The incidence of positive cultures in women suspected of having PID/Salpingitis
OBJECTIVES: To determine the incidence of GC and chlamydia in women with suspected acute pelvic inflammatory disease. A secondary objective was to investigate the clinical usefulness of physical exam findings of vaginal discharge, cervical motion, and adnexal tenderness. METHODS: This was a retrospective chart review of patients seen in the ED. Patients were entered into the study if they had PID/salpingitis as their discharge diagnosis and cultures performed for GC and chlamydia. RESULTS: A total of 133 charts were reviewed. 13 patients were excluded due to incomplete charting of history and physical exam or inability to obtain culture results. Of the remaining 120 patients, 70 cultures were negative for any growth. 10 cultures were positive for GC and 10 cultures were positive for chlamydia. In reviewing the physical exam findings in women with negative cultures, 74% had discharge, 93% had cmt, and 66% had adnexal tenderness. For women with cultures positive for GC and chlamydia, 90% had discharge, 80% had cmt, and 75% had adnexal tenderness. For vaginal discharge the sens, spec, ppv, npv were 0.90, 0.26, 0.35, 0.90. For cmt the sens, spec, ppv, npv were 0.80, 0.07, 0.20, 0.55. For adnexal tenderness the sens, spec, ppv, npv were 0. 75, 0.34, 0.25, 0.83. No combination of the three physical exam findings increased the ppv. CONCLUSIONS: The incidence of positive cultures in women suspected of having PID/salpingitis is 16%. The physical exam findings were not predictive of disease secondary to the high number of false positives. Although 16% positives may warrant empiric treatment, patients should not be told they have PID/salpingitis until the cultures are available.
Parker
CA
OUCOM / Doctors Hospital, Columbus, OH.
Topinka
MA