Association of Lower Genital Tract InflammationWith Objective Evidence of Endometritis

[摘要] The purpose of this report is to evaluate the association between lower genital tract inflammationand objectively diagnosed endometritis. We analyzed the first 157 patients enrolled in the PEACHstudy, a multicenter randomized clinical trial designed to compare the effectiveness of outpatientand inpatient therapy for PID. Women less than 38 years of age, who presented with a history ofpelvic discomfort for 30 days or less and who were found to have pelvic organ tenderness (uterineor adnexal tenderness) on bimanual examination, were initially invited to participate. After recruitmentof the first 58 patients (group 1) we added the presence of leukorrhea, mucopurulent cervicitis,or untreated positive test forN. gonorrhoeaeorC. trachomatisto the inclusion criteria (group 2, N = 99). We compared rates of endometritis in the two groups and calculated the sensitivity, specificity,and predicted values of the presence of white blood cells in the vaginal wet preparation. The rate ofupper genital tract infection in group 1 was 46.5% (27/58) compared to 49.5% (49/99) in group 2.Microbiologic evidence of eitherN. gonorrhoeaeorC. trachomatisincreased from 22.4% in group 1to 38.3% in group 2. The presence of Vaginal white blood cells or mueopus has a high sensitivity(88.9%), but a low specificity (19.4%) for the diagnosis of upper genital-tract infection. Assessmentof the lower genital tract for evidence of infection or inflammation is a valuable component of thediagnostic evaluation of pelvic inflammatory disease. The presence of either mucopus or vaginalwhite blood cells is a highly sensitive test for endometritis in patients with pelvic pain and tenderness.Infect. Dis. Obstet. Gynecol. 8:83–87, 2000.

[学科分类] 妇产科学