Pelvic inflammatory disease self-examination

Since pelvic inflammatory disease does not show obvious symptoms at the beginning, people can only rely on their own examinations to preliminarily determine whether they have this disease. In fact, when you feel that your menstruation is irregular or your leucorrhea is abnormal, you should be alert and closely observe your body changes. If any adverse reactions occur, you should go for corresponding examinations.

A preliminary diagnosis can be made based on medical history, symptoms, signs and laboratory tests. Because the clinical manifestations of pelvic inflammatory disease vary greatly, the accuracy of clinical diagnosis is not high (compared with laparoscopy, the positive predictive value is 65% to 90%). The ideal diagnostic criteria for pelvic inflammatory disease should be sensitive enough to detect mild cases and specific enough to avoid the use of antibiotics in non-inflammatory patients. However, there is currently no single medical history, physical sign, or laboratory test that is both sensitive and specific. Because it is difficult to correctly diagnose pelvic inflammatory disease clinically, delayed diagnosis leads to the occurrence of sequelae of pelvic inflammatory disease.

The diagnostic criteria for pelvic inflammatory disease (PID) recommended by the U.S. Centers for Disease Control (CDC) in 2010 (Table 24-1) are intended to raise awareness of pelvic inflammatory disease in young women with abdominal pain or abnormal vaginal discharge or irregular vaginal bleeding, to further evaluate suspected patients, to provide timely treatment, and to reduce the occurrence of sequelae. The minimum diagnostic criteria suggest that in sexually active young women or those at high risk of sexually transmitted diseases, if they have lower abdominal pain and other causes of lower abdominal pain can be ruled out, and the gynecological examination meets the minimum diagnostic criteria, empirical antibiotic treatment can be given.

Additional criteria can increase the specificity of the diagnosis. Most patients with pelvic inflammatory disease have mucopurulent cervical discharge or a large number of white blood cells in a 0.9% sodium chloride wet mount of vaginal discharge. If the cervical discharge is normal and no white blood cells are seen under the microscope in vaginal discharge, the diagnosis of cellular pelvic inflammatory disease should be made with caution, and other diseases that cause abdominal pain should be considered. Vaginal secretion examination can also detect vaginal infections, such as bacterial vaginosis and Trichomonas vaginitis. Specific criteria can basically diagnose pelvic inflammatory disease, but because all examinations except B-type ultrasound examination are invasive or costly, specific criteria are only applicable to some selected cases. Laparoscopic diagnosis of pelvic inflammatory disease criteria include:

①The surface of the fallopian tube is obviously congested;

②Edema of fallopian tube wall;

③ There is purulent exudate at the fimbria or serosal surface of the fallopian tube. Laparoscopic diagnosis of salpingitis has a high accuracy rate and can directly obtain secretions from the infected site for bacterial culture. However, its clinical application has certain limitations. For example, its diagnostic accuracy for mild salpingitis is low and it has no diagnostic value for isolated endometritis. Therefore, not all patients suspected of pelvic inflammatory disease require laparoscopic examination.