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Diagnosing PID Studies show that treatment of PID is most effective when started early – within two days of first noticing symptoms. Unfortunately, pelvic inflammatory disease is difficult to diagnose and this often delays treatment. There is no simple, standard procedure to test for PID, and because symptoms may be mild or non-existent, it can go unnoticed for months or years. Even when there are symptoms, many women are so used to experiencing discomfort or pelvic pain with their periods that abdominal pain (the main symptom of PID) may be dismissed – by themselves or their GPs – as nothing out of the ordinary. It may be only when pain becomes severe or incapacitating that women seek help or are taken seriously. Without a definitive test for PID, most cases are diagnosed based on reported symptoms (what you tell your doctor) and the results of an internal pelvic examination. This involves the doctor inserting two fingers into your vagina while pushing gently on your abdomen with the other hand. If this is painful for you, it is considered highly likely that you have PID. |
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You may be given antibiotics immediately – a delay of just a few days may be enough time for the infection to cause serious damage. Your doctor may also want to confirm the diagnosis with other tests. Chlamydia and gonorrhoea screening This is done routinely at GUM clinics when PID is suspected, but may not be done automatically by your GP. The doctor (or nurse) will take a sample (swab) of mucus from your vagina, cervix and/or urethra. Some clinics and GPs may offer urine screening instead of, or in addition to, the swab tests. If the test results show signs of chlamydia or gonorrhoea, it will back up the initial diagnosis and mean you almost certainly have PID. But even if the test is negative, you may still have PID caused by another type of, or undetected, bacteria. Blood tests Blood tests may be used to support a diagnosis of PID. Some tests look for increased white blood cells – a sign that the body is fighting an infection. A positive result, however, doesn’t mean you have PID (your body may be fighting a different type of infection), and a negative result doesn’t mean you don’t have PID (if your body is fighting a very low-level infection it may not show up on the blood test). Another type of blood test looks for signs of pregnancy. Some symptoms of PID are the same as those of an ectopic pregnancy and misdiagnosis could be fatal.  Ultrasound In some cases, an ultrasound scan is used to look for swelling or an abscess (infected pocket of pus) in the internal reproductive organs. An ultrasound uses sound waves to produce an image of your internal organs and this may be done abdominally or vaginally. For an abdominal scan, the doctor simply moves the probe over your belly. The scan itself is not painful, but you need to have a full bladder during the procedure and this may be uncomfortable. If you have a vaginal scan, a small probe will be put into your vagina. You do not need a full bladder for this type of ultrasound, but the procedure may be a little uncomfortable. Laparoscopy A laparoscopy is a minor surgical procedure that enables the doctor to look directly at the internal organs, and if necessary, take a tissue sample to test for bacteria. Laparoscopy is considered the most reliable way to diagnose PID, but is generally only used as a last resort, when treatment is not working. Laparoscopy is done in hospital under general or local anaesthetic, and usually takes about 30 minutes. During the procedure, the doctor makes a small cut just below your belly button and inserts a very thin telescope (the laparoscope). Another small instrument is inserted to move your organs around. This may be inserted through a second incision above your pubic hair or through your vagina. The doctor can then look for signs of infection, such as swelling, inflammation or scar tissue. If a tissue sample needs to be taken, this will be done through an additional incision. As laparoscopy examines the outside of the organs, however, it may not detect infections inside the womb or low level infections that aren’t causing visible swelling. Magnetic Resonance Imaging (MRI) A recent study in Finland suggests that magnetic resonance imaging may be able to diagnose PID as accurately as laparoscopy, but without the need for surgery. MRI is not currently used to diagnose PID, but if other studies support its effectiveness, it may be a new way to help diagnose PID accurately and early. If you think your symptoms are not being taken seriously by your doctor, you may want to try a GUM clinic. They specialise in sexual health and genito-urinary medicine and are likely to have more experience of dealing with PID. See Resources for more information. |
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Written by Tamara Beus and published in printed format (2002) by Women's Health
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