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• Response to Piyadigamage and Wilson
  Meena Gupta
  Published on: 29 September 2005

• Published on: 29 September 2005

  Response to Piyadigamage and Wilson

  • Meena Gupta, Doctor
  • Other Contributors:
    • Asha Kasliwal

  Dear Editor,

  We read with interest the article “Improvement in the clinical cure rate of outpatient management of pelvic inflammatory disease following a change in the therapy”.[1]

  In most GUM clinics gonorrhoea is identified by microscopy (x 1000) of Gram stained genital specimens (sensitivity 20%- 51%)[2] and culture (sensitivity 75%-95%).[3] In the above study gonorrhoea was identified in 12% of c...

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  Dear Editor,

  We read with interest the article “Improvement in the clinical cure rate of outpatient management of pelvic inflammatory disease following a change in the therapy”.[1]

  In most GUM clinics gonorrhoea is identified by microscopy (x 1000) of Gram stained genital specimens (sensitivity 20%- 51%)[2] and culture (sensitivity 75%-95%).[3] In the above study gonorrhoea was identified in 12% of cases. Inspite of this, the authors found that the clinical cure rate was better (72%v55%) when single parenteral dose of ceftriaxone was added to doxycycline and metronidazole regimen (as per UK National guidelines[4]). This may be due to the effect of ceftriaxone on gonococci as well as other bacteria less commonly implicated in the pathogenesis of PID.

  We feel that adherence to the UK National guidelines for managing PID is even more important in settings where there may be limited facilities for diagnosing gonorrhoea e.g. in GP surgeries or Gynaecology units. An audit of management of PID in Gynaecology units in North West of England and North Wales in 2001 showed that management of PID was suboptimal. Swabs for gonorrhoea were taken by only 34% of doctors. Type and duration of antibiotic treatment varied considerably (from 1 to 3 weeks).[5]

  Cost is often an issue. However we should be looking at long-term benefits as appropriate management of PID may prevent serious sequelae like ectopic pregnancy, infertility and chronic pelvic pain which cost health services about 300 million pounds a year.

  Contributors: Both authors have contributed to writing this letter.

  Competing interests: None.

  References:

  1. Piyadigamage A, Wilson J. Improvement in the clinical cure rate of outpatient management of pelvic inflammatory disease following a change in therapy. Sex Transm Infect. 2005 Jun;81(3):233-5.

  2. Manavi K, Young H, Clutterbuck D. Sensitivity of microscopy for the rapid diagnosis of gonorrhoea in men and women and the role of gonorrhoea serovars. Int J STD AIDS. 2003 Jun;14(6):390-4.

  3. Bignell C. National Guideline on the Management of Gonorrhoeae in adults (Revised 2004). www.bashh.org , viewed August 2005

  4. Ross JDC. The UK national guidelines for the management of pelvic inflammatory disease (Revised 2005). www.bashh.org, viewed June 2005

  5. Gupta M, Kasliwal A. Management of PID : Are we getting it right? Abstracts: XV11 FIGO World Congress of Gynaecology and

  Authors:
  1. Corresponding author:
  Dr Meena Gupta
  Specialist Registrar in Sexual Health
  Countess of Chester Hospital
  Liverpool Road
  Chester, Cheshire
  CH2 1UL
  UK
  e-mail: dr_mgupta@hotmail.com
  Tel: 01925 861293
  Fax: 0151 7065821

  2. Dr Asha Kasliwal
  Consultant in Community Gynaecology and Reproductive Health Care
  Palatine Centre
  63-65 Palatine Road
  Manchester
  M20 3LJ
  UK

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  Conflict of Interest:
  None declared.

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