A Need for Standardization of the Diagnosis and Treatment of Pelvic Inflammatory Disease: Pilot Study in an Outpatient Clinic in Quito, Ecuador.

Francisco Cueva,Paula Hidalgo,Andrés Caicedo

doi:10.1155/2020/5423080

Abstract

Background Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. This study sought to characterize the diagnostic and therapeutic trend among physicians at the outpatient level, in Quito, Ecuador, where currently no nationwide screening or specific clinical guideline has been implemented on PID or its main microbiological agents. Methods A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Electronic medical records from 2013 to 2018 with any pelvic inflammatory disease-related diagnoses were retrieved. Information with regard to age, sexually related risk factors, symptoms and physical exam findings, ancillary tests, method of diagnosis, and antibiotic regimens was extracted. Results A total of 186 records were included. The most frequent clinical manifestations were vaginal discharge (47%) and pelvic pain (39%). In the physical examination, leucorrhea was the most frequent finding (47%), followed by lower abdominal tenderness (35%) and cervical motion tenderness in 51 patients (27%). A clinical diagnosis was established in 60% of patients, while 37% had a transvaginal sonography-guided diagnosis. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. Additionally, an average of 1.9 drugs were prescribed per patient, with a range from 1 to 5, all in different combinations and dosages. Conclusions No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections.

Highlights

Pelvic inflammatory disease (PID) is an infectious polymicrobial disorder of the upper genital tract that affects around 4-12% of young women worldwide [1]
Charts that met any of the following exclusion criteria were eliminated from the study: (i) Male patients (ii) Pediatric patients with exception of adolescents older than 12 (iii) Cases where PID was ruled out by physicians after nucleic acid amplification tests (NAATs) for N. gonorrhoeae and C. trachomatis were negative (iv) Duplicated and/or incomplete medical records (v) Patients who were diagnosed with PID presumptively but did not complete the complementary studies and did not receive antibiotic treatment (vi) Incorrect and/or inconsistent International Classification Disease-10 (ICD-10) diagnoses (vii) Severe PID diagnosis [7]
From the 515 medical records retrieved, 19 of them corresponded to male patients, 181 had incorrect ICD-10 diagnoses, were empty, five had a PID diagnosis ruled out by the attending physician due to negative Nucleic acid amplification tests (NAATs), patients had incomplete workup, 34 were duplicated, two women rejected treatment, and one was transferred to an emergency department

Summary

Introduction

Pelvic inflammatory disease (PID) is an infectious polymicrobial disorder of the upper genital tract that affects around 4-12% of young women worldwide [1]. This clinical entity can be attributed to a variety of bacteria. Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections

Methods

Results

Conclusion