Farrukh S, et al. - In a pediatric emergency department (ED), pelvic examinations were evaluated for their additive value in predicting sexually transmitted infection for young female patients with suspected cervicitis or pelvic inflammatory disease. As per findings, the pelvic examination did not seem to increase the sensitivity or specificity of chlamydia, gonorrhea, or trichomonas diagnosis vs taking a history alone among these young female patients.

Methods

• Researchers performed a prospective observational study of female patients aged 14 to 20 years who presented to an urban academic pediatric ED with a complaint of vaginal discharge or lower abdominal pain.
• A urine sample was provided by the enrolled patients for chlamydia, gonorrhea, and trichomonas testing, which served as the criterion standard for diagnosis.
• A standardized history from the patient was taken by a practitioner (pediatric ED attending physician, emergency medicine or pediatric resident, pediatric ED fellow, or advanced practice provider) to assess for cervicitis or pelvic inflammatory disease according to the Centers for Disease Control and Prevention criteria.
• Then on a 100-mm visual analog scale, they recorded the likelihood of cervicitis or pelvic inflammatory disease.
• Then a pelvic examination was performed by the same practitioner, who again recorded the likelihood of cervicitis or pelvic inflammatory disease on a visual analog scale with this additional information.
• The results of the urine sexually transmitted infection tests were used by the practitioner to calculate and compare the test characteristics of history alone and history with pelvic examination.

Results

• Researchers enrolled 288 patients; of whom, 79 displayed positive urine test results for chlamydia, gonorrhea, or trichomonas, with a sexually transmitted infection rate of 27.4% (95% confidence interval [CI] 22.6% to 32.8%).
• In diagnosis of cervicitis or pelvic inflammatory disease, the sensitivity of history alone was 54.4% (95% CI 42.8% to 65.5%), whereas the specificity was 59.8% (95% CI 52.8% to 66.4%).
• Observations revealed that the sensitivity of history with pelvic examination in the diagnosis of cervicitis or pelvic inflammatory disease was 48.1% (95% CI 36.8% to 59.5%), whereas the specificity was 60.7% (95% CI 53.8% to 67.3%).
• In 71 cases, management changed in light of information from the pelvic examination; 35 of those cases correlated with the sexually transmitted infection test and 36 did not.