Skip to main content
PMC home page
Infectious Diseases in Obstetrics and Gynecology logoLink to Infectious Diseases in Obstetrics and Gynecology
. 2002;10(4):171–180. doi: 10.1155/S1064744902000194

Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease.

Hernando Gaitán 1, Edith Angel 1, Rodrigo Diaz 1, Arturo Parada 1, Lilia Sanchez 1, Cara Vargas 1
PMCID: PMC1784624  PMID: 12648310

Abstract

OBJECTIVE: To evaluate the clinical diagnosis of pelvic inflammatory disease (PID) compared with the diagnosis of PID made by laparoscopy, endometrial biopsy, transvaginal ultrasound, and cervical and endometrial cultures. Study design: A diagnostic performance test study was carried out by cross-sectional analysis in 61 women. A group presenting PID (n = 31) was compared with a group (n = 30) presenting another cause for non-specific lower abdominal pain (NSLAP). Diagnosis provided by an evaluated method was compared with a standard diagnosis (by surgical findings, histopathology, and microbiology). The pathologist was unaware of the visual findings and presumptive diagnoses given by other methods. RESULTS: All clinical and laboratory PID criteria showed low discrimination capacity. Adnexal tenderness showed the greatest sensitivity. Clinical diagnosis had 87% sensitivity, while laparoscopy had 81% sensitivity and 100% specificity; transvaginal ultrasound had 30% sensitivity and 67% specificity; and endometrial culture had 83% sensitivity and 26% specificity. CONCLUSIONS: Clinical criteria represent the best diagnostic method for discriminating PID. Laparoscopy showed the best specificity and is thus useful in those cases having an atypical clinical course for discarding abdominal pain when caused by another factor. The other diagnostic methods might have limited use.

Full Text

The Full Text of this article is available as a PDF (160.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arredondo J. L., Diaz V., Gaitan H., Maradiegue E., Oyarzún E., Paz R., Reynal J. L., Stamm W., Zambrano D. Oral clindamycin and ciprofloxacin versus intramuscular ceftriaxone and oral doxycycline in the treatment of mild-to-moderate pelvic inflammatory disease in outpatients. Clin Infect Dis. 1997 Feb;24(2):170–178. doi: 10.1093/clinids/24.2.170. [DOI] [PubMed] [Google Scholar]
  2. Boardman L. A., Peipert J. F., Brody J. M., Cooper A. S., Sung J. Endovaginal sonography for the diagnosis of upper genital tract infection. Obstet Gynecol. 1997 Jul;90(1):54–57. doi: 10.1016/S0029-7844(97)00241-X. [DOI] [PubMed] [Google Scholar]
  3. Buchan H., Vessey M., Goldacre M., Fairweather J. Morbidity following pelvic inflammatory disease. Br J Obstet Gynaecol. 1993 Jun;100(6):558–562. doi: 10.1111/j.1471-0528.1993.tb15308.x. [DOI] [PubMed] [Google Scholar]
  4. Cacciatore B., Leminen A., Ingman-Friberg S., Ylöstalo P., Paavonen J. Transvaginal sonographic findings in ambulatory patients with suspected pelvic inflammatory disease. Obstet Gynecol. 1992 Dec;80(6):912–916. [PubMed] [Google Scholar]
  5. Decadt B., Sussman L., Lewis M. P., Secker A., Cohen L., Rogers C., Patel A., Rhodes M. Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain. Br J Surg. 1999 Nov;86(11):1383–1386. doi: 10.1046/j.1365-2168.1999.01239.x. [DOI] [PubMed] [Google Scholar]
  6. Gaitán H., Angel E., Sánchez J., Gómez I., Sánchez L., Agudelo C. Laparoscopic diagnosis of acute lower abdominal pain in women of reproductive age. Int J Gynaecol Obstet. 2002 Feb;76(2):149–158. doi: 10.1016/s0020-7292(01)00563-x. [DOI] [PubMed] [Google Scholar]
  7. Gogate A., Brabin L., Nicholas S., Gogate S., Gaonkar T., Naidu A., Divekar A., Karande A., Hart C. A. Risk factors for laparoscopically confirmed pelvic inflammatory disease: findings from Mumbai (Bombay), India. Sex Transm Infect. 1998 Dec;74(6):426–432. doi: 10.1136/sti.74.6.426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hadgu A., Westrom L., Brooks C. A., Reynolds G. H., Thompson S. E. Predicting acute pelvic inflammatory disease: a multivariate analysis. Am J Obstet Gynecol. 1986 Nov;155(5):954–960. doi: 10.1016/0002-9378(86)90324-8. [DOI] [PubMed] [Google Scholar]
  9. Hager W. D., Eschenbach D. A., Spence M. R., Sweet R. L. Criteria for diagnosis and grading of salpingitis. Obstet Gynecol. 1983 Jan;61(1):113–114. [PubMed] [Google Scholar]
  10. Hillier S. L., Kiviat N. B., Hawes S. E., Hasselquist M. B., Hanssen P. W., Eschenbach D. A., Holmes K. K. Role of bacterial vaginosis-associated microorganisms in endometritis. Am J Obstet Gynecol. 1996 Aug;175(2):435–441. doi: 10.1016/s0002-9378(96)70158-8. [DOI] [PubMed] [Google Scholar]
  11. Jacobson L., Weström L. Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy. Am J Obstet Gynecol. 1969 Dec 1;105(7):1088–1098. doi: 10.1016/0002-9378(69)90132-x. [DOI] [PubMed] [Google Scholar]
  12. Kiviat N. B., Wølner-Hanssen P., Eschenbach D. A., Wasserheit J. N., Paavonen J. A., Bell T. A., Critchlow C. W., Stamm W. E., Moore D. E., Holmes K. K. Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis. Am J Surg Pathol. 1990 Feb;14(2):167–175. doi: 10.1097/00000478-199002000-00008. [DOI] [PubMed] [Google Scholar]
  13. Lepine L. A., Hillis S. D., Marchbanks P. A., Joesoef M. R., Peterson H. B., Westrom L. Severity of pelvic inflammatory disease as a predictor of the probability of live birth. Am J Obstet Gynecol. 1998 May;178(5):977–981. doi: 10.1016/s0002-9378(98)70534-4. [DOI] [PubMed] [Google Scholar]
  14. McCormack W. M. Pelvic inflammatory disease. N Engl J Med. 1994 Jan 13;330(2):115–119. doi: 10.1056/NEJM199401133300207. [DOI] [PubMed] [Google Scholar]
  15. Morcos R., Frost N., Hnat M., Petrunak A., Caldito G. Laparoscopic versus clinical diagnosis of acute pelvic inflammatory disease. J Reprod Med. 1993 Jan;38(1):53–56. [PubMed] [Google Scholar]
  16. Paavonen J., Aine R., Teisala K., Heinonen P. K., Punnonen R. Comparison of endometrial biopsy and peritoneal fluid cytologic testing with laparoscopy in the diagnosis of acute pelvic inflammatory disease. Am J Obstet Gynecol. 1985 Mar 1;151(5):645–650. doi: 10.1016/0002-9378(85)90156-5. [DOI] [PubMed] [Google Scholar]
  17. Peipert J. F., Ness R. B., Blume J., Soper D. E., Holley R., Randall H., Sweet R. L., Sondheimer S. J., Hendrix S. L., Amortegui A. Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Am J Obstet Gynecol. 2001 Apr;184(5):856–864. doi: 10.1067/mob.2001.113847. [DOI] [PubMed] [Google Scholar]
  18. Quazi M. A. Lethal outcome of pelvic inflammatory disease in five women who were seropositive for HIV. Eur J Surg. 1996 Jan;162(1):67–69. [PubMed] [Google Scholar]
  19. Ransohoff D. F., Feinstein A. R. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med. 1978 Oct 26;299(17):926–930. doi: 10.1056/NEJM197810262991705. [DOI] [PubMed] [Google Scholar]
  20. Roper W. L., Winkenwerder W., Hackbarth G. M., Krakauer H. Effectiveness in health care. An initiative to evaluate and improve medical practice. N Engl J Med. 1988 Nov 3;319(18):1197–1202. doi: 10.1056/NEJM198811033191805. [DOI] [PubMed] [Google Scholar]
  21. Sellors J., Mahony J., Goldsmith C., Rath D., Mander R., Hunter B., Taylor C., Groves D., Richardson H., Chernesky M. The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease. Am J Obstet Gynecol. 1991 Jan;164(1 Pt 1):113–120. doi: 10.1016/0002-9378(91)90639-9. [DOI] [PubMed] [Google Scholar]
  22. Soper D. E. Diagnosis and laparoscopic grading of acute salpingitis. Am J Obstet Gynecol. 1991 May;164(5 Pt 2):1370–1376. doi: 10.1016/0002-9378(91)91474-b. [DOI] [PubMed] [Google Scholar]
  23. Sugarbaker P. H., Sanders J. H., Bloom B. S., Wilson R. E. Preoperative laparoscopy in diagnosis of acute abdominal pain. Lancet. 1975 Feb 22;1(7904):442–445. doi: 10.1016/s0140-6736(75)91505-6. [DOI] [PubMed] [Google Scholar]

Articles from Infectious Diseases in Obstetrics and Gynecology are provided here courtesy of Wiley

RESOURCES