Abstract
The purpose of this report is to evaluate the association between lower genital tract inflammation and objectively diagnosed endometritis. We analyzed the first 157 patients enrolled in the PEACH study, a multicenter randomized clinical trial designed to compare the effectiveness of outpatient and inpatient therapy for PID. Women less than 38 years of age, who presented with a history of pelvic discomfort for 30 days or less and who were found to have pelvic organ tenderness (uterine or adnexal tenderness) on bimanual examination, were initially invited to participate. After recruitment of the first 58 patients (group 1) we added the presence of leukorrhea, mucopurulent cervicitis, or untreated positive test for N. gonorrhoeae or C. trachomatis to the inclusion criteria (group 2, N = 99). We compared rates of endometritis in the two groups and calculated the sensitivity, specificity, and predicted values of the presence of white blood cells in the vaginal wet preparation. The rate of upper genital tract infection in group 1 was 46.5% (27/58) compared to 49.5% (49/99) in group 2. Microbiologic evidence of either N. gonorrhoeae or C. trachomatis increased from 22.4% in group 1 to 38.3% in group 2. The presence of Vaginal white blood cells or mueopus has a high sensitivity (88.9%), but a low specificity (19.4%) for the diagnosis of upper genital‐tract infection. Assessment of the lower genital tract for evidence of infection or inflammation is a valuable component of the diagnostic evaluation of pelvic inflammatory disease. The presence of either mucopus or vaginal white blood cells is a highly sensitive test for endometritis in patients with pelvic pain and tenderness. Infect. Dis. Obstet. Gynecol. 8:83–87, 2000.
Highlights
The clinical diagnosis of PID is inaccurate
The absence of white blood cells in the vaginal discharge plus clear cervical mucus is felt to reliably exclude upper genital-tract infection.[8]. The purpose of this preliminary report is to evaluate the association between lower genitaltract inflammation and objectively diagnosed upper genital-tract infection
The percentage of women with microbiologic evidence of C. trachomatis increased from 8.6% in group to 17.4% in group 2 (N 150)
Summary
The clinical diagnosis of PID is inaccurate. The Centers for Disease Control and Prevention’s minimal criteria for the diagnosis of PID have low sensitivity and specificity,s,6 These criteria do not reliably discriminate infectious from other genitaltract etiologies of pelvic pain. The largest cohort study to date, in which Swedish women suspected of having PID underwent a laparoscopic evaluation, found that a marked increase in the number of inflammatory cells (i.e., inflammatory cells outnumbering all other cellular elements in the smear) was associated with laparoscopic salpingitis.[4] In addition, the absence of white blood cells in the vaginal discharge plus clear cervical mucus is felt to reliably exclude upper genital-tract infection (high negative predictive value).[8]. It is the largest prospective study of PID ever conducted in North America, and the first trial to evaluate the effectiveness and costeffectiveness of currently recommended antibiotic regimens in terms of preventing long-term reproductive sequelae
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