Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia

Bronwyn Joy Silver, Janet Knox, Kirsty Smith, James Ward, Jacqueline Boyle, Rebecca Guy, John Kaldor, Alice Rumbold

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objective: To assess the extent of diagnosed and undiagnosed pelvic inflammatory disease (PID) in Aboriginal women in remote central Australia.

    Design, setting and subjects: Retrospective cross-sectional study in five remote central Australian primary health care centres. Medical records of all resident Aboriginal women aged 14–34 years were examined. Data were from presentations with documented lower abdominal pain, excluding other causes, for 2007–2008.

    Main outcome measures: PID investigations undertaken, PID diagnoses made, recommended treatment, and presentations meeting the guideline criteria for diagnosing PID based on pelvic examination, symptom profile or history.

    Results: Of 655 medical records reviewed, 119 women (18%) presented 224 times with lower abdominal pain. Recommended investigations to diagnose PID were infrequently undertaken: bimanual examination (15 cases [7%]); testing for gonorrhoea and chlamydia (78 [35%]); and history taking for vaginal discharge (59 [26%]), intermenstrual bleeding (27 [12%]) and dyspareunia (17 [8%]). There were 95 presentations (42%) consistent with guidelines to diagnose PID, most (87 [39%]) based on symptom profile and history. Of these, practitioners made 15 diagnoses of PID, and none had the recommended treatment documented.

    Conclusion: Pelvic inflammatory disease occurred frequently among Aboriginal women in central Australia during the study period but was vastly underdiagnosed and poorly treated. Undiagnosed or inadequately treated PID leads to poorer reproductive health outcomes in the long term. Increased awareness of PID symptoms, diagnosis and treatment and a revision of the guidelines is needed to improve detection and management of PID in this high-risk setting.
    Original languageEnglish
    Pages (from-to)647-651
    Number of pages5
    JournalMedical Journal of Australia
    Volume197
    Issue number11
    DOIs
    Publication statusPublished - 2012

    Fingerprint

    Pelvic Inflammatory Disease
    Guidelines
    Abdominal Pain
    Medical Records
    History
    Dyspareunia
    Vaginal Discharge
    Gynecological Examination
    Metrorrhagia
    Chlamydia
    Gonorrhea
    Reproductive Health
    Primary Health Care
    Therapeutics
    Cross-Sectional Studies
    Outcome Assessment (Health Care)

    Cite this

    Silver, B. J., Knox, J., Smith, K., Ward, J., Boyle, J., Guy, R., ... Rumbold, A. (2012). Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia. Medical Journal of Australia, 197(11), 647-651. https://doi.org/10.5694/mja11.11450
    Silver, Bronwyn Joy ; Knox, Janet ; Smith, Kirsty ; Ward, James ; Boyle, Jacqueline ; Guy, Rebecca ; Kaldor, John ; Rumbold, Alice. / Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia. In: Medical Journal of Australia. 2012 ; Vol. 197, No. 11. pp. 647-651.
    @article{998bef545b73488fab3bbeeac54fd700,
    title = "Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia",
    abstract = "Objective: To assess the extent of diagnosed and undiagnosed pelvic inflammatory disease (PID) in Aboriginal women in remote central Australia.Design, setting and subjects: Retrospective cross-sectional study in five remote central Australian primary health care centres. Medical records of all resident Aboriginal women aged 14–34 years were examined. Data were from presentations with documented lower abdominal pain, excluding other causes, for 2007–2008.Main outcome measures: PID investigations undertaken, PID diagnoses made, recommended treatment, and presentations meeting the guideline criteria for diagnosing PID based on pelvic examination, symptom profile or history.Results: Of 655 medical records reviewed, 119 women (18{\%}) presented 224 times with lower abdominal pain. Recommended investigations to diagnose PID were infrequently undertaken: bimanual examination (15 cases [7{\%}]); testing for gonorrhoea and chlamydia (78 [35{\%}]); and history taking for vaginal discharge (59 [26{\%}]), intermenstrual bleeding (27 [12{\%}]) and dyspareunia (17 [8{\%}]). There were 95 presentations (42{\%}) consistent with guidelines to diagnose PID, most (87 [39{\%}]) based on symptom profile and history. Of these, practitioners made 15 diagnoses of PID, and none had the recommended treatment documented.Conclusion: Pelvic inflammatory disease occurred frequently among Aboriginal women in central Australia during the study period but was vastly underdiagnosed and poorly treated. Undiagnosed or inadequately treated PID leads to poorer reproductive health outcomes in the long term. Increased awareness of PID symptoms, diagnosis and treatment and a revision of the guidelines is needed to improve detection and management of PID in this high-risk setting.",
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    Silver, BJ, Knox, J, Smith, K, Ward, J, Boyle, J, Guy, R, Kaldor, J & Rumbold, A 2012, 'Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia', Medical Journal of Australia, vol. 197, no. 11, pp. 647-651. https://doi.org/10.5694/mja11.11450

    Frequent occurrence of undiagnosed pelvic inflammatory disease in remote communities of central Australia. / Silver, Bronwyn Joy; Knox, Janet; Smith, Kirsty; Ward, James; Boyle, Jacqueline; Guy, Rebecca; Kaldor, John; Rumbold, Alice.

    In: Medical Journal of Australia, Vol. 197, No. 11, 2012, p. 647-651.

    Research output: Contribution to journalArticleResearchpeer-review

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