title: The role of speculum and bimanual examinations when evaluating attendees at a sexually transmitted diseases clinic.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Divisions of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.rsingh6@jhmi.edu
authors.forename: Rameet H
authors.initials: RH
authors.lastname: Singh
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Erbelding
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Zenilman
authors.forename: Khalil G
authors.initials: KG
authors.lastname: Ghanem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000209:etiology; D010808:Physical Examination / Q000379:methods; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D013048:Specimen Handling / Q000379:methods; D002577:Uterine Cervical Diseases / Q000175:diagnosis*; D014623:Vaginal Diseases / Q000175:diagnosis*; D014626:Vaginal Smears