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Al-Kuran OA, AL-Mehaisen L, Al-Karablieh M, Abu Ajamieh M, Flefil S, Al-Mashaqbeh S, Albustanji Y, Al-Kuran L. Gynecologists and pelvic inflammatory disease: do we actually know what to do?: A cross-sectional study in Jordan. Medicine (Baltimore) 2023; 102:e35014. [PMID: 37800796 PMCID: PMC10553103 DOI: 10.1097/md.0000000000035014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/08/2023] [Indexed: 10/07/2023] Open
Abstract
Pelvic inflammatory disease (PID) is an upper genital tract infection caused by a variety of aerobic and anaerobic microorganisms ascending from the cervix or vagina. Though PID is mainly a sexually transmitted disease; 15% are non-sexually transmitted.[1] In our study, we aim to assess gynecologists' understanding and awareness of PID; as it presents an important health issue affecting the Jordanian community and similar communities with the same cultural and religious backgrounds. A cross-sectional study was conducted using an online questionnaire that received responses from 172 gynecologists in Jordan. The questionnaire aimed at testing gynecologists' knowledge of different aspects of PID starting with diagnosis and ending with management. 68.6% of gynecologists acknowledged that PID is a problem in Jordan. However, obvious confusion was observed in the scopes of clinical presentation, choosing the most reliable PID investigations, and treatment. PID is not being addressed properly in a sexually conservative community that has low rates of sexually transmitted diseases like Jordan, which is misleading and dangerous. In addition, we think there is a lack of certain standards on how to define PID and acknowledge its effect on the community as well as the disappointing level of knowledge about different aspects of PID gynecologists show, starting with its prevalence and ending with treatment policy. Clearer guidelines for the diagnosis, management, and prevention of PID should be adopted. These findings should be acknowledged by all doctors from neighboring countries as well as those within similar communities to Jordan.
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Affiliation(s)
- Oqba Al Al-Kuran
- Department of Obstetrics and Gynecology, School of Medicine, University of Jordan, Amman, Jordan
| | - Lama AL-Mehaisen
- Department of Obstetrics and Gynecology, School of Medicine, Al-Balqa Applied University, Salt, Jordan
| | | | | | | | | | | | - Lena Al-Kuran
- School of Medicine, University of Jordan, Amman, Jordan
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Bittleston H, Hocking JS, Goller JL, Coombe J, Bateson D, Sweeney S, Fleming K, Huston WM. Is there a place for a molecular diagnostic test for pelvic inflammatory disease in primary care? An exploratory qualitative study. PLoS One 2022; 17:e0274666. [PMID: 36121793 PMCID: PMC9484633 DOI: 10.1371/journal.pone.0274666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
There is currently no test for pelvic inflammatory disease (PID) that is non-invasive and sufficiently sensitive and specific. Clinicians must therefore diagnose PID clinically, ruling out medical emergencies and conducting pelvic examinations where possible. While guidelines state that clinicians should be prepared to over-diagnose PID, it remains an under-diagnosed condition, with severe reproductive health impacts when left untreated. This research is the first to consider the perspectives of end-users on the development of a diagnostic test for PID.
Methods
Semi-structured live video feed online (Zoom) interviews were conducted with 11 clinicians and nine women (aged 18–30 years) in Australia to understand how a diagnostic test might be used, and what characteristics a test would need for it to be acceptable to clinicians and young women. Participants were recruited via researcher and university student networks. Reflexive thematic analysis was used to identify key themes relating to the acceptability and characteristics of a diagnostic test for PID.
Results
Seven general practitioners, four clinicians working in sexual health clinics, and nine young women (aged 21–27 years) were interviewed. Clinicians were aged between 31–58 years and were predominantly female. Clinicians recognised that the development of an accurate test to diagnose PID would be valuable to themselves and other clinicians, particularly those who lack experience diagnosing PID, and those working in certain settings, including emergency departments. They discussed how they might use a test to enhance their clinical assessment but highlighted that it would not replace clinical judgement. Clinicians also considered how a test would impact the patient experience and time to treatment, emphasising that it should be minimally invasive and have a quick turnaround time. Young women said a test would be acceptable if endorsed by a trustworthy clinician.
Conclusions
PID remains a challenging diagnosis. Development of a minimally invasive and sufficiently accurate diagnostic test would be acceptable to young women and benefit some clinicians, although no test would completely replace an experienced clinician’s judgement in making a PID diagnosis.
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Affiliation(s)
- Helen Bittleston
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- * E-mail: (HB); (WMH)
| | - Jane S. Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane L. Goller
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Family Planning NSW, Newington, New South Wales, Australia
- Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sally Sweeney
- Family Planning NSW, Newington, New South Wales, Australia
| | | | - Wilhelmina M. Huston
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
- * E-mail: (HB); (WMH)
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Goller JL, De Livera AM, Fairley CK, Guy RJ, Bradshaw CS, Chen MY, Simpson JA, Hocking JS. Population attributable fraction of pelvic inflammatory disease associated with chlamydia and gonorrhoea: a cross-sectional analysis of Australian sexual health clinic data. Sex Transm Infect 2016; 92:525-531. [DOI: 10.1136/sextrans-2015-052195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 02/21/2016] [Accepted: 03/26/2016] [Indexed: 11/04/2022] Open
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Pacheco M, Katz AR, Hayes D, Maddock JE. Physician Survey Assessing Pelvic Inflammatory Disease Knowledge and Attitudes to Identify Diagnosing and Reporting Barriers. Womens Health Issues 2015; 26:27-33. [PMID: 26341567 DOI: 10.1016/j.whi.2015.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 07/24/2015] [Accepted: 07/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pelvic inflammatory disease (PID) is a notifiable disease in Hawaii with legal implications for noncompliance. A previous study comparing PID diagnoses in Hawaii's hospitals and state surveillance data confirmed underreporting in Hawaii. Reasons for noncompliance and underreporting are not well understood. METHODS All licensed primary care physicians in Hawaii were mailed a survey addressing PID diagnosis and reporting attitudes and practices. Hierarchical logistic regression was used to determine if physician characteristics, PID knowledge, or attitudes related to the diagnosis or reporting of PID, increased the odds of diagnosing and reporting PID. RESULTS Among survey respondents (486 of 1,062; response rate of 45.8%), 104 (21.4%) had diagnosed PID. The PID reporting rate was 55.8% (58 of 104). The majority of physicians who diagnosed PID reported that PID reporting was time consuming. In hierarchical regression, obstetrician/gynecologists and family practitioners had the highest odds of diagnosing PID and internists had the lowest odds of reporting PID, those 15 years or longer since residency were less likely to report PID than those fewer than 15 years since residency, and increased PID diagnosing and reporting knowledge increased the odds of PID reporting by 1.63 times. CONCLUSION Our findings suggest the need for training of all physicians on reportable diagnoses on a regular basis. There is a need to simplify the reporting process, because the time burden of reporting may present a modifiable barrier to reporting. Increased PID-related communication between local health departments and physicians is essential, and physicians should be provided technical assistance with reporting.
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Affiliation(s)
- Misty Pacheco
- Office of Public Health Studies, Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, Hawaii.
| | - Alan R Katz
- Office of Public Health Studies, Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Donald Hayes
- Family Health Services Division, Hawaii Department of Health, Honolulu, Hawaii
| | - Jay E Maddock
- Office of Public Health Studies, Department of Public Health Sciences, University of Hawaii at Manoa, Honolulu, Hawaii
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Li M, McDermott R. Smoking, poor nutrition, and sexually transmitted infections associated with pelvic inflammatory disease in remote North Queensland Indigenous communities, 1998-2005. BMC WOMENS HEALTH 2015; 15:31. [PMID: 25887145 PMCID: PMC4392641 DOI: 10.1186/s12905-015-0188-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022]
Abstract
Background Indigenous women in remote North Queensland have a high prevalence of unhealthy lifestyle behaviors and associated health conditions such as sexual transmitted infections (STI). The association of severe pelvic inflammatory disease (PID) with these factors has not been studied. The purpose of this study is to associate the factors with severe PID, as indicated by hospitalization in a high risk population in North Queensland Indigenous communities. Methods A cross-sectional association of 1445 Indigenous women using linked hospital separation and survey data during 1998–2005. Results The mean age of participating women was 37.4 years, 60% were of Aboriginal and 40% were Torres Strait Island (TSI) people. More than half of them (52.5%) were smokers, 9.3% had chlamydia and 2.6% had gonorrhoea with the overall prevalence of STI among those less than 25 years of age being 23.9%. Among the 47 participants diagnosed with PID in the study period, 42.5% were under 25 years and 95.7% (45 cases) were under 55 years (OR 2.5, 95% CI 1.2-4.1 among women younger than 25 compared to those 25 years and over). PID was strongly associated with smoking (OR 3.1, 95% CI 1.4-9.2) independent of age, ethnicity, STI and folate status. Low red cell folate increased PID hospitalization by 4 times (95% CI 1.5-13.2 of lowest quartile compared to the highest quartile) regardless of age. Having a STI significantly increased the likelihood of severe PID by 2.2 times (95% CI: 1.03-4.5) in Indigenous women younger than 45 years, independent of smoking and folate level. The risk of PID hospitalization was higher for gonorrheal infections (OR 3.2, 955 CI 1.1-9.6) compared to chlamydial infections (OR 1.5 95% CI 0.7-3.5). Conclusions Young Indigenous women in North Queensland communities are at very high risk for STI and PID. Smoking, low folate, and STI are clustered, and are associated with PID hospitalizations. Much of this can be prevented with improved nutrition and access to preventive services, especially tobacco control, regular STI screening and treatment, as well as more investment in sexual health education and awareness. Electronic supplementary material The online version of this article (doi:10.1186/s12905-015-0188-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Li
- School of Population Health, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
| | - Robyn McDermott
- School of Population Health, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia. .,Faculty of Medicine, Health & Molecular Sciences, James Cook University, Cairns, Australia.
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Morris GC, Stewart CMW, Schoeman SA, Wilson JD. A cross-sectional study showing differences in the clinical diagnosis of pelvic inflammatory disease according to the experience of clinicians: implications for training and audit. Sex Transm Infect 2014; 90:445-51. [DOI: 10.1136/sextrans-2014-051646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pelvic inflammatory disease in the adolescent: understanding diagnosis and treatment as a health care provider. Pediatr Emerg Care 2013; 29:720-5. [PMID: 23714759 DOI: 10.1097/pec.0b013e318294dd7b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pelvic inflammatory disease (PID) is a common clinical syndrome with highest rates in adolescents, but no studies have singularly focused on this population in relationship to established guidelines for diagnosis and treatment. The study objective was to assess knowledge of diagnosis and treatment criteria for PID within an adolescent population and to compare factors associated with adherence to Centers for Disease Control and Prevention guidelines in outpatient settings. METHODS Data were collected as part of a retrospective chart review of evaluation, diagnosis, and treatment of sexually transmitted infections in adolescent women in an outpatient setting. Participant charts were eligible for review if they were 12 to 21 years of age and were given an International Classification of Diseases, Ninth Revision/chart diagnosis of PID. Two primary outcome variables were utilized: meeting PID diagnosis guidelines (no/yes) and correct treatment for subject meeting criteria with guidelines (no/yes). The study controlled for race, age, medical venue, and current/past infection with gonorrhea/chlamydia. RESULTS Subjects (n = 150) were examined for the primary outcome variables; 78% (117/150) met at least 1 criterion for PID diagnosis. Nearly 75% (111/150) had cervical motion tenderness, 34% (51/150) adnexal tenderness, and 5% (7/150) had uterine tenderness; nearly 11% (16/150) were positive for all 3 criteria. Symptoms associated with PID were compared for subjects meeting diagnosis criteria versus subjects not meeting diagnosis criteria: abdominal pain and vomiting were significantly associated with PID diagnosis at P < 0.05. CONCLUSIONS Our findings show that PID diagnosis/treatment often does not follow guidelines in the adolescent population. Pelvic inflammatory disease and cervicitis appear to be confused by providers in the diagnosis process, and educational tools may be necessary to increase the knowledge base of practitioners in regard to PID.
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Leichliter JS, Chandra A, Aral SO. Correlates of self-reported pelvic inflammatory disease treatment in sexually experienced reproductive-aged women in the United States, 1995 and 2006-2010. Sex Transm Dis 2013; 40:413-8. [PMID: 23588132 PMCID: PMC5245165 DOI: 10.1097/olq.0b013e318285ce46] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few studies have examined recent temporal trends in self-reported receipt of pelvic inflammatory disease (PID) treatment. We assessed trends in receipt of PID treatment and associated correlates using national survey data. METHODS We used data from the National Survey of Family Growth, a multistage national probability survey of 15- to 44-year-old women. We examined trends in self-reported receipt of PID treatment from 1995, 2002, to 2006-2010. In addition, we examined correlates of PID treatment in 1995 and 2006-2010 in bivariate and adjusted analyses. RESULTS From 1995 to 2002, receipt of PID treatment significantly declined from 8.6% to 5.7% (P < 0.0001); however, there was no difference from 2002 to 2006-2010 (5.0%, P = 0.16). In bivariate analyses, racial differences in PID treatment declined across time; in 2006-2010, there was no significant difference between racial/ethnic groups (P = 0.22). Also in bivariate analyses, similar to 1995, in 2006 to 2010, some of the highest reports of receipt of PID treatment were women who were 35 to 44 years old (5.6%), had an income less than 150% of poverty level (7.5%), had less than high school education (6.7%), douched (7.7%), had intercourse before age 15 years (10.3%), and had 10 or more lifetime partners (8.0%). In adjusted analyses, differing from 1995, women at less than 150% of the poverty level were more likely (adjusted odds ratio [AOR], 2.60; 95% confidence interval [CI], 1.79-3.76) than women at 300% or more of the poverty level to have received PID treatment in 2006-2010. CONCLUSIONS Receipt of PID treatment declined from 1995 to 2006-2010, with the burden affecting women of lower socioeconomic status.
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Affiliation(s)
- Jami S Leichliter
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Silver BJ, Knox J, Smith KS, S Ward J, Boyle J, J Guy R, Kaldor J, Rumbold AR. Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia. Med J Aust 2012; 197:647-51. [DOI: 10.5694/mja11.11450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 07/11/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Bronwyn J Silver
- Epidemiology and Health Systems, Menzies School of Health Research, Alice Springs, NT
| | - Janet Knox
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW
| | - Kirsty S Smith
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW
| | - James S Ward
- Preventative Health, Baker IDI Heart and Diabetes Institute, Alice Springs, NT
| | - Jacqueline Boyle
- Jean Hailes Foundation for Women's Health, Monash University, Melbourne, VIC
| | - Rebecca J Guy
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW
| | - John Kaldor
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW
| | - Alice R Rumbold
- Epidemiology and Health Systems, Menzies School of Health Research, Alice Springs, NT
- Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA
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Fairley CK, Hocking JS. Sexual health in Indigenous communities. Med J Aust 2012; 197:597-8. [DOI: 10.5694/mja12.11448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 10/23/2012] [Indexed: 11/17/2022]
Affiliation(s)
| | - Jane S Hocking
- School of Population Health, University of Melbourne, Melbourne, VIC
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Liu B, Donovan B, Hocking JS, Knox J, Silver B, Guy R. Improving adherence to guidelines for the diagnosis and management of pelvic inflammatory disease: a systematic review. Infect Dis Obstet Gynecol 2012; 2012:325108. [PMID: 22973085 PMCID: PMC3437626 DOI: 10.1155/2012/325108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/19/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence suggests adherence to clinical guidelines for pelvic inflammatory disease (PID) diagnosis and management is suboptimal. We systematically reviewed the literature for studies describing strategies to improve the adherence to PID clinical guidelines. METHODS The databases MEDLINE and EMBASE, and reference lists of review articles were searched from January 2000 to April 2012. Only studies with a control group were included. RESULTS An interrupted time-series study and two randomised controlled trials (RCTs) were included. The interrupted time-series found that following a multifaceted patient and practitioner intervention (practice protocol, provision of antibiotics on-site, written instructions for patients, and active followup), more patients received the recommended antibiotics and attended for followup. One RCT found a patient video on PID self-care did not improve medication compliance and followup. Another RCT found an abbreviated PID treatment guideline for health-practitioners improved their management of PID in hypothetical case scenarios but not their diagnosis of PID. CONCLUSION There is limited research on what strategies can improve practitioner and patient adherence to PID diagnosis and management guidelines. Interventions that make managing PID more convenient, such as summary guidelines and provision of treatment on-site, appear to lead to better adherence but further empirical evidence is necessary.
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Affiliation(s)
- Bette Liu
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
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Management of first-episode pelvic inflammatory disease in primary care: results from a large UK primary care database. Br J Gen Pract 2010; 60:e395-406. [PMID: 20883614 DOI: 10.3399/bjgp10x532404] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Prompt and effective treatment of pelvic inflammatory disease (PID) may help prevent long-term complications. Many PID cases are seen in primary care but it is not known how well management follows recommended guidelines. AIM To estimate the incidence of first-episode PID cases seen in UK general practice, describe their management, and assess its adequacy in relation to existing guidelines. DESIGN OF STUDY Cohort study. SETTING UK general practices contributing to the General Practice Research Database (GPRD). METHOD Women aged 15 to 40 years, consulting with a first episode of PID occurring between 30 June 2003 and 30 June 2008 were identified, based on the presence of a diagnostic code. The records within 28 days either side of the diagnosis date were analysed to describe management. RESULTS A total of 3797 women with a first-ever coded diagnosis of PID were identified. Incidence fell during the study period from 19.3 to 8.9/10 000 person-years. Thirty-four per cent of cases had evidence of care elsewhere, while 2064 (56%) appeared to have been managed wholly within the practice. Of these 2064 women, 34% received recommended treatment including metronidazole, and 54% had had a Chlamydia trachomatis test, but only 16% received both. Management was more likely to follow guidelines in women in their 20s, and later in the study period. CONCLUSION These analyses suggest that the management of PID in UK primary care, although improving, does not follow recommended guidelines for the majority of women. Further research is needed to understand the delivery of care in general practice and the coding of such complex syndromic conditions.
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Taylor-Robinson D, Stacey CM, Jensen JS, Thomas BJ, Munday PE. Further observations, mainly serological, on a cohort of women with or without pelvic inflammatory disease. Int J STD AIDS 2009; 20:712-8. [PMID: 19759049 DOI: 10.1258/ijsa.2008.008489] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An analysis was undertaken of data pertaining to over 100 women with lower abdominal pain who were laparoscoped. Prior to laparoscopy, 11 of the women were considered to almost certainly have salpingitis, of whom six (55%) had salpingitis at laparoscopy; 17 to probably have salpingitis, of whom six (35%) did; 28 to possibly have salpingitis, of whom five (18%) did; and 56 to be very unlikely to have salpingitis, of whom five (9%) did. Of the 22 women who had salpingitis at laparoscopy, 14 (64%) had a Chlamydia trachomatis IgG antibody titre of >or=1:128 and might reasonably be regarded as having chlamydial disease on this basis; six without such a titre probably did not have chlamydial disease as C. trachomatis could not be detected at any genital site. At laparoscopy, 18 women had adhesions without obvious tubal inflammation; clinically, 15 of them had been regarded as possibly having salpingitis or unlikely to have it, with 12 having chronic pelvic pain. Twelve (67%) of the 18 women had a chlamydial IgG antibody titre of >or=1:128. IgM antibody was also detected most often in the 'salpingitis' group. Of 49 women without any abnormality detected at laparoscopy, nine (18%) had a high chlamydial IgG antibody titre. Overall, a woman who had a high titre of chlamydial IgG antibody and acute pelvic pain, together with a clinical picture of pelvic inflammation, was more likely to have salpingitis than adhesions alone. Likewise, a woman who had a high titre of chlamydial IgG antibody and chronic pelvic pain, together with a clinical picture suggesting that salpingitis was unlikely, was more likely to have adhesions alone than acute chlamydial salpingitis. However, while antibody measurement and seeking cervical C. trachomatis may help in formulating a diagnosis, there seems no simple way of detecting the small proportion of women who are infected by C. trachomatis in the upper genital tract but whose laparoscopic findings indicate normality. So far as patient care is concerned, the only way of preventing damage to the upper genital tract is to treat early on the basis of suspicion.
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Affiliation(s)
- D Taylor-Robinson
- Division of Medicine, Imperial College London, St Mary's Campus, London, UK.
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