Low yield of anogenital examination among asymptomatic clients of an urban sexual health clinic

Abstract

Background: The use of self-collected specimens to test for sexually transmissible infections (STI) has reduced the opportunity for physical examination. Physical examination has been found to be of limited value in asymptomatic heterosexual women and men; however, prior studies have excluded higher risk populations. We performed a retrospective cross-sectional study to determine the diagnostic yield of physical examination among all clients attending our sexual health service.

Methods: The Sydney Sexual Health Centre database was used to identify asymptomatic clients attending for the first time between January and June 2009. Demographic and behavioural data were extracted from the database for all clients. Medical records were then manually reviewed to determine the number and nature of diagnoses related to the examination and whether this varied by sex and sex of sexual partners.

Results: Of the 590 clients included, 450 (76%) received anogenital examinations. Ten (2.2%; 95% confidence interval 1.1-4.1%) STI were found, including four cases of cervicitis, four of anogenital warts and two of molluscum. Nineteen (4.2%) other non-STI conditions were detected, mostly in heterosexual women and men who have sex with men (MSM).

Conclusion: Physical examination of asymptomatic clients attending our sexual health clinic was of limited value, even among higher risk individuals such as MSM. Sexual health clinics should direct resources currently used to examine clients towards increasing the STI testing rate.