Acute exacerbation of recurrent pelvic inflammatory disease. Laparoscopic findings in 141 women with a clinical diagnosis.

OBJECTIVE To evaluate the accuracy of the clinical diagnosis of recurrent pelvic inflammatory disease (PID) and to determine the positive and negative predictive value of laboratory tests for the diagnosis of PID. STUDY DESIGN According to a prospective study design, 141 consecutively hospitalized patients with the clinical diagnosis of PID were evaluated. The basic inclusion criterion was a history of at least one episode of PID. Standard laboratory tests were performed, specimens for aerobic and anaerobic culture and for Chlamydia trachomatis isolation were obtained, and temperature was regularly monitored. All patients underwent laparoscopy under general anesthesia within 24 hours of admission. RESULTS The clinical diagnosis of PID was confirmed by laparoscopy in 30% of patients. In almost one-third of patients, at laparoscopy the pelvic organs were within normal limits. Adhesions without signs of PID were found in 16%. The third-most-frequent finding was endometriosis (14%). Neither the individual monitored parameters nor their combination reached satisfactory positive and negative predictive values for diagnosing PID. CONCLUSION Recurrent clinical symptoms and laboratory signs of PID should be an indication for confirming or excluding the clinical diagnosis by laparoscopy.