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Pelvic inflammatory disease (PID) affects almost 11 percent of U.S. women during their reproductive years and can lead to infertility, chronic pelvic pain, ectopic pregnancy, and recurrent infections. Unfortunately, the clinical diagnosis of PID is inaccurate, with current tests unable to discriminate PID from other genital-tract causes of pelvic pain. However, a new study shows that the presence of lower genital-tract inflammation (the presence of white blood cells or pus in vaginal discharge) is a highly sensitive test for endometritis (upper genital-tract infection or PID) in patients with pelvic pain and tenderness. The authors conclude that assessment of the lower genital tract for evidence of infection or inflammation is an inexpensive, quick, and sensitive way to diagnose PID.
There were few false negatives. Thus, one should suspect other causes of pelvic pain in women who have pelvic pain and tenderness but no white blood cells or mucopus in the vaginal discharge, concludes Jeffrey F. Peipert, M.D., M.P.H., of Women and Infants Hospital in Rhode Island. Dr. Peipert and his colleagues analyzed the first 157 patients enrolled in the PID Evaluation and Clinical Health (PEACH) study, the largest randomized, multicenter study of therapy for PID ever conducted in North America. The PEACH study is led by Roberta Ness, M.D., M.P.H., and supported by the Agency for Healthcare Research and Quality (HS08358).
The 58 women in group one were less than 38 years of age, had a history of pelvic discomfort for 30 days or less, and had pelvic organ tenderness on physical examination. The 99 women in group two had additional evidence of lower-genital tract inflammation (mucopus or white blood cells in the vaginal discharge) or an untreated positive test for N. gonorrhoeae or C. trachomatis infections. The rate of endometritis in group one was 46.5 percent but jumped to 49.5 percent in group two after the presence of white blood cells or mucopus in the vaginal discharge was added to the inclusion criteria. Microbiologic evidence of either gonorrhea or trachomatis increased from 22.4 percent in group one to 38.3 percent in group two. The presence of vaginal white blood cells or mucopus had a high sensitivity (88.9 percent) but a low specificity (19.4 percent) for diagnosis of endometritis.
More details are in "Association of lower genital tract inflammation with objective evidence of endometritis," by Drs. Peipert and Ness, David E. Soper, M.D., and Debra Bass, M.S., in Infectious Diseases in Obstetrics and Gynecology 8, pp. 83-87, 2000.
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