Routine Pelvic Examinations in Asymptomatic Young Women

Abstract
A first-catch urine sample from women may be an appropriate specimen for diagnosing chlamydial and gonococcal infection by DNA-amplification procedures.1,2 This noninvasive means of obtaining a diagnostic specimen may provide a way to reach sexually active women who should be screened for sexually transmitted diseases but who lack adequate access to health care or fear pelvic examinations. One concern about substituting the examination of first-catch urine specimens for pelvic examinations is that clinical information may be lost. To determine the treatable conditions that were detected during routine pelvic examinations, we reviewed the charts of all girls and young women (13 to 20 years of age) who had routine pelvic examinations at a health maintenance organization and a university-based clinic for teenagers. During a one-year period 564 girls and young women had pelvic examinations, and 330 (mean age, 16.4 years) met our criteria: they were sexually active, were asymptomatic (symptoms were not the reason for the visit), and had tests for chlamydiae and gonococci. Most of the pelvic examinations (51 percent) were routine, 15 percent were done to rule out sexually transmitted diseases, 13 percent to rule out pregnancy, and 21 percent to establish a means of contraception. According to their histories, 78 percent of the subjects had had no recent genital symptoms, whereas 15 percent had had vaginal discharge, itching, or abnormal bleeding. On examination, 92 percent of the subjects had no abnormal signs; the most common finding (6 percent) was vaginal discharge. A total of 6.2 percent had chlamydial infection, and 0.6 percent had gonorrhea on the basis of culture, enzyme immunoassay, or both. Wet mounts were positive for infection in about 12 percent (5 percent had a yeast infection, 6 percent bacterial vaginosis, and 2 percent trichomoniasis). Nine percent of the subjects were pregnant, and 1.4 percent had an abnormal Papanicolaou smear (all had cervical intraepithelial neoplasia grade 1 or low-grade squamous intraepithelial lesions).