Background: Patients diagnosed with pelvic inflammatory disease (PID) or cervicitis in the emergency department are treated presumptively and aggressively with antibiotics according to conventional recommendations. There is a paucity of current data on the actual rates of gonorrhea and Chlamydia in these patients.
Objectives: The goal of this study was to determine the rates of gonorrhea and Chlamydia in emergency department patients who were diagnosed and treated presumptively. The secondary goal examines which clinical criteria were met in those diagnosed with PID who tested positive for one of the sexually transmitted diseases.
Methods: We conducted a retrospective chart review of all emergency department patients diagnosed with PID or cervicitis during a 40 month period (1/07–3/10) at an urban academic hospital. Charts were reviewed for laboratory-confirmed gonorrhea or Chlamydia. Of the patients who were diagnosed with PID and were positive for gonorrhea or Chlamydia, the chart was further reviewed for clinical criteria that are often used in the diagnosis of PID.
Results: 1469 patients were diagnosed with cervicitis and 343 patients were diagnosed with PID. 136/1469 (9.3%) and 34/343 (10.0%) were Chlamydia only positive. 27/1469 (1.8%) and 15/343 (4.4%) were gonorrhea only positive. 26 (1.8%) and 9 (2.6%) patients were positive for both infections (i.e. co-infections). 189 (12.9%) and 58 (16.9%) were positive for at least one infection. Of the 59 patients with PID who were gonorrhea and/or Chlamydia positive, the following clinical criteria were present: abdominal pain 58/59; abdominal tenderness 50 59; adnexal tenderness 32/59; cervical motion tenderness 46/59; cervical discharge 47/59; vaginal bleeding 8/59; fever 2/59. White blood cell count was obtained in 25 patients and averaged 12.1, ESR was obtained in 3 patients, and CRP was obtained in 2 patients.
Conclusion: There is a generally low prevalence of gonorrhea and Chlamydia in this emergency department population diagnosed with cervicitis or PID. There is a very low prevalence of co-infection. Given the current crisis with antibiotic resistance, it is warranted to review the current practice of treatment. Future studies may evaluate if a patient population at low risk of infection may be observed without presumptive antibiotic treatment.