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The role of speculum and bimanual examinations when evaluating attendees at a sexually transmitted diseases clinic
  1. Rameet H Singh1,
  2. Emily J Erbelding2,
  3. Jonathan M Zenilman2,
  4. Khalil G Ghanem2
  1. 1Divisions of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Divisions of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to:
 Dr R H Singh
 Department of Obstetrics and Gynecology, Johns Hopkins University, Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA; rsingh6{at}


Background: With the advent of molecular techniques, self-collected specimens without a clinician’s examination are often adequate to detect common genital infections.

Objective: To evaluate the additional information that speculum and bimanual examinations provides clinicians in the routine evaluation of genital infections among attendees of a sexually transmitted disease (STD) clinic.

Methods: Cross-sectional study from a database of all visit records to two STD clinics in Baltimore between 1996 and 2002. Women were stratified on the basis of reason for visit. Proportional and likelihood ratio estimates of the speculum examination in detecting clinically relevant cervicovaginal lesions (leading to a diagnosis of other infections or outside referral for further management) 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 odour), 1676 were asymptomatic contacts of an infected partner (CON) and 2169 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 relevant 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. However, 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.

  • ASYM, asymptomatic patients, not known to be contacts of partners with a STI presenting to clinic for a check-up
  • CON, asymptomatic women who presented as known contacts of a partner with a STI
  • PID, pelvic inflammatory disease
  • STD, sexually transmitted disease
  • STI, sexually transmitted infection
  • SYM, women with symptoms

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  • Published Online First 15 November 2006

  • Funding: None.

  • Competing interests: None.

  • RHS and KGG were involved in the study design, analysis and drafting of the manuscript; EJE and JMZ were involved in the study design and revision of the manuscript.