The Role of Speculum and Bimanual Examinations when Evaluating STD Clinic Attendees.

Abstract

Objective: With the advent of molecular techniques, self-collected specimens without a clinician's exam are often adequate to detect common genital infections. We evaluate the additional information speculum and bimanual examinations provide clinicians in routine evaluation of genital infections among STD clinic attendees.

Methods: Cross-sectional study from a database of all visit records to two STD clinics in Baltimore between 1996 and 2002. Women were stratified based on their reason for visit. Proportional and likelihood ratio (LR) estimates of the speculum examination in detecting clinically significant cervicovaginal lesions (leading to a diagnosis of other infections or outside referral) and bimanual examination in detecting abnormalities (leading to a diagnosis of pelvic inflammatory disease or referral) are presented.

Results: 15,918 of 21,703 records were included: 12,073 were symptomatic (SYM) (discharge, rash, abdominal pain, dysuria, genital irritation, or odor), 1,676 were asymptomatic contacts of an infected partner (CON), and 2,169 were asymptomatic and presented for checkup (ASYM). The median age was 26 years, 94% were Black. 11.8% of SYM, 4.6% of CON, and 3.9% of ASYM patients had clinically meaningful lesions detected on speculum examination. The bimanual examination detected clinically significant abnormalities in 6.5% of SYM, 0.8% of CON, and 0.6% of ASYM patients.

Conclusion: Symptomatic women are most likely to benefit from speculum and bimanual examinations. Their yield in evaluating asymptomatic women is low. Prospective studies are needed to determine whether eliminating speculum and bimanual examinations in a subset of women would offer an operational advantage without compromising patient safety.