Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis

Abstract

Objective: The aim of this study was to determine the rates of laboratory confirmed gonorrhea (GC) and chlamydia (CT) in emergency department (ED) patients with pelvic inflammatory disease (PID) and cervicitis who were diagnosed clinically and treated empirically. A secondary goal examines which clinical criteria were present in patients with PID testing positive for GC/CT.

Methods: We conducted a retrospective chart review of all ED patents diagnosed with PID or cervicitis during a 40-month period (January 2007-March 2010). Charts were reviewed for laboratory-confirmed GC or CT. For patients with positive GC or CT studies, the presence of key clinical criteria used in the diagnosis of PID was tallied.

Results: A total of 1469 patients were diagnosed with cervicitis and 343 with PID. Of these patients, 27 (1.8%) of 1469 and 15 (4.4%) of 343 were GC positive, and 136 (9.3%) of 1469 and 34 (10%) of 343 were CT positive. Twenty-six cervicitis (1.8%) and 9 PID (2.6%) patients were positive for both infections. One hundred eighty-nine cervicitis (13%) and 58 PID (17%) patients were positive for at least 1 sexually transmitted infection. Of the 58 patients with PID with laboratory-confirmed GC/CT, the following clinical criteria were present: abdominal pain, 58 of 58; abdominal tenderness, 50 of 58; cervical discharge, 47 of 58; cervical motion tenderness, 46 of 58; adnexal tenderness, 32 of 58; vaginal bleeding, 8 of 58; and fever, 2 of 58. Ultrasound was preformed in 27 (47%) of 58 GC/CT-positive patients with PID, with findings suggestive of PID in 12 (44%) of 27 ultrasounds. One hundred percent of abnormal ultrasounds were associated with positive GC and/or CT results.

Conclusion: There is a generally low prevalence of GC and CT in this patient population diagnosed with cervicitis or PID. There is a very low prevalence of coinfection.