Genital examination, microscopy and high vaginal swabs: are these valuable components of a sexually transmitted infection screen in asymptomatic women?

Abstract

Improving access to genitourinary (GU) medicine services in the face of increasing demand and escalating rates of sexually transmitted infections (STIs) necessitates a review of current practice and modernization of service provision. At a time when GU medicine resources are limited and technology is available to perform non-invasive screening tests for chlamydia and gonorrhoea, we question the cost-effectiveness of routine genital examination, microscopy and culture of a high vaginal swab (HVS) in the management of asymptomatic women attending a GU medicine clinic. We conducted a case-note review of 206 consecutive asymptomatic female GU medicine clinic attendees who requested 'a check up'. We conclude that routine on-site microscopy of samples from the cervix, urethra and vagina, and laboratory culture of a HVS did not influence the outcome of patient care. No clinically significant genital tract pathology was identified on examination, with the possible exception of one woman in whom HSV1 was diagnosed opportunistically. The results of this study have significant implications for service provision and patient management.