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Doctors should consider antibiotic treatment for women with tenderness suggesting pelvic inflammatory disease

Unfortunately, the clinical diagnosis of pelvic inflammatory disease (PID) is difficult and often inaccurate. PID is a sexually transmitted disease that can cause infertility, tubal pregnancies, and other problems. A new study finds that adnexal tenderness (tenderness of the ovaries and/or fallopian tubes) will identify over 95 percent of women with PID compared with 83 percent identified by the minimum criteria for diagnosing PID suggested by the Centers for Disease Control and Prevention (CDC).

The CDC criteria are: lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. The CDC recommends antibiotic treatment for sexually active young women if all criteria are present, unless another cause of the clinical signs can be identified. However, the new study concludes that doctors should consider antibiotic treatment for at-risk women with adnexal tenderness when there is no other obvious diagnosis to explain the patient's clinical signs and symptoms.

Also, a positive test for chlamydia or gonorrhea increased the odds of disease by a factor of 4.4. An elevated temperature and leukocyte count (above 10,000) were associated with a 6.7-fold increased risk of endometritis (inflammation of the endometrium or uterine lining). The probability of endometritis on the basis of clinical signs exceeded 65 percent only when there was an abnormal cervical-vaginal discharge and a positive test result for N. gonorrhoeae or C. trachomatis.

In the study supported by the Agency for Healthcare Research and Quality (HS08358), Roberta B. Ness, M.D., M.P.H., of the University of Pittsburgh, and her colleagues analyzed the baseline characteristics of 651 women enrolled in a multicenter randomized treatment trial for PID. They recorded clinical and laboratory findings for all patients and performed endometrial sampling. They calculated the sensitivity and specificity of clinical criteria based on results from the sampling.

Details are in "Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease," by Jeffrey F. Peipert, M.D., M.P.H., Dr. Ness, Jeffrey Blume, Ph.D., and others, in the April 2001 American Journal of Obstetrics and Gynecology 184, pp. 856-864.

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