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Pelvic inflammatory disease - Management
Basis for recommendation

Taking swabs for Chlamydia trachomatis and Neisseria gonorrhoeae

  • The recommendation that all women with suspected PID should be tested for C. trachomatis and N. gonorrhoeae is based on expert opinion in guidelines from the Royal College of Obstetricians and Gynaecologists [RCOG, 2009], the British Association for Sexual Health and HIV [BASHH, 2005a], the European guideline for the management of pelvic inflammatory disease [Ross et al, 2008], and guidelines from the Department of Health and Human Services — Centres for Disease Control and Prevention [CDC, 2006].
    • A positive result supports a diagnosis of PID and reinforces the need to treat sexual partners.
    • However, a negative result does not exclude PID [BASHH, 2005a].

Interpreting the results of a wet-mount smear

  • The absence of endocervical or vaginal pus cells suggests that the diagnosis is not PID. The negative predictive value for a diagnosis of PID is 95% (that is, 19/20 people who have a negative test result will not have the disease) [BASHH, 2005a; RCOG, 2009].
  • The presence of pus cells is a non-specific finding. The positive predictive value is low (that is, the proportion of people who have a positive test result and who have PID is only 17%) [BASHH, 2005a; RCOG, 2009].

Erythrocyte sedimentation rate (ESR), C-reactive protein, and leucocyte count

  • Increased ESR or C-reactive protein, and leucocytosis, all support the diagnosis of PID and can provide a useful measure of disease severity [RCOG, 2009].
  • However, the ESR, C-reactive protein, or white cell count may be normal in mild or moderate PID [Ross et al, 2008].

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