Abstract
The diagnosis of acute pelvic inflammatory disease (PID) is usually based on clinical criteria and can be challenging for even the most astute clinicians. Although diagnostic accuracy is advocated, antibiotic treatment should be instituted if there is a diagnosis of cervicitis or suspicion of acute PID. Currently, no single test or combination of diagnostic indicators have been found to reliably predict PID, and laparoscopy cannot be recommended as a first line tool for PID diagnosis. For this reason, the clinician is left with maintaining a high index of suspicion for the diagnosis as he/she evaluates the lower genital tract for inflammation and the pelvic organs for tenderness in women with genital tract symptoms and a risk for sexually transmitted infection. This approach should minimize treating women without PID with antibiotics and optimize the diagnosis in a practical and cost-effective way.
Highlights
Acute pelvic inflammatory disease (PID) is associated with significant sequelae including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain
Other ancillary tests (Table 2) that can be useful in diagnosing PID include a complete blood count, erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). These tests are recommended for patients with clinically severe PID
Duk et al from The Netherlands looked at the relationship of CA125 in 50 patients with a provisional diagnosis of PID and concluded that the finding of an elevated serum CA-125 level confirms the diagnosis of peritoneal involvement in patients with a clinical diagnosis of PID [17]. They measured CA-125 concentrations in serum before laparoscopy and during hospitalization, using an enzyme immunoassay and found that CA-125 concentration before laparoscopy correlated with the extent of inflammatory peritoneal involvement and the predictive value of an elevated serum CA-125 level to indicate the presence of salpingitis was 97%
Summary
Acute PID is associated with significant sequelae including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. To ameliorate these adverse outcomes, an approach to its diagnosis must promote the ability to intervene with antimicrobial therapy early on the course of this ascending infection. There is a wide variation in the symptoms, some of which fail to imply a pelvic etiology, associated with acute PID (Table 1) They may range from subtle or mild to severe. We are left with the challenge of diagnosing PID in such a way as to minimize its associated sequelae while at the same time not over treating all women with pelvic pain or other genital tract symptoms with antimicrobials. (2) Determine which women with acute PID have acute salpingitis since these women are at the highest risk for the reproductive sequelae associated with this disease
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