Clinical Diagnosis Of Pelvic Inflammatory Disease Research Articles

RUPTURED TUBO-OVARIAN ABSCESS: RARE PRESENTATION OF PELVIC INFLAMMATORY DISEASE - A CASE REPORT

Background: Infection of the endometrium, fallopian tubes, ovaries, pelvic peritoneam, and adjacent structures is known as Pelvic Inflammatory Disease (PID). Pelvic inflammatory disease and its consequences are still at epidemic levels, Despite the availability of effective broad-spectrum antibiotics. Tubo-ovarian abscess (TAO) may be difficult to identify since the clinical signs are comparable to those of other pelvic and abdominal illnesses. Case Description: Here we are reporting a case, 34 years nulligravida came to emergency department with acute abdomen, she was a known case of chronic PID, Emergency laparotomy was performed, per operatively ruptured tubo-ovarian abscess was present. Conclusion: The clinical diagnosis of PID and TAO is similar, imaging evidence from ultrasonography (US) or magnetic resonance (MR) should be used to supplement the clinical diagnosis. Clinical Significance: To avoid complications and resultant emergency surgeries and their consequences, a vigilant eye must be kept to promptly diagnose, and manage PID at the earliest.

Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus.

We assessed the association between the causative agents of vaginal discharge and pelvic inflammatory disease (PID) among women attending a rural sexually transmitted disease clinic in South Africa; the role played by coinfection with human immunodeficiency virus type 1 (HIV-1) was studied. Vaginal and cervical specimens were obtained to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and bacterial vaginosis. HIV-1 infection was established by use of serum antibody tests. A total of 696 women with vaginal discharge were recruited, 119 of whom had clinical PID. Patients with trichomoniasis had a significantly higher risk of PID than did women without trichomoniasis (P=.03). PID was not associated with any of the other pathogens. When the patients were stratified according to HIV-1 status, the risk of PID in HIV-1-infected patients with T. vaginalis increased significantly (P=.002); no association was found in patients without HIV-1. T. vaginalis infection of the lower genital tract is associated with a clinical diagnosis of PID in HIV-1-infected women.

Acute Exacerbation of Recurrent Pelvic Inflammatory Disease: Laparoscopic Findings in 141 Women With a Clinical Diagnosis

OBJECTIVE: To evaluate the accuracy of the clinical diagnosis of recurrent pelvic inflammatory disease (PID) and to determine the positive and negative predictive value of laboratory tests for the diagnosis of PID. STUDY DESIGN: According to a prospective study design, 141 consecutively hospitalized patients with the clinical diagnosis of PID were evaluated. The basic inclusion criterion was a history of at least one episode of PID. Standard laboratory tests were performed, specimens for aerobic and anaerobic culture and for Chlamydia trachomatis isolation were obtained, and temperature was regularly monitored. All patients underwent laparoscopy under general anesthesia within 24 hours of admission. RESULTS: The clinical diagnosis of PID was confirmed by laparoscopy in 30% of patients. In almost one-third of patients, at laparoscopy the pelvic organs were within normal limits. Adhesions without signs of PID were found in 16%. The third-most-frequent finding was endometriosis (14%). Neither the individual monitored parameters nor their combination reached satisfactory positive and negative predictive values for diagnosing PID. CONCLUSION: Recurrent clinical symptoms and laboratory signs of PID should be an indication for confirming or excluding the clinical diagnosis by laparoscopy.

Peripheral blood T cell proliferative response to chlamydial organisms in gonococcal and non-gonococcal urethritis and presumed pelvic inflammatory disease.

OBJECTIVE: To study peripheral blood mononuclear cell (PBMC) proliferative response to Chlamydia trachomatis elementary bodies in (a) controls, (b) various stages of gonococcal (c) and non-gonococcal urethritis, and (d) women...

Diagnosing Pelvic Inflammatory Disease with Limited Diagnostic Tools in a Region of Ghana

The objective of this study was to describe how pelvic inflammatory disease (PID) is diagnosed in a region with limited technological diagnostic tools. Subsequently, we retrospectively reviewed 208 PID case notes and interviewed 25 clinicians in two regional level and four district hospitals of the Central Region of Ghana We found out that the clinical diagnosis of PID was frequently based on the features of lower abdominal pain, vaginal discharge, fever, lower abdominal tenderness, cervical motion, and adnexal tenderness. Sexual histories of suspected cases were rarely obtained while menstrual and contraceptive histories were scanty. Fifty-one per cent and two per cent of patients received bimanual and vaginal speculum examinations respectively. Predisposing factors were observed in 23 per cent of patients. There was a notion that poor genital hygiene was a cause of PID. We conclude that the periodic audit of clinical management of PID even in the absence of objective diagnostic tools is essential in identifying issues that could improve case prevention, recognition, and management. (Afr J Reprod Health 1999; 3 [1]: 88 - 97) Key Words : Pelvic inflammatory disease, diagnosis, Ghana

Risk factors for laparoscopically confirmed pelvic inflammatory disease: findings from Mumbai (Bombay), India.

OBJECTIVES: Sexually transmitted diseases (STDs) are an important cause of pelvic inflammatory disease (PID) but have often not been detected in microbiological studies of Indian women admitted to hospital gynaecology...

PELVIC INFLAMMATORY DISEASE: From Diagnosis to Prevention

Pelvic inflammatory disease (PID) refers to infection of the uterus, fallopian tubes, and adjacent pelvic structures that is not associated with surgery or pregnancy. PID causes major medical, social, and economic problems worldwide. Long-term sequelae, most notably tubal factor infertility and ectopic pregnancy, are common and extremely costly to the healthcare system. The most important causative micro-organisms are Chlamydia trachomatis, Neisseria gonorrhoeae, and micro-organisms associated with bacterial vaginosis. The clinical spectrum of PID ranges from subclinical endometritis to severe salpingitis, pyosalpinx, tubo-ovarian abscess, pelvic peritonitis, and perihepatitis. Clinical diagnosis of PID has limitations. The clinical diagnostic criteria are insensitive and nonspecific, and false-positive and false-negative diagnosis is common; however, direct visual diagnosis is not always feasible, requires general anesthesia, and is costly. More research is needed of noninvasive diagnosis of PID. Current treatment guidelines call for broad-spectrum antimicrobial coverage. Screening for asymptomatic chlamydial infection is the mainstay of prevention of PID. Emerging evidence from randomized controlled trials provides strong evidence that intervention with selective screening for chlamydial infection effectively reduces the incidence of PID.

Significance of Genital Mycoplasmas in Pelvic Inflammatory Disease: Innocent Bystander!

Objective: Our objective was to determine the role of Mycoplasma hominis and Ureaplasma urealyticum in pelvic inflammatory disease (PID). Methods: The clinical and microbiologic variables in 114 patients with a clinical diagnosis of PID were compared prospectively according to the isolation of M. hominis and U. urealyticum from their endometrial cavities. Results: The groups were epidemiologically well matched. Clinical parameters such as temperature, leukocyte count, erythrocyte count, and C-reactive protein on admission and length of hospital stay were similar in the patients, regardless of their mycoplasma status. A significant percentage of the patients either continued or started to harbor genital mycoplasmas after the resolution of PID without any significant clinical sequelae. Conclusions: The presence of genital mycoplasmas does not change the clinical presentation and course of PID. Both M. hominis and U. urealyticum can persist or colonize the endometrium after complete recovery from PID. Therefore, the genital mycoplasmas do not seem to have a dominant pathogenic role in PID.

Practice Variability in the Inpatient Treatment of Pelvic Inflammatory Disease

ABSTRACT Objective. To examine variability in the practice of hospitalization and the factors predictive of hospitalization for women with diagnosed Pelvic Inflammatory Disease (PID). Design. Population-based chart review. Setting. Twenty-three hospitals and 40 clinics in King County, Washington. Patients. 2,803 women with a clinical diagnosis of PID who were evaluated at participating hospitals and clinics. Results. Thirteen percent of women diagnosed with PID were hospitalized. Women presenting for care to hospitals were more likely to be referred for inpatient treatment than were those presenting to non-hospital-affiliated clinics (adjusted odds ratio 8.7, 95% confidence interval 5.4 to 13.9). Of clinical features recommended as criteria for hospitalization by the Centers for Disease Control (CDC) that we could evaluate, only patients′ complaints of fever, chills or sweats, indicative of severity of illness, significantly predicted hospitalization. Other factors independently associated with more hospi...

Endometrial Cultures in Acute Pelvic Inflammatory Disease

Objective: The objective of this study was to investigate the correlation of endometrial culture results with the clinical diagnosis of acute pelvic inflammatory disease (PID). Methods: A total of 130 patients admitted with the clinical diagnosis of acute PID were prospectively enrolled in this study. Endometrial cultures by transcervical aspirate currette were obtained from all patients. Results: Of 130 patients, 114 were discharged with a clinical diagnosis of PID. Of these 114 patients, 112 had positive endometrial cultures for pathogenic organisms. The correlation between endometrial culture results and the clinical diagnosis of acute PID was 98.2%. When patients with only mycoplasmas in the endometrial cavity were excluded, the correlation between endometrial culture results and the clinical diagnosis of acute PID was 93.8%. Conclusion: These data demonstrate the exceedingly high degree of correlation between endometrial culture results and the clinical diagnosis of acute PID. Therefore, endometrial cultures may serve as a useful adjunct in the evaluation of patients with a clinical diagnosis of acute PID.

Serum CA 125 levels in patients with a provisional diagnosis of pelvic inflammatory disease. Clinical and theoretical implications.

In 50 patients with a provisional diagnosis of pelvic inflammatory disease (PID), CA 125 concentrations in serum were measured before laparoscopy and during hospitalization, using an enzyme immunoassay. The findings at laparoscopy were graded on the basis of the extent of inflammatory peritoneal involvement (grades 0-3; normal observations having a score of 0). On admission, 66% of the patients had serum CA 125 concentrations in excess of the cut-off value of 16 U/ml (range: 20-1300 U/ml). The serum CA 125 concentration before laparoscopy correlated with the extent of inflammatory peritoneal involvement (eta = 0.74). The predictive value of an elevated serum CA 125 level to indicate the presence of salpingitis (grades 1-3) was 97%. However, the predictive value of a normal CA 125 level indicating normal observations at laparoscopy (grade 0) was only 47%. During treatment and follow-up, the serum CA 125 concentration returned gradually to normal levels. It was 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.

Syphilis and pelvic inflammatory disease.

Since screening every patient in the emergency department for venereal disease is impractical, we hypothesized that patients with the clinical diagnosis of pelvic inflammatory disease (PID) might be at higher risk and a group that should be screened. Seventy women with a clinical diagnosis of PID treated in our adult emergency department from July to November 1976 were screened for syphilis using three separate serologic tests: Venereal Disease Research Laboratory, fluorescent treponemal antibody absorption, and treponema pallidum hemagglutination. The incidence of positive serologies in our study group was significantly higher (11.4%) than that of 100 controls (4%). All patients with a clinical diagnosis of PID should be screened for syphilis using both FTA-Abs and TPHA tests, as well as a VDRL.