Is the routine pelvic examination needed with the advent of urine-based screening for sexually transmitted diseases?

Objective: To determine the most cost-effective method of screening for chl amydia and gonorrhea to prevent pelvic inflammatory disease (PID) in asympt omatic sexually active adolescent females. Design: Cost-effectiveness decision analysis comparing pelvic examination w ith cervical screening (the current national standard) with a model of urin e screening with ligase chain reaction testing for Chlamydia trachomatis an d Neisseria gonorrhoeae. Methods: Four strategies using decision analysis were compared for a potent ial cohort of 100 000 asymptomatic sexually active young women: (1) pelvic examination screening in 100%; (2) urine screening in 100%; (3) actual pred icted pelvic examination screening in 70%; and (4) actual predicted urine s creening in 90%. Assumptions and costs were generated from published source s. Main Outcome Measures: Cases of PID prevented per year and cost to prevent a case of PID. Results: A total of 1750 cases of PID would be predicted to occur per year with no screening. Strategy 1 would prevent the most cases of PID (1283) at a mean cost of $10 230. Strategy 2 would prevent 1215 cases of PID at a mea n cost of $5093. The marginal cost to prevent an additional case of PID by strategy 1 is $101 454. Strategy 3 would prevent 898 cases of PID and 1093 cases of PID would be prevented with urine screening in strategy 4. Conclusion: Urine-based ligase chain reaction screening is the most cost-ef fective strategy to detect chlamydial and gonococcal genital infection in a symptomatic sexually active adolescent females and, owing to ease of implem entation, the most likely to prevent the greatest number of cases of PID.