Pelvic Exam in ER Doesn't Help Predict STI for Young Females
TUESDAY, July 10, 2018 -- Pelvic examination does not increase the sensitivity or specificity for diagnosis of chlamydia, gonorrhea, or trichomonas over taking a history alone for young female patients presenting to the emergency department with suspected cervicitis or pelvic inflammatory disease, according to a study published online July 2 in the Annals of Emergency Medicine.
Shamyla Farrukh, M.D., from Staten Island University Hospital North in New York, and colleagues enrolled 288 female patients age 14 to 20 years who presented to a pediatric emergency department with a complaint of vaginal discharge or lower abdominal pain. Patients provided a urine sample, which served as the criterion standard for diagnosis. A practitioner obtained a standardized history from the patient to assess for cervicitis or pelvic inflammatory disease; pelvic examination was performed by the same practitioner.
The researchers found that 79 patients had positive urine test results for chlamydia, gonorrhea, or trichomonas, with a 27.4 percent sexually transmitted infection rate. For diagnosis of cervicitis or pelvic inflammatory disease, the sensitivity of history alone was 54.4 percent, while the specificity was 59.8 percent. The sensitivity of history with pelvic examination was 48.1 percent, while specificity was 60.7 percent. In 71 cases, the information from the pelvic examination changed management; 35 of these cases correlated with the sexually transmitted infection test and 36 did not.
"Because the test characteristics for the pelvic examination are not adequate, its routine performance should be reconsidered," the authors write.
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Posted: July 2018