric resident | Pediatric ED fellow | Advanced practice provider 
  • Urine sample obtained for chlamydia, gonorrhea, and trichomonas (genomic molecular test)  
    • Turnaround time for gonorrhea and chlamydia: 3 to 5 days 
    • Turnaround time for trichomonas: 1 to 3 hours  
  • To assess for STI, practioners 
    • Obtained a standardized history and recorded the likelihood of cervicitis or pelvic inflammatory disease on a 100-mm visual analog scale (VAS) score (based on CDC criteria) 
    • Performed a pelvic examination and recorded a second VAS score 
      • Score of ≥50 meant practioner thought patient had STI and should be treated  
    • Physical examination portion of the data form included  
      • External genital visual inspection 
      • Speculum exam  
      • Bimanual exam  
    • Using the results of the urine STI tests, investigators calculated and compared the test characteristics of history alone and history with pelvic examination for the detection of STI

RESULTS: 

  • 288 patients had complete urine tests and VAS scores 
    • STI rate of 27.4% based on urine tests  
  • Prior to pelvic exam: 127 patients were thought to STD 
  • After the pelvic examination 
    • Management changed in 71 cases 
      • 35 of those cases had confirmed STI on urine test 
      • 36 cases were not confirmed 
  • History alone for the diagnosis of STI  
    • Sensitivity: 54.4% (95% CI, 42.8% to 65.5%) 
    • Specificity: 59.8% (95% CI 52.8% to 66.4%) 
  • Pelvic examination included (2nd VAS) 
    • Sensitivity: 48.1% (95% CI 36.8% to 59.5%) 
    • Specificity: 60.7% (95% CI 53.8% to 67.3%) 
  • Cervical motion tenderness, adnexal tenderness, and uterine tenderness were not significantly different between groups

CONCLUSION: 

  • Authors acknowledge potential limitations 
    • Urine test more sensitive for chlamydia but may be less sensitive for gonorrhea compared to cervical swabs 
    • ‘Convenience sample’ and not consecutive patients   
    • Other organisms can cause STI beyond the 3 tested for in this study  
  • For young female patients with suspected cervicitis or PID that can be managed as an outpatient, pelvic examination does not increase quality of diagnosis for chlamydia, gonorrhea, or trichomonas

Learn More – Primary Sources: 

The Additive Value of Pelvic Examinations to History in Predicting Sexually Transmitted Infections for Young Female Patients With Suspected Cervicitis or Pelvic Inflammatory Disease

image_pdfFavoriteLoadingFavorite

< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

ACOG, AAFP & USPSTF Guidance: Still a Role for the Annual Pelvic Exam?
The ABCs of PID Diagnosis – What You Need to Know
Chlamydia: CDC Recommendations for Diagnosis and Treatment
Sexually Transmitted Diseases and Partner Notification
Practical obstetrics info for your women's healthcare practice
STI Screening in Pregnancy: CDC Recommendations
Trichomoniasis: CDC Diagnosis and Treatment Guidelines
Gonorrhea: CDC Diagnosis and Treatment Guidelines

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site