P1-S2.70 The detection and management of pelvic inflammatory disease in aboriginal women in Central Australia: challenges of a remote high prevalence setting
Background In many remote Aboriginal communities in Australia, the prevalence of gonorrhoea and chlamydia is very high. Client mobility, frequent staff turnover and delays in laboratory results hamper timely treatment. Untreated gonorrhoea and chlamydia can lead to pelvic inflammatory disease (PID). In Central Australia, current remote health guidelines recommend three levels of criteria for diagnosing PID in women with lower abdominal pain: (1) cervical excitation or adnexal tenderness or uterine tenderness; or (2) in the absence of a bimanual examination, vaginal discharge; or (3) in the absence of vaginal discharge in women aged <35 years, intermenstrual bleeding or dyspareunia or a history of STI or PID in the past 12 months. We review adherence to these guidelines in remote primary healthcare centres.
Methods We conducted a review of medical records of Aboriginal women aged 14−34 years attending five primary healthcare centres in areas with high STI prevalence. Any clinical presentation during 2007−2008 with documented lower abdominal pain after the exclusion of other causes was included. We ascertained if the recommended investigations, diagnosis and treatment were documented, according to the guidelines.
Results Of the 741 medical records reviewed, there were 224 presentations with lower abdominal pain in 119 women (16%). Of these, a bimanual examination was undertaken in 15 presentations and either cervical excitation, adnexal or uterine tenderness was recorded in eight (Level 1). History taking for vaginal discharge was documented in 59 presentations (26%), and vaginal discharge recorded in 16 (Level 2). History taking for intermenstrual bleeding or dyspareunia was documented in 27 (12%) and 17 (8%) presentations, respectively and recorded in 10 and 3 presentations, respectively (Level 3). From the available records, at least 78 presentations had evidence of a positive STI or PID in the previous year (Level 3). Overall, a PID diagnosis was documented by the remote practitioner in 35 (16%) of the 224 presentations and none had the recommended treatment regime documented.
Conclusion These results show that most Aboriginal women in remote Central Australia presenting with lower abdominal pain are having inadequate investigations for PID. When a PID diagnosis is made treatment is often inappropriate. Efforts are currently being made to develop electronic diagnosis and management pathways to improve adherence to clinical guidelines.