Blake D R, Fletcher K, Joshi N, Emans S J
Department of Pediatrics, University of Massachusetts Medical School, Worcester 01655, USA.
J Pediatr Adolesc Gynecol. 2003 Feb;16(1):25-30. doi: 10.1016/s1083-3188(02)00207-3.
Diagnosis of chlamydia, gonorrhea, and vaginitis is now possible in adolescents using urine testing and vaginal swabs obtained by care provider or patient. However, a complete pelvic examination is necessary to diagnose pelvic inflammatory disease (PID). It is thus important to identify patients who might have pelvic inflammatory disease to assure complete gynecologic assessment of genitourinary symptoms.
To determine whether adolescent patients with pelvic inflammatory disease report predictable symptoms during the medical interview and to determine what proportion of patients diagnosed with PID report at least one predictor symptom.
Observational study.
Hospital-based adolescent clinic and Job Corps health service.
A convenience sample (n = 193) of adolescent and young adult women who had a pelvic examination performed to evaluate a wide range of genitourinary symptoms.
Clinical diagnosis of pelvic inflammatory disease.
Sensitivity, specificity, and positive and negative predictive value of predictor symptoms for identifying patients given a diagnosis of pelvic inflammatory disease.
Twenty (10.4%) patients received a clinical diagnosis of PID. Lower abdominal pain was the most common symptom (90.0%) reported by these patients. All of the patients with PID reported either lower abdominal pain or dyspareunia in the medical history compared with 97 (56.1%) of those without PID. The presence of lower abdominal pain and/or dyspareunia in the clinical history yielded a sensitivity of 100%, specificity of 44%, and positive and negative predictive value of 17% and 100%, respectively, for identifying patients given a diagnosis of PID.
This study identified two symptoms reported in the medical history (lower abdominal pain and dyspareunia) that were associated with a clinical diagnosis of pelvic inflammatory disease. If lack of these two symptoms was used as a criterion for omitting a pelvic examination, more than one third of the patients in this study could have been evaluated for cervical and vaginal infections with urine and directly obtained vaginal swabs. Although some of these patients might have required a pelvic examination to exclude other causes of abnormal vaginal bleeding, at least 30% of the total sample could have been evaluated without a speculum and bimanual examination. If further studies support these findings, patients with symptoms suggestive of uncomplicated genitourinary infection (e.g., vaginal discharge, vaginal pruritus, or dysuria) who deny lower abdominal pain and dyspareunia can be evaluated with urine and vaginal samples in place of a speculum and bimanual examination.
如今，通过尿液检测以及由医护人员或患者采集的阴道拭子，可对青少年进行衣原体、淋病和阴道炎的诊断。然而，诊断盆腔炎（PID）需要进行完整的盆腔检查。因此，识别可能患有盆腔炎的患者对于确保对泌尿生殖系统症状进行全面的妇科评估至关重要。
确定患有盆腔炎的青少年患者在医学问诊期间是否会报告可预测的症状，并确定被诊断为PID的患者中报告至少一种预测症状的比例。
观察性研究。
以医院为基础的青少年诊所和职业培训团健康服务机构。
对193名青少年及年轻成年女性进行了便利抽样，她们接受了盆腔检查以评估各种泌尿生殖系统症状。
盆腔炎的临床诊断。
用于识别被诊断为盆腔炎患者的预测症状的敏感性、特异性、阳性预测值和阴性预测值。
20名（10.4%）患者被临床诊断为PID。下腹部疼痛是这些患者报告的最常见症状（90.0%）。所有PID患者在病史中均报告了下腹部疼痛或性交困难，而无PID的患者中有97名（56.1%）报告了这些症状。临床病史中存在下腹部疼痛和/或性交困难，对于识别被诊断为PID的患者，敏感性为100%，特异性为44%，阳性预测值和阴性预测值分别为17%和100%。
本研究确定了病史中报告的两种症状（下腹部疼痛和性交困难）与盆腔炎的临床诊断相关。如果将缺乏这两种症状作为省略盆腔检查的标准，本研究中超过三分之一的患者本可以通过尿液和直接采集的阴道拭子进行宫颈和阴道感染的评估。尽管其中一些患者可能需要进行盆腔检查以排除异常阴道出血的其他原因，但至少30%的总样本本可以在不进行窥阴器和双合诊检查的情况下进行评估。如果进一步的研究支持这些发现，对于那些有提示单纯泌尿生殖系统感染症状（如白带、阴道瘙痒或排尿困难）且否认下腹部疼痛和性交困难的患者，可以用尿液和阴道样本进行评估，而无需进行窥阴器和双合诊检查。
