The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease

Article Abstract:

Diagnosing the cause of pelvic pain in women is not simple; clinical, laboratory, operative, and histopathological methods may be used to make the diagnosis. To evaluate the accuracy of clinical diagnosis by primary care physicians, 95 women with pelvic pain were studied. Sixty-three percent of the group were initially diagnosed by their primary care physicians; 33 percent, in an emergency department; and 4 percent, in hospital wards. The patients were referred to one of three gynecologists for laparoscopy (viewing the internal organs with a fiberoptic tube) or laparotomy (surgical opening of the abdomen). Biopsy specimens were evaluated independently by three pathologists. The diagnostic accuracy of the primary care physicians and gynecologists was then compared with results from histopathological analysis only (PATH-PID) or from visual inspection plus histopathology (ALL-PID). The diagnostic criteria for pelvic inflammatory disease (an infection of the uterus, fallopian tubes, and ligaments); endometritis (inflammation of the uterine lining); and salpingitis (inflammation of the fallopian tubes) are presented. Results showed that the diagnostic accuracy of gynecologists and primary care physicians was no greater than the chance level, except when gynecologists' diagnoses were compared with ALL-PID. Using ALL-PID or PATH-PID as the standard, gynecologists' ability to correctly diagnose pelvic inflammatory disease when it was present was 74 percent, and to correctly diagnose its absence, 67 percent. A diagnosis of salpingitis via laparoscopy had a sensitivity (true positive results) of 50 percent and a specificity (true negatives) of 80 percent. Agreement among diagnoses based on clinical, visual, and histopathological evidence was rather poor; the reasons for this are discussed. Laparoscopy, with biopsy of the endometrium or fallopian tube ending if no signs of disease are apparent, seems the best approach to diagnosing pelvic inflammatory disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Practice, Gynecology, Pelvic inflammatory disease, Laparoscopy, Endometritis, Salpingitis, Pelvic pain

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Detection of Chlamydia trachomatis antigens in urine as an alternative to swabs and cultures

Article Abstract:

Chlamydia trachomatis infections of the lower genital tract are common problems in both men and women. Specimens for laboratory testing have usually been collected with swabs and inoculated in cell cultures for pathogen identification. The use of urethral swabs to collect specimens is not a well accepted procedure in males. Alternative methods have been sought for diagnosing C. trachomatis infection. Serum (blood) antigen detection tests have recently come into use, especially with females. The examination of urine, as an antigen source, was assessed. Three urethral swabs and 20 milliliters (ml) of the first voided urine (FVU) of the day were collected from 224 male patients who were seen in a sexually transmitted disease clinic in 1988. Two cervical swabs and 20 ml of the FVU were collected from 228 female clinic patients during the same interval. Three urethral swabs from another 80 female patients completed the study group population. All specimens were tested using commercially prepared antigen detection kits; two enzyme immunoassay kits and one immunofluorescence test kit. Testing and collection sequences were changed during the project to account for possible sequential variations. The results revealed that C. trachomatis antigens were detected in male FVU sediments at the same frequency as C. trachomatis identification in urethral swab cultures. The sensitivity (identification of the true positives) was equal by both procedures. The use of C. trachomatis antigen detection in the FVU of males provides a rapid, reliable, noninvasive and nontraumatic procedure for diagnosing chlamydia infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Analysis, Demographic aspects, Identification and classification, Chlamydia, Urine, Urinalysis, Bacterial antigens, O antigens, Immunodiagnosis

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Can serology diagnose upper genital tract chlamydia trachomatis infection?

Article Abstract:

No single blood test appears to be able to accurately distinguish women with and without chlamydia infections who have characteristic pelvic pain. Blood tests were performed on 45 symptomatic women and compared with genetic tests on tissue samples. Fourteen of these women had confirmed chlamydia infections and 31 were not infected. The percentage of true positive blood test results ranged from 42.9% using the heatshock protein-60 enzyme immunoassay (HSP-60 EIA) to 100% using whole inclusion fluorescence (WIF). The percentage of true negative blood test results ranged from 80.6% using WIF to 100% using HSP-60 EIA.

Enzyme-linked immunosorbent assay, Endometrium, Endometrial biopsy

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