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P2.055 “P.I.D.” or Endometriosis? Laparoscopic Assessment, Chlamydial Antibodies and Dysmenorrhea Symptom Scoring in Women with Acute Pelvic Pain
  1. P Greenhouse1,2,
  2. V Lees2,
  3. C Overton3,
  4. S Vyas4,
  5. V Akande4,
  6. C Bevan2,3
  1. 1Bristol Sexual Health Centre, Bristol, UK
  2. 2Weston General Hospital, Weston-super-Mare, UK
  3. 3Bristol Royal Infirmary, Bristol, UK
  4. 4Southmead Hospital, Bristol, UK

Abstract

Background Most women with endometriosis receive unnecessary antibiotics for “P.I.D.” because both conditions present with pelvic pain and dyspareunia.

We used negative chlamydial antibody titre and laparoscopy to confirm diagnoses in women identified by dysmenorrhea symptom scoring (DSS) as more probably having endometriosis than PID.

Methods Retrospective review of women meeting CDC diagnostic criteria for “acute P.I.D.” who completed a pain history questionnaire identifying symptoms strongly suggestive of endometriosis, namely:

  1. Severe dysmenorrhoea interfering with schooling or work

  2. Cyclical use of painkillers or heat application

  3. Improvement on hormonal contraception

  4. Cyclical dyschezia

  5. Family history

Those who scored > 50% and whose symptoms failed to respond to hormonal treatment, were assessed by laparoscopy.

Results Of 149 women with high DSS, all tested negative for chlamydia by AptimaCombo2. 41 were referred to gynaecology, and 36 (aged 16–39, median 24y) had laparoscopy.

Of these, 23 had chlamydial antibody titre (CAT) measured, 4 were raised. 26/36 (72%) had endometriosis confirmed at laparoscopy including the four with raised CAT.

10/36 (28%) had no obvious signs of endometriosis or PID nor any other diagnosis.

Scores were similar in those with mild, moderate or severe endometriosis and the apparently disease-free group (mean score 87% & 85% respectively).

Conclusions

  1. DSS is a simple means of excluding PID in women with acute pelvic pain and filtering appropriate referrals to gynaecology with high rates of endometriosis disease finding.

  2. Laparoscopy may not identify exclusively uterine or rectovaginal endometriosis and negative cases remain under review.

  3. DSS cannot predict disease extent due to “high end failure” as genuinely severe endometriosis is uncontrolled by hormonal contraception.

  4. Dysmenorrhoea symptom scoring reliably identifies women who are likely to be given antibiotics for PID when they actually require hormones for endometriosis, and could improve specificity in patient selection for PID research.

  • Endometriosis
  • Laparoscopy
  • pelvic inflammatory disease

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