Routine Pelvic Examinations in Asymptomatic Young Women

Schachter, Julius; Shafer, Mary–Ann; Young, Myra; Ott, Mary A.

doi:10.1056/nejm199612123352417

Cited by 22 publications

(16 citation statements)

References 3 publications

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“…There has been debate as to whether pelvic examination of young women is beneficial in these programmes. However, the rate of detectable pathology in this group is so low that it may not be necessary [95].…”

Section: Discussionmentioning

confidence: 92%

The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review

Watson¹,

Templeton²,

Russell

et al. 2002

Journal of Medical Microbiology

192

114

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Screening women for lower genital tract infection with Chlamydia trachomatis is important in the prevention of pelvic inflammatory disease, ectopic pregnancy and infertility. This systematic review aims to state clearly which of the available diagnostic tests for the detection of C. trachomatis would be most effective in terms of clinical effectiveness. The review included all studies published from 1990 onward that evaluated diagnostic tests in asymptomatic, young, sexually active populations. Medline and Embase were searched electronically and key journals were hand-searched. Further studies were identified through the Internet and contact with experts in the field. All studies were reviewed by two reviewers and were scored by Irwig's assessment criteria. Additional quality assessment criteria included a documented sexual history and recording of previous chlamydial infection. The reviews were subjected to meta-analysis and meta-regression. The 30 studies that were included examined three types of DNAbased test -ligase chain reaction (LCR), PCR and gene probe -as well as enzyme immuno-assay (EIA). The results showed that while specificities were high, sensitivities varied widely across the tests and were also dependent on the specimen tested. Pooled sensitivities for LCR, PCR, gene probe and EIA on urine were 96.5%, 85.6%, 92% and 38%, respectively, while on cervical swabs the corresponding sensitivities of PCR, gene probe and EIA were 88.6%, 84% and 65%. Meta-analysis demonstrated that DNA amplification techniques performed best for both urine and swabs in low prevalence populations. We conclude that nucleic acid amplification tests used on non-invasive samples such as urine are more effective at detecting asymptomatic chlamydial infection than conventional tests, but there are few data to relate a positive result with clinical outcome.

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Section: Discussionmentioning

confidence: 92%

The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review

Watson¹,

Templeton²,

Russell

et al. 2002

Journal of Medical Microbiology

192

114

View full text Add to dashboard Cite

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“…10,25,26,42 for whom all prior test results (Ն1) were negative during the study period. OR indicates odds ratio; CI, confidence interval; STD, sexually transmitted disease; and ellipses, data not applicable.…”

Section: -41mentioning

confidence: 99%

Incident <EMPH TYPE="ITAL">Chlamydia trachomatis</EMPH> Infections Among Inner-city Adolescent Females

Burstein

Gaydos²,

Diener‐West

et al. 1998

JAMA

249

129

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Context.-Adolescents are at highest risk for infection with Chlamydia trachomatis, an important preventable cause of pelvic inflammatory disease and subsequent tubal factor infertility in US women. Current guidelines for delivery of adolescent primary care services recommend yearly chlamydia screening for those adolescent females considered to be at risk.Objectives.-To describe the epidemiology of prevalent and incident chlamydia infection among adolescent females to assess the appropriate interval for chlamydia screening and to define risk factors that would identify adolescent females to target for screening.Design.-Prospective longitudinal study.Patients.-A consecutive sample of 3202 sexually active females 12 through 19 years old making 5360 patient visits over a 33-month period, January 1994 through September 1996.Setting.-Baltimore, Md, family planning, sexually transmitted disease, and school-based clinics.Intervention.-Testing for C trachomatis by polymerase chain reaction. Main Outcome Measures.-Prevalence and incidence of C trachomatis infections; predictors of positive test result for C trachomatis.Results.-Chlamydia infection was found in 771 first visits (24.1%) and 299 repeat visits (13.9%); 933 adolescent females (29.1%) had at least 1 positive test result. Females who were 14 years old had the highest age-specific chlamydia prevalence rate (63 [27.5%] of 229 cases; P=.01). The chlamydia incidence rate was 28.0 cases per 1000 person-months (95% confidence interval, 24.9-31.5 cases). The median time was 7.2 months to a first positive chlamydia test result and 6.3 months to a repeat positive test result among those with repeat visits. Independent predictors of chlamydia infection-reason for clinic visit, clinic type, prior sexually transmitted diseases, multiple or new partners, or inconsistent condom use-failed to identify a subset of adolescent females with the majority of infections.Conclusions.-A high prevalence and incidence of C trachomatis infection were found among adolescent females. We, therefore, recommend screening all sexually active adolescent females for chlamydia infection every 6 months, regardless of symptoms, prior infections, condom use, or multiple partner risks.

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“…Reasons given by physicians for performing the bimanual pelvic examination include that it is a standard part of a well woman examination, to screen for ovarian cancer, to screen for other gynecologic cancers, to screen for sexually transmitted infections (STIs), 2 and as a requirement for hormonal contraception. 3 A study 4 surveyed physicians and found that 47% of obstetrician-gynecologists believed that the pelvic examination is an effective screening test for ovarian cancer.…”

Section: Introductionmentioning

confidence: 99%