Diagnosis and management of pelvic inflammatory disease at an outpatient sexual health clinic: a chart audit

Background/Aims: To compare the management of pelvic inflammatory disease (PID) at the Townsville Sexual Health Services (TNSHS) with the Queensland Sexual Health Clinical Management Guidelines (QSHCMG), and identify areas of discrepancy. Methods: A retrospective chart audit of patients diagnosed with PID between January 2012 and December 2013 was conducted. Information from patient charts on the diagnostic criteria, investigations performed and management was retrieved and compared with the QSHCMG. Results: A total of 47 charts was identified with patient age range of 16-48 years. There was insufficient documentation of many features that were deemed as risk factors for PID by the QSHCMG, such as having multiple partners, concurrent bacterial vaginosis, previous sexually transmitted disease, vaginal douching, post-partum endometriosis and recent uterine instrumentation. Minimal diagnostic criteria were met by 37 (79%) patients. Documentation of investigations and management plan was complete in all patients. The antibiotic regimen prescribed (ceftriaxone 500 mg IMI stat, metronidazole 400 mg BD for two weeks and azithromycin 1 g stat (plus repeat in one week) matched that in the QSHCMG in all patients. Symptom improvement was documented in 33 of 40 patients (83%). Seven patients (15%) were lost to follow-up. Conclusion: Improvements could be made in the documentation of important parts of the history and clinical features that identify those patients diagnosed with PID.