SILENT PELVIC INFLAMMATORY DISEASE - IS IT OVERSTATED

Objective: To determine the relationship between a history of abdomina l pain and laparoscopic findings in infertile women. Methods: From Sep tember 1993 through December 1994, consecutive infertile women were in terviewed approximately 1 hour before diagnostic laparoscopy. A standa rdized questionnaire was used. The questions focused on medical histor y. Laparoscopic findings were recorded on a standardized form. Results : One hundred twelve women were prospectively studied. Thirty-six wome n (32.1%) had one or more of the following: adnexal adhesions, distal tubal occlusions, perihepatic adhesions. A history of pelvic inflammat ory disease (PID) was related to distal tubal occlusion (odds ratio [O R] 2.6, 95% confidence interval [CI] 0.7-10.0), tubal adhesions (OR 1. 9, 95% Cl 0.7-5.1), ovarian adhesions (OR 2.3, 95% CI 0.9-6.5), and pe rihepatic adhesions (OR 6.8, 95% Cl 1.1-43.9). However, only 11 of the 36 (30.6%) women with adhesions and/or distal tubal occlusion had a h istory of FID. By contrast, 29 of 36 (80.6%) of those with adhesions a nd/or distal tubal occlusion had a history of lower abdominal pain. Th is was true for 32 of the 76 (42.1%) remaining women (OR 5.7, 95% CI 2 .0-14.6). Only four women with adhesions and/or distal tubal occlusion had no history of abdominal pain and no evidence of endometriosis at laparoscopy, and therefore qualified for a possible diagnosis of silen t PID. Conclusion: Silent PID does not seem to be as common among infe rtile women as previously thought. This study suggests that in the fut ure, more extensive questions about medical history are needed than ha ve been asked in the past.