(a) Relationship between lower abdominal pain and pelvic tenderness (ie, key LCSH PID diagnostic criteria) and PID diagnoses in all women assessed (whole cross-sectional study group) (n=3804); (b) Presenting symptoms and signs in PID cases (n=169) and (c) concordance with LCSH PID diagnostic criteria
| Experience level of clinicians (number of clinicians) | Whole study (n=36) | All inexperienced (n=17) | All experienced (n=19) | Consultants (n=6) | All experienced versus all inexperienced | Consultants versus all inexperienced | ||
|---|---|---|---|---|---|---|---|---|
| OR (95% CI) | p Value | OR (95% CI) | p Value | |||||
| Relationship between key LCSH PID diagnostic criteria and PID diagnoses in whole study group | ||||||||
| Total number of women assessed | 3804 | 789 | 3015 | 930 | ||||
| PID diagnoses % (n) | 4.4 (169) | 4.3 (34) | 4.5 (135) | 5.1 (47) | 1.04 (0.71 to 1.53) | 0.84 | 1.18 (0.74 to 1.90) | 0.47 |
| Lower abdominal pain and pelvic tenderness % (n) | 3.2 (120) | 2.5 (20) | 3.3 (100) | 4.2 (39) | 1.32 (0.81 to 2.14) | 0.26 | 1.68 (0.97 to 2.91) | 0.06 |
| Percentage with lower abdominal pain and pelvic tenderness diagnosed with PID | 83.3 | 70.0 | 86.0 | 89.7 | 3.07 (1.05 to 8.94) | 0.05* | 3.75 (0.92 to 15.30) | 0.07 |
| Presenting symptoms and signs in PID cases | ||||||||
| Lower abdominal pain % (n) | 66.9 (113) | 44.1 (15) | 72.6 (98) | 80.9 (38) | 3.36 (1.54 to 7.29) | 0.002 | 5.35 (1.79 to 16.44) | 0.0007 |
| Deep dyspareunia % (n) | 41.4 (70) | 38.2 (13) | 42.2 (57) | 42.6 (20) | 1.18 (0.55 to 2.55) | 0.67 | 1.20 (0.44 to 3.25) | 0.70 |
| Vaginal Discharge % (n) | 63.3 (107) | 58.8 (20) | 64.4 (87) | 76.6 (36) | 1.27 (0.59 to 2.74) | 0.54 | 2.29 (0.87 to 5.99) | 0.09 |
| Abnormal bleeding % (n) | 34.3 (58) | 29.4 (10) | 35.6 (48) | 48.9 (23) | 1.32 (0.58 to 3.00) | 0.50 | 2.30 (0.90 to 5.85) | 0.08 |
| At least 2 of the above symptoms % (n) | 71.6 (121) | 55.9 (19) | 75.6 (102) | 87.2 (41) | 2.44 (1.12 to 5.34) | 0.02 | 5.39 (1.81 to 16.08) | 0.001 |
| At least 3 of the above symptoms % (n) | 29.0 (49) | 20.6 (7) | 31.1 (42) | 46.8 (22) | 1.74 (0.70 to 4.3) | 0.23 | 3.39 (1.24 to 9.32) | 0.02 |
| Bimanual pelvic examination performed % (n) | 96.4 (163) | 97.1 (33) | 96.3 (130) | 97.9 (46) | 1.18 (0.96 to 1.46) | 0.12 | 0.93 (0.72 to 1.21) | 0.60 |
| Cervical motion tenderness % (n) | 60.9 (103) | 70.6 (24) | 58.5 (79) | 78.7 (37) | 0.59 (0.26 to 1.33) | 0.20 | 1.54 (0.50 to 4.79) | 0.56 |
| Uterine/adnexal tenderness % (n) | 55.6 (94) | 58.8 (20) | 54.8 (74) | 51.1 (24) | 0.85 (0.40 to 1.82) | 0.67 | 0.43 (0.13 to 1.43) | 0.17 |
| Concordance of PID cases with LCSH PID diagnostic criteria | ||||||||
| (a) met key criteria | ||||||||
| Lower abdominal pain and pelvic tenderness % (n) | 59.2 (100) | 41.2 (14) | 63.7 (86) | 74.5 (35) | 2.51 (1.16 to 5.40) | 0.02 | 4.17 (1.47 to 12.08) | 0.005 |
| Percentage of above with at least one supportive symptom | 81.9 | 71.4 | 83.7 | 91.4 | 2.06 (0.56 to 7.50) | 0.45* | 4.27 (0.81 to 22.37) | 0.17* |
| Percentage testing CT positive | 30.0 | 14.3 | 32.6 | 34.3 | 2.90 (0.61 to 13.83) | 0.22* | 3.13 (0.60 to 16.33) | 0.29* |
| Percentage testing CT/GC positive | 35.0 | 21.4 | 37.2 | 37.1 | 2.17 (0.56 to 8.38) | 0.37* | 2.17 (0.51 to 9.23) | 0.34* |
| (b) partially met key criteria | ||||||||
| Lower abdominal pain without pelvic tenderness % (n) | 7.7 (13) | 2.9 (1) | 8.9 (12) | 6.4 (3) | 3.22 (0.40 to 25.70) | 0.31* | 2.25 (0.19 to 58.83) | 0.64* |
| Percentage of above with at least one supportive symptom | 76.9 | 100.0 | 75.0 | 100.0 | Uncalculable | 1.00* | Uncalculable | 1.00* |
| Percentage testing CT positive | 7.7 | 0.0 | 8.3 | 33.3 | Uncalculable | 1.00* | Uncalculable | 1.00* |
| Percentage testing CT/GC positive | 23.1 | 0.0 | 25.0 | 33.3 | Uncalculable | 1.00* | Uncalculable | 1.00* |
| Pelvic tenderness without lower abdominal pain % (n) | 26.0 (44) | 47.1 (16) | 20.7 (28) | 14.9 (7) | 0.29 (0.13 to 0.65) | 0.002 | 0.20 (0.06 to 0.63) | 0.002 |
| Percentage with above with at least one supportive symptom | 97.7 | 93.8 | 100.0 | 100.0 | uncalculable | 0.36* | uncalculable | 1.00* |
| Percentage with above plus at least two supportive symptoms | 59.1 | 43.8 | 67.9 | 71.4 | 2.71 (0.76 to 9.63) | 0.12 | 3.21 (0.47 to 21.8) | 0.37* |
| Percentage testing CT positive | 15.9 | 6.25 | 21.4 | 28.6 | 4.09 (0.45 to 37.53) | 0.24* | 6.00 (0.44 to 81.20) | 0.21* |
| Percentage testing CT/GC positive | 15.9 | 6.25 | 21.4 | 28.6 | ||||
| (c) Did not meet any key criteria | ||||||||
| No lower abdominal pain or pelvic tenderness % (n) | 7.1 (12) | 8.8 (3) | 6.7 (9) | 4.3 (2) | 0.74 (0.19 to 2.89) | 0.71* | 0.46 (0.07 to 2.91) | 0.65* |
| Percentage with above with at least 1 supportive symptom | 41.6 | 66.7 | 33.3 | 50.0 | 0.25 (0.02 to 4.00) | 0.52* | 0.50 (0.01 to 19.56) | 1.00* |
| Percentage with above plus at least 2 supportive symptoms | 33.3 | 33.3 | 33.3 | 50.0 | 1.00 (0.06 to 15.99) | 1.00* | 2.00 (0.05 to 78.25) | 1.00* |
| Percentage testing CT positive | 0.0 | 0.0 | 0.0 | 0.0 | Uncalculable | 1.00* | Uncalculable | 1.00* |
| Percentage testing CT/GC positive | 0.0 | 0.0 | 0.0 | 0.0 | Uncalculable | 1.00* | Uncalculable | 1.00* |
p Values obtained using χ2 except those labelled * which were obtained using Fisher's Exact method.
CT, Chlamydia trachomatis; GC, gonococcal infection; LCSH, Leeds Centre for Sexual Health; PID, pelvic inflammatory disease.