P27 An audit on the management of pelvic inflammatory disease (PID)

Abstract

BackgroundThe 2005 (revised in 2011) UK national guidelines on the management of PID state two auditable outcomes: (1) Proportion of women receiving treatment with a recommended regimen—target 95%. (2) Proportion of named male contacts screened for infection and/or treated—target 0.4 (large urban centres) or 0.6 (other centres) per index case. The guidelines also recommend patients with moderate or severe PID are reviewed after 72 h and all patients are reviewed after 2–4 weeks.AimsTo audit the management, follow-up and partner notification (PN) of PID in our clinic.MethodsRetrospective notes review of PID cases presenting between December 2009 and July 2011. Data were collected on drug treatment, follow-up and PN. Cases with a sexually transmitted infection (STI) were compared to cases with no STI identified.ResultsOf 130 PID cases identified, 58 had an STI diagnosed of whom seven hadNeisseria gonorrhoeae(GC) and 57 hadChlamydia trachomatis(CT). Six cases had both GC and CT. One patient had no documentation of drugs prescribed and one received only Doxycycline (see abstract P27 table 1).Abstract P27 Table 1Management of patients diagnosed with PIDSTI identified (n=58)No STI identified (n=72)Partner notification (PN) Partner notified21 (36.2%)19 (26.4%) Partner notified and treated20 (34.5%)5 (6.9%) PN recommended6 (10.3%)0 No documentation of PN31 (53.5%)53 (73.6%)Treatment prescribed Doxycycline and metronidazole46 (79.3%)59 (81.9%) Macrolide and metronidazole6 (10.4%)7 (9.7%) Ofloxacin and metronidazole (GC cover)5 (8.6%)5 (7.0%) Cephalosporin prescribed (GC cover)40 (69.0%)44 (61.1%)Follow-up Follow-up advised in 3 days00 Follow-up advised in 2–4 weeks47 (81%)69 (95.8%) Follow-up attended47 (81%)29 (40.3%)ConclusionBASHH guidelines recommend GC cover for all PID cases but the proportion receiving this was 72.9%. All cases diagnosed with GC received GC cover. PN rates did not reach national recommendations and this may be related to diagnostic uncertainty especially when no STI is apparent. PN was better in cases with a STI where health advisers were involved than in cases without an STI, seen by doctors. No patients were advised to return for follow-up within 3 days but the majority returned within 2–4 weeks. Those with an STI diagnosed were significantly more likely to attend follow-up p<0.0001.