Although the management of pelvic inflammatory disease (PID) is improving in general practice, most patients are still failing to be treated according to national guidelines, a UK study has shown.

The British Association of Sexual Health and HIV (BASHH) has published guidelines for the management of PID which includes tests that are routinely available in primary care and antibiotics that are easily obtained from community pharmacists.

The investigators used information from the General Practice Research Database (GPRD), a database of anonymised longitudinal patient records from 460 general practices.

Women aged 15-40 years with a first episode of PID from 30th June 2003 to 30th June 2008 were included in the study. Various aspects of PID management were assessed such as testing for STIs, treatment using specific antibiotics, evidence of referral for further care or management only within the practice.

A total of 3,797 women were coded as having a first episode of PID during the study period; the incidence appeared to decrease from 19.3 to 8.9/10,000 person-years. The National Chlamydia Screening Programme had just been rolled out at the beginning of the study period; in theory, screening and treating for chlamydia may prevent cases of PID but this relationship cannot be substantiated from this study alone.

Overall, 34% of women had evidence of care elsewhere and 56% appeared to have been managed solely within general practice. Of these 2,064 women, 34% received recommended treatment including metronidazole and 54% had a chlamydia test but only 16% had both. Management guidelines were more likely to be adhered to for women in their 20s and later in the study period (23% received testing and treatment including metronidazole in 2007).

PID can present with pelvic pain, dyspareunia, abnormal vaginal discharge and fever and may be a result of bacterial (often sexually transmitted) infection. It can lead to long-term complications including tubal infertility and ectopic pregnancy but prompt treatment is believed to reduce the risk of complications.

The authors conclude that education could improve management but further studies are needed to identify the barriers to adhering to national guidelines.

Dr Richard Ma