July 26, 2018, Healio

The pelvic examination did not increase the sensitivity or specificity of chlamydia, gonorrhea or trichomonas diagnoses in young female patients with suspected cervicitis or pelvic inflammatory disease, according to findings recently published in Annals of Emergency Medicine.

“Physicians are taught that the pelvic exam is a crucial part of the evaluation of lower abdominopelvic pain in adolescent girls. When I began working in the emergency room I followed this medical mantra, until realizing the exam findings never seemed very specific. I pursued this topic to see if this part of the physical exam is really still necessary,” Cena Tejani, MD, of the Children’s Hospital of New Jersey, told Healio Family Medicine.

Other groups, including the American College of Gynecology, AAP and CDC, have also noted pelvic exams lack utility in asymptomatic women, according to researchers.

Tejani and colleagues obtained medical history and urine samples from 288 female patients aged 14 to 20 years who presented to an ED with lower abdominal pain or vaginal discharge. Tests for chlamydia, gonorrhea and trichomonas were conducted.

Researchers found that 79 had positive urine test results for chlamydia, gonorrhea or trichomonas, with an STD rate of 27.4% (95% CI, 22.6-32.8). The sensitivity of history with pelvic examination in diagnosis of cervicitis or pelvic inflammatory disease was 48.1% (95% CI, 36.8-59.5), and specificity was 60.7% (95% CI, 53.8-67.3). The sensitivity of history alone in diagnosis of cervicitis or pelvic inflammatory disease was 54.4% (95% CI, 42.8-65.5), and specificity was 59.8% (95% CI, 52.8-66.4).

In discussing the results, Tejani offered alternatives to the pelvic exam that primary care physicians can use.

“The use of a pelvic examination to diagnose cervicitis and pelvic inflammatory needs to be reconsidered. I suggest use of rapid urine [nucleic acid amplification testing]. These tests take 1 hour to run, so patients can wait in the office or emergency room for results. Primary care physicians should consider purchasing and using this test to make an accurate quick diagnosis.” – by Janel Miller

Disclosures:  The authors report no relevant financial disclosures.