Abstract

PIP: The research objective was to determine how often gonorrhea could be found in pelvic inflammatory disease (PID) using a simple bacteriological method. 58 consecutive patients who were admitted to the acute gynecological ward of the Kenyatta National Hospital in Nairobi were investigated. The diagnosis of PID was made clinically. The common presenting features were: pyrexis; pain in the lower abdomen; vaginal discharge; and bilateral adnexal tenderness. Specimens were taken from pus or discharge from the urethra and endocervix. The material was inoculated on the medium of Thayer and Martin and incubated for 24-48 hours in CO2 rich surroundings at 36 degrees. Neisseria gonorrhea was identified on the basis of the aspect of the colonies, a smear from the colonies stained with Gram's method and a positive oxidase reaction. Acute PID accounted for about 12 emergency admissions per week to this ward of the Kenyatta National Hospital. Many more cases were treated as outpatients and a few were found in surgical wards. 30 of the patients studied has received some form of treatment prior to admission. This was antibiotic treatment in at least 10 cases. In another 20 cases the nature of the treatment was unknown. The figures from this single ward, in which only a minority of patients with PID presenting at the hospital are admitted, showed that PID, acute and chronic, is a very common problem encountered in gynecological practice in Nairobi and probably other parts of Kenya. It is a reasonable estimate that in women not more than 3/4 of the actual cases with gonococcal infection will be discovered on a single culture. This is indicated by the 6 cases in whom typical gram negative diplococci were found in the smear, in some of them definitely intracellular, although the culture was negative. The results showed how ineffective the previous treatment was in eliminating the gonococcus from the genital tract. A systematic prophylactic and therapeutic program is urgently needed in Kenya if the problem of gonorreha and its sequelae are to be controlled.