Abstract
Ultrasound scanning (USS) and high vaginal swab culture and urine microscopy culture and sensitivity (m/c/s) tests are the most common investigations used for the diagnosis of pelvic inflammatory disease (PID) in our locality. The aim of this study was to determine the diagnostic accuracy of ultrasound in the diagnosis of PID keeping laboratory high vaginal swab/urine microscopy, culture as gold standard. The USS, high vaginal swab and urine m/c/s reports of patients referred with PID conditions between January 2010 to April 2013 were obtained from the medical records departments of Nnamdi Azikiwe University teaching hospital, Nnewi, Anambra state. The diagnostic accuracy was determined by calculating sensitivity, specificity, positive predictive value and negative predictive value using performance characteristics test. Descriptive and inferential statistics were also used. Spearman rho’s non parametric analysis and statistical package for social sciences (SPSS) version 17.0 was equally used. The total number of subjects that were scanned for PID was 120. The highest number of subjects 80 (66.6%) was seen in 21 to 30 years age group. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of ultrasound in PID diagnosis was found to be 100, 65.3, 89.2, 100 and 86.3%, respectively. There was no significant correlation between USS diagnosis of PID and HVS/urine culture findings (p > 0.01). Ultrasound is valuable as the first line of investigation (screening tool) in the diagnosis of PID and should be used in conjunction with other medical investigations to facilitate accurate diagnosis of PID. Key words: Ultrasound, pelvic inflammatory disease, urine culture, high vaginal swab culture, diagnostic accuracy.
Highlights
Pelvic inflammatory disease (PID) is a polymicrobial infection in women characterised by infection of the upper genital tract including endometritis, salpingitis, pelvic peritonitis, occasionally leading to the formation of tuboovarian abscess (Turzic and Kocijancic, 2010)
Pelvic inflammatory disease refers to the infection of the upper genital tract of the female reproductive organ which if left untreated can lead to serious consequences including infertility, ectopic pregnancy, abscess formation and chronic pelvic pain (CDC, 2011)
The diagnosis of pelvic inflammatory disease (PID) is facilitated with the combined use of ultrasonography and laboratory high vaginal swab culture and urine culture, as these laboratory tests aid in the identification of the causative organisms of PID and in determining their level of sensitivity to antibiotic therapy which is used in the treatment of PID (Monica, 2000) while sonography on the other hand reveals the extent of the damage and effects on surrounding tissues (Njoku et al, 2008)
Summary
Pelvic inflammatory disease (PID) is a polymicrobial infection in women characterised by infection of the upper genital tract including endometritis, salpingitis, pelvic peritonitis, occasionally leading to the formation of tuboovarian abscess (Turzic and Kocijancic, 2010). It is an infection caused by inflammatory continuum from the cervix to the peritoneal cavity (Soper, 2010). Adolescents are at the increased risk for PID and should be advised to delay the onset of sexual activity until age 16 years or older (Simms et al, 2006). They can lead to infertility, ectopic pregnancy, abscess formation and chronic pelvic pain (CDC, 2011)
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