A new review of nearly 300 cases treated at a pediatric emergency department implies that pelvic exams fail to help doctors diagnose sexually transmitted diseases (STDs) in adolescent girls. The finding that a routine medical procedure is essentially without benefit may sound like grim news, but there is actually a silver lining.  

Citing past research, the authors of the current study, published in the Annals of Emergency Medicine, claim that patients are less likely to return for follow-up visits when they know that it will involve a pelvic exam. Given that urine tests are known to be far more accurate anyway, they believe that shifting away from mandatory exams when STDs are suspected may help increase rates of preventative care and treatment among teen and young adult women. The CDC now estimates that one in four sexually active females aged 15 to 24 years has an STD. 

The researchers, led by Dr Cena Tejani at Newark Beth Israel Medical Center, drew their conclusion from observations of 288 patients (14 to 20 years of age) who came to the clinic because of symptoms suggestive of an STD. In 217 of these cases, pelvic exam findings had no influence on the physician’s treatment decision. In the 71 cases where the exams did sway doctors, the findings were only in line with results of laboratory tests half of the time. Furthermore, the authors reported that the pelvic exams were not consistently helpful when doctors were trying to differentiate if a patient was positive or negative for an infection; according to urine analyses, 79 patients had chlamydia, gonorrhea, or trichomoniasis infections. 

"Pelvic exams lack reliability and provide very little new information when compared with other methods of diagnosis. A closer review of STD diagnosis protocol could benefit the health and well-being of adolescent women all over the country," Dr Tejani said in a statement. “Sexually transmitted disease rates for adolescent women are reaching their highest recorded rate."

Gonorrhea, the second most commonly reported communicable disease, is on a particularly troubling upswing. Between 2015 and 2016, rates of infection increased 11.3 percent in people 15 to 19 years of age and 10.9 percent in those 20 to 24. The increasingly antibiotic-resistant causative bacteria spreads easily because male carriers are often asymptomatic, and thus do not seek treatment before engaging in sexual activity. Untreated gonorrhea in women can lead to pelvic inflammatory disease and, eventually, infertility. 

Urine samples are considered to be less accurate for diagnosis than cultures or stains performed from vaginal and cervical swabs that would typically be collected during an exam, but the authors note that infection surveillance programs could turn instead to patient-collected sampling. 

For infections that can be reliably detected with urine, including chlamydia (the number one most common communicable disease), Dr Tejani recommends that clinics invest in routine rapid urine STD panels. 

Now, bear in mind that this research does not invalidate the benefit of Pap smears, a procedure that tests for cervical abnormalities that could indicate HPV infection or cancer. This type of exam is recommended every few years for sexually active women up to age 65.