The Additive Value of Pelvic Examinations to History in Predicting Sexually Transmitted Infections for Young Female Patients With Suspected Cervicitis or Pelvic Inflammatory Disease
| Autor: | Cena Tejani, Bilgehan Onogul, Adam B. Sivitz, Shamyla Farrukh, Kavita Patel |
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| Rok vydání: | 2017 |
| Předmět: |
Vaginal discharge
medicine.medical_specialty Adolescent Gonorrhea Sexually Transmitted Diseases Cervicitis Trichomonas Infections Physical examination Sensitivity and Specificity 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine Pelvic inflammatory disease medicine Urban Health Services Humans 030212 general & internal medicine Prospective Studies Pelvic examination Chlamydia Trichomoniasis medicine.diagnostic_test business.industry 030208 emergency & critical care medicine Chlamydia Infections medicine.disease Uterine Cervicitis Emergency Medicine Female Gynecological Examination medicine.symptom business Pelvic Inflammatory Disease |
| Zdroj: | Annals of emergency medicine. 72(6) |
| ISSN: | 1097-6760 |
| Popis: | Study objective We evaluate the additive value of pelvic examinations in predicting sexually transmitted infection for young female patients with suspected cervicitis or pelvic inflammatory disease in a pediatric emergency department (ED). Methods This was 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. Enrolled patients provided a urine sample for chlamydia, gonorrhea, and trichomonas testing, which served as the criterion standard for diagnosis. A practitioner (pediatric ED attending physician, emergency medicine or pediatric resident, pediatric ED fellow, or advanced practice provider) obtained a standardized history from the patient to assess for cervicitis or pelvic inflammatory disease according to the Centers for Disease Control and Prevention criteria. They then recorded the likelihood of cervicitis or pelvic inflammatory disease on a 100-mm visual analog scale. The same practitioner then performed a pelvic examination and again recorded the likelihood of cervicitis or pelvic inflammatory disease on a visual analog scale with this additional information. Using the results of the urine sexually transmitted infection tests, the practitioner calculated and compared the test characteristics of history alone and history with pelvic examination. Results Two hundred eighty-eight patients were enrolled, of whom 79 had 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%). The sensitivity of history alone in diagnosis of cervicitis or pelvic inflammatory disease was 54.4% (95% CI 42.8% to 65.5%), whereas the specificity was 59.8% (95% CI 52.8% to 66.4%). The sensitivity of history with pelvic examination in 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%). The information from the pelvic examination changed management in 71 cases; 35 of those cases correlated with the sexually transmitted infection test and 36 did not. Conclusion For young female patients with suspected cervicitis or pelvic inflammatory disease, the pelvic examination does not increase the sensitivity or specificity of diagnosis of chlamydia, gonorrhea, or trichomonas compared with taking a history alone. Because the test characteristics for the pelvic examination are not adequate, its routine performance should be reconsidered. |
| Databáze: | OpenAIRE |
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