Management of PID: are we getting it right?
M. Gupta (1), A. Kasliwal (2)
Department of Genito Urinary Medicine, Royal Liverpool Hospital, Liverpool,
UK (1); Palatine Centre, Manchester, UK (2)
Objective: To establish from the Gynaecology Departments if women with
suspected Pelvic inflammatory Disease (PID) are being managed appropriately.
Method: The Junior Doctor on call for Gynaecology in all the hospitals
in the Northwest region of England and North Wales was interviewed by telephone.
This was a structured interview using a questionnaire.
Results: All the doctors interviewed routinely took a high vaginal
swab (HVS) for culture and sensitivity and an endocervical swab for Chlamydia (CtS).
Only 45% of the doctors used the correct technique of taking the endocervical
swab. 34% of the doctors took a second endocervical swab for gonorrhoea in
charcoal medium. Out of office hours, 21% of doctors stored all the swabs at
room temperature, 38% stored them in the refrigerator and 41% did not know how
they were stored in their hospital. The choice and duration of antibiotic
treatment varied greatly from hospital to hospital. It was the policy in 21% of
the units to refer all women with suspected PID to the Genito Urinary Medicine
(GUM) clinic, whereas 55% of the units referred only those women with a positive
test result.
Conclusion: This study suggests deficiencies in the management of
women with suspected PID in the hospital setting in the region surveyed. It is
essential that protocols for diagnostic tests, treatment and follow-up including
referral to GUM clinic (for screening sexually transmitted infections and sexual
contact tracing) are drawn up according to the National Guidelines. Adherence to
protocols may avoid serious sequelae such as infertility, chronic pelvic pain
and ectopic pregnancy.
