A cross-sectional study showing differences in the clinical diagnosis of pelvic inflammatory disease according to the experience of clinicians: implications for training and audit

Morris, Georgina; Stewart, Catherine; Schoeman, Sarah; Wilson, Janet

doi:10.1136/sextrans-2014-051646

Cited by 17 publications

(9 citation statements)

References 16 publications

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“…It is well known that clinical PID diagnosis is imprecise, which is our study's main limitation. There is no specific non-invasive diagnostic test or physical feature both sensitive and specific to PID diagnosis1 which can also vary by clinician and experience 8. Pelvic pain is a key PID characteristic but its duration, intensity and cause can vary.…”

Section: Discussionmentioning

confidence: 99%

“…Univariable and multivariable logistic regression was conducted to identify characteristics associated with pathogen-negative-PID. As clinical PID diagnosis can vary by clinician8 we accounted for clustering within clinician by obtaining robust variance estimates that adjust for within-cluster correlation 9. Results are reported as OR with 95% CIs.…”

Section: Methodsmentioning

confidence: 99%

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Characteristics of pelvic inflammatory disease where no sexually transmitted infection is identified: a cross-sectional analysis of routinely collected sexual health clinic data

et al. 2016

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These findings highlight uncertainties around PID diagnosis and aetiology. Pathogen-negative-PID could represent (i) a false positive diagnosis where the woman does not have a sexually transmitted infection (STI) or PID, (ii) PID of another microbiological aetiology or associated with a past STI or (iii) PID where the cervical infection has cleared. However, until diagnostic biomarkers are available, PID treatment should be based on clinical features and sexual risk.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Characteristics of pelvic inflammatory disease where no sexually transmitted infection is identified: a cross-sectional analysis of routinely collected sexual health clinic data

et al. 2016

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“…In a study involving nearly 4,000 cisgender women attending a sexual health clinic in the UK, PID was reported in approximately 14% of those with gonorrhoea. 5…”

Section: Clinical Features1–3mentioning

confidence: 99%

2018 UK national guideline for the management of infection with Neisseria gonorrhoeae

et al. 2019

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Changes since 2011 guideline • First line empirical treatment is now monotherapy with ceftriaxone 1 g intramuscularly • If antimicrobial susceptibility test results from all sites of infection are available prior to treatment and the isolate is sensitive to ciprofloxacin, then this should be used for treatment in preference to ceftriaxone • Inclusion of testing recommendations in people following genital reconstructive surgery • Recommendations for extra-genital testing in those with suspected or confirmed antimicrobial resistance • Epidemiological treatment is recommended only for those presenting within 14 days of exposure. For those presenting after 14 days of exposure we recommend treatment based on the results of testing SCOPE AND PURPOSE This guideline offers recommendations for the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of gonorrhoea in people aged 16 years and older. For individuals under the age of 16 years please see the British Association for Sexual Health and HIV (BASHH) guideline on STI and Related Conditions in Children and Young People. The guidelines are primarily aimed at level 3 sexual health services within the United Kingdom (UK) although the principles of the recommendations could be adopted at all levels. EDITORIAL INDEPENDENCE This guideline was commissioned and edited by the Clinical Effectiveness Group (CEG) of BASHH, which provided funding for the literature search. No other funding was obtained. RIGOUR OF DEVELOPMENT This guideline was produced according to specifications set out in the CEG's 2015 document 'Framework for guideline development and assessment' outlined at https://www.bashh.org/bashh-groups/clinical-effective ness-group/ and has been updated by reviewing the previous gonorrhoea guideline (2011) and medical literature since its publication. A MEDLINE search of published articles in English language for the years 2009-18 was done using the subject headings 'gonorrhoea' OR 'gonorrhea' OR 'Neisseria gonorrhoeae' AND 'therapy' OR 'treatment' OR 'therapeutics' OR 'resistance' OR 'anti-bacterial agents' OR 'antibiotics' OR 'failure' OR 'toxicity'. All entries in the English language or with abstracts in English were viewed because of the paucity of 'clinical trials' or 'reviews'. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness and Cochrane Controlled Trials Register were reviewed using the textword 'gonorrhoea' and all entries were considered. Abstracts from meetings in the relevant period were hand-searched and considered. Priority was given to randomized controlled trials and

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“…In general, PID presents with endometritis and salpingitis (mild-to-moderate disease) and occasionally with tubo-ovarian abscess or pelvic peritonitis (severe disease). 2 PID should be thought of as a polymicrobial disease. The most common causative organism is chlamydia, followed by gonorrhea, and both may be present.…”

Section: Pathophysiologymentioning

confidence: 99%

Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents

Risser¹,

Risser

2017

AHMT

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In this review, the epidemiology, diagnosis, and treatment of pelvic inflammatory disease (PID) are discussed from a USA perspective and the difficulties that USA adolescents face in recognizing and seeking care for PID and other sexually transmitted infections (STIs) are emphasized. Females aged 15–24 years have the highest incidence of cervical infection with Chlamydia trachomatis and Neisseria gonorrheae, the principal causes of PID. PID is common in this age group. However, the incidence of PID in the USA is not known, because it is not a reportable disease, and because clinicians vary in the criteria used for the diagnosis. The Centers for Disease Control and Prevention (CDC) recommended the following diagnostic criteria that include lower abdominal or pelvic pain and at least one of the following: adnexal tenderness or cervical motion tenderness or uterine tenderness. Because PID can have serious sequelae, the criteria emphasize sensitivity (few false-negatives) at the expense of specificity (some false-positives). Patients who have PID are usually treated in the outpatient setting, following the CDC’s Guidelines for the Treatment of Sexually Transmitted Diseases 2015. They receive one dose of an intramuscular cephalosporin, together with 2 weeks of oral doxy cycline, and sometimes oral metronidazole. Improvement should usually be evident in 3 days. The USA does not offer comprehensive sex education for adolescents in public or private schools. Adolescents are unlikely to recognize the symptoms of PID and seek medical treatment. Confidentiality is important to adolescents, and low cost or free sources of confidential care are uncommon, making it unlikely that an adolescent would seek care even if she suspected an STI. The CDC has concluded that screening programs for chlamydia and gonorrhea infection help prevent PID; however, the lack of appropriate sources of care makes adolescents’ participation in screening programs unlikely.

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A cross-sectional study showing differences in the clinical diagnosis of pelvic inflammatory disease according to the experience of clinicians: implications for training and audit

Abstract: ISRCTN 42867448.

Cited by 17 publications

References 16 publications

Characteristics of pelvic inflammatory disease where no sexually transmitted infection is identified: a cross-sectional analysis of routinely collected sexual health clinic data

Characteristics of pelvic inflammatory disease where no sexually transmitted infection is identified: a cross-sectional analysis of routinely collected sexual health clinic data

2018 UK national guideline for the management of infection with Neisseria gonorrhoeae

Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents

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