Acute pelvic inflammatory disease in a gynecological casualty setting

Abstract

This paper presents a prospective study on the validity of clinical diagnostic criteria of acute pelvic inflammatory disease (PID) in Sri Lanka over a period of 15 months. The study assessed 1817 consecutive gynecological admissions and acute PID was diagnosed according to the established clinical criteria. Clinical signs and symptoms of PID among women aged 18-22 years include abdominal pain abnormal vaginal discharge urinary symptoms irregular bleeding vomiting rectal symptoms fever an erythrocyte sedimentation rate of 15 mm/hour or higher abnormal adnexal tenderness and a palpable adnexal mass. The gynecological casualty admissions categorized into one of the following clinical groups are outlined. The study identified 29 visually confirmed acute PID cases with 41 patients with acute PID in the series. This indicates that there is a 2.26% acute PID incidence in the casualty gynecological setting (95% confidence interval 1.91-2.61). When the clinical diagnosis was equivocal the positive value for acute PID diagnosis was 76%. This indicates that if laparoscopy had not been used to confirm acute PID 24 patients with equivocal PID would have been overtreated with expensive broad-spectrum antibiotics. This article emphasizes that in the absence of contraindications and availability of facilities laparoscopy is very useful; and at the same time treatment of clinically equivocal cases must not be delayed as this may lead to serious consequences.