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Doubt cast on diagnostic criteria for pelvic inflammatory disease

There is insufficient evidence to support existing diagnostic criteria for pelvic inflammatory disease, concludes a study by the Health Protection Agency.

And the authors say future efforts should go into developing a quick and easy diagnostic test.

Ian Simms, senior scientist at the HPA's department of epidemiology, found of nine symptoms commonly associated with PID, only lower abdominal pain was significant.

Mr Simms and colleagues, who evaluated the available evidence base concerned with the diagnosis of PID, concluded GPs should be 'highly suspicious' of PID in any woman who presents with lower abdominal pain, even when no other symptoms are present.

However, abnormal menstrual bleeding, fever and abnormal vaginal discharge were all poor indicators of PID, which can lead to ectopic pregnancy and infertility, the study found.

Current guidelines on diagnosing PID, including those from the Royal College of Obstetricians and Gynaecologists, recommend a range of symptoms suggestive of PID, including abnormal vaginal or cervical discharge, cervical excitation and adnexal tenderness motion and fever (>38° centigrade).

The researchers looked at the relationship between signs and symptoms and presence of laparoscopically diagnosed PID in a cohort of women attending the department of obstetrics and gynaecology at Lund University Hospital in Sweden between 1960 and 1984.

They concluded there was insufficient evidence to support existing clinical criteria for PID but as symptoms are pathognomonic further research would be less useful than development of a quick and easy diagnostic test.

Mr Simms highlighted a lack of awareness of PID among GPs and patients and called for more information to be incorporated into sexual health awareness campaigns.

GPs with a special interest in sexual health agreed diagnosing PID could be a 'minefield'.

Dr Trevor Stammers, a part-time GP in Wimbledon, south-west London, said it is 'extraordinarily difficult' to confirm a diagnosis of PID because lower abdominal pain is a common symptom of many conditions.

Dr Sarah Humphery, a GP in north London, said a lack of clear-cut guidelines led GPs to feel they do a 'half-rate job' and 'you worry about under-diagnosing or overtreating the condition'.

Latest figures show one in 10 young women in inner-city areas has chlamydia ­ the main cause of PID ­ and 70 per cent of patients do not know they are infected, opening the way for potentially large increases in cases of PID.

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