Comparison of Clinical Evaluation of Genitourinary Symptoms in Female Adolescents Among Primary Care Versus Emergency Department Physicians

Objective: To compare clinical approaches to assessment and treatment of female adolescents with genitourinary symptoms among primary care and emergency department (ED) physicians.

Design: A chart review was performed of the evaluation and treatment of 472 patients presenting between July 1, 2005, and June 30, 2006.

Setting: Suburban and tertiary care EDs and primary care settings.

Participants: Female patients age 13-21 years with genitourinary symptoms.

Interventions: None.

Outcome Measures: Physician assessment of sexual history, performance of pelvic exam and sexually transmitted infection (STI) tests, empiric treatment of suspected STIs.

Results: Patients seen in primary care settings were more likely to be asked about sexual history, including contraceptive use, than patients in the ED (P<0.001). After adjustment for age and race, there was no statistically significant difference between the ED and primary care sites in performance of pelvic exams or gonorrhea and chlamydia tests. However, there was a higher likelihood that older adolescents would undergo pelvic exams (P=0.001), and STI testing (P=0.002) than younger patients. There was no significant difference in empiric treatment of patients with positive STI tests between ED and primary care sites or across the age spectrum.

Conclusions: ED physicians should obtain sexual histories on patients with genitourinary symptoms. Both primary care and ED clinicians should consistently test for STIs in sexually active patients who have genitourinary symptoms. Physicians in both settings should have a low threshold for testing and empirically treating adolescents with symptoms or physical exam findings consistent with STIs.