[Pelvic inflammatory diseases: Microbiologic diagnosis - CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]

How prevalent are symptoms and risk factors of pelvic inflammatory disease in a sexually conservative population

Background

Pelvic inflammatory disease (PID) is the inflammation of the adnexa of the uterus, that mainly manifests in a subclinical/chronic context and goes largely underreported. However, it poses a major threat to women’s health, as it is responsible for infertility and ectopic pregnancies, as well as chronic pelvic pain. Previous studies in Jordan have not reported PID, attributed mainly to the social structure of the country which largely represents a sexually conservative population. Our study aims to report the clinical symptoms that point towards PID and investigate the major risk determinants for the Jordanian population, in a cross-sectional study, using our scoring system based only on clinical data and examination.

Methods

One hundred sixty-eight consecutive adult women that came in the Outpatient Clinics of Gynaecological Department of the Jordan University Hospital were interviewed and their medical history and symptoms were registered and analysed. A Score for PID symptoms, we developed, was given to each woman. Results and correlations were then statistically tested.

Results

Our study population consisted of relatively young women (37.7 ± 11) that had their first child at an average age of 24.1 (± 4.8) and a mean parity of 3.1 (± 2.2). Fifty-eight women (34.5%) reported having undergone at least one CS, while the mean PID Symptom Score was 3.3 (± 2.3). The women in our study exhibited 8 symptoms of PID, namely dysmenorrhea and vaginal discharge; being the commonest (45.2% and 44.6% respectively), in addition to chronic pelvic pain, pelvic heaviness, menorrhagia, dyspareunia, urinary symptoms, and smelly urine. They also reported history of 3 conditions that can be attributed to PID, that is infertility, preterm labour, and miscarriages.

Conclusions

Our PID Scoring System seems to identify the risk factors of PID and predict well the PID likelihood. This score predicts that women with higher parity, who used contraceptives and underwent any invasive medical procedure are expected to score higher in the PID Symptom Score. Our data also suggest that PID should not be ruled out in the Jordanian population when symptoms are compatible to this diagnosis.

As a sexually conservative country, Jordan is thought to have a low prevalence of pelvic inflammatory disease. The prevalence of STD pathogens is very low, however many patients present symptoms of PID, so we randomly interviewed 168 healthy participants and investigated symptoms related to PID. Surprisingly the percentage of participants who had symptoms of PID was high, reaching up to 64% for some symptoms. We then created a PID symptom score; where every symptom gets one mark (1–11), and tested it for association against independent factors. As a result, it can be predicted that a woman with higher parity, who used contraceptives, and underwent E & C, D & C, HSG, or Hysteroscopy is expected to score higher in the PID Symptom Score.

This result draws the attention to PID incidence in similar conservative communities, and therefore further research is needed to confirm the prevalence of PID and identify the causative factors.

[Epidemiological, clinical and therapeutic features of acute pelvic pain in female patients hospitalized in the Yaoundé Gynaecology-Obstetrics and Pediatrics Hospital]

Introduction

Les algies pelviennes aiguës sont responsables d’une morbi-mortalité importante. L’objectif de ce travail était de décrire leurs aspects épidémiologiques, cliniques et thérapeutiques à Yaoundé

Méthodes

Nous avons mené une étude transversale descriptive avec collecte prospective des données au Service de Gynécologie-Obstétrique de l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé du 1^er avril au 31 juillet 2015. Nous avons inclus toutes les femmes admises pour douleur pelvienne dont l’évolution était inférieure à un mois et ayant accepté de participer à l’étude. Nous avons exclu les femmes qui étaient au troisième trimestre de grossesse ou en post-partum. Le logiciel Epi info version 3.5.4 a servi à l’analyse des données. Ces données ont été présentées sous forme de fréquence et de pourcentage.

Résultats

Au total 5915 femmes ont consulté pendant la période de l’étude dont 125(2,11%) étaient des algies pelviennes aiguës. La moyenne d’âge était de 29,5 ± 6,9 ans. Les étiologies des douleurs étaient les infections génitales hautes (36,8%) et la grossesse extra-utérine (18,4%). Le traitement surtout médical (92,8%), associait antibiotiques (65,5%), anti-inflammatoires (56,9%) et antalgiques (39,7%). La chirurgie a été réalisée chez 25(20%) patientes par laparotomie (80%) et cœlioscopie (20%). L’indication chirurgicale était la grossesse extra-utérine dans 76% des cas. La régression de la douleur était obtenue chez 99% des cas.

Conclusion

Les d’algies pelviennes aigues survenaient chez les femmes jeunes, dues aux infections génitales hautes et à la grossesse extra-utérine étaient principalement. En cas de grossesse extra-utérine le traitement chirurgical était surtout la laparotomie.