Background: Pelvic inflammatory disease (PID) is commonly due to Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT). CDC treatment guidelines recommend treatment for PID based on the presence of at least 1 criterion (uterine, adnexal, or cervical motion tenderness). Little is known about how women with PID are diagnosed and managed in STD clinics. The objectives of this analysis were to evaluate the management of PID in STD clinics and assess how frequently PID was associated with laboratory-confirmed GC or CT.
Methods: A total of 1080 (1.3%) female patients diagnosed with PID in 14 STD clinics participating in the STD Surveillance Network were identified from January 1, 2010 through December 31, 2011. A sample of 219 (20%) women was randomly selected for medical record review. Patient history, physical findings, treatment and laboratory results were reviewed. We evaluated CT and GC positivity in the preceding year by age groups (≤25 years versus >25 years).
Results: Of 219 women diagnosed with PID, 96% had 1 or more criteria documented on physical examination. Adnexal tenderness was the most common sign in 66.2% and lower abdominal pain was the most common symptom in 58.9%. Sixty-eight percent of women diagnosed with PID received antibiotics consistent with CDC recommendations, with the remaining 32% receiving alternative therapies. Ninety-five percent were tested for either GC or CT in the preceding 12 months. Among younger women, 33.8% had CT, 12% had GC and 41.6% had infection with either organism compared to 15.9%, 7.9% and 18.9%, respectively, among older women.
Conclusions: Diagnosis of PID in STD clinics does follow recommended guidelines and appropriate treatment for PID was provided to the majority of, though not all, patients. Many young women and fewer older women had documentation of recent CT or GC infection.