Silent pelvic inflammatory disease: is it overstated?

To determine the relationship between a history of abdominal pain and laparoscopic findings in infertile women.

From September 1993 through December 1994, consecutive infertile women were interviewed approximately 1 hour before diagnostic laparoscopy. A standardized questionnaire was used. The questions focused on medical history. Laparoscopic findings were recorded on a standardized form.

One hundred twelve women were prospectively studied. Thirty-six women (32.1%) had one or more of the following: adnexal adhesions, distal tubal occlusions, perihepatic adhesions. A history of pelvic inflammatory disease (PID) was related to distal tubal occlusion (odds ratio [OR] 2.6, 95% confidence interval [CI] 0.7-10.0), tubal adhesions (OR 1.9, 95% CI 0.7-5.1), ovarian adhesions (OR 2.3, 95% CI 0.9-6.5), and perihepatic adhesions (OR 6.8, 95% CI 1.1-43.9). However, only 11 of the 36 (30.6%) women with adhesions and/or distal tubal occlusion had a history of PID. By contrast, 29 of 36 (80.6%) of those with adhesions and/or distal tubal occlusion had a history of lower abdominal pain. This 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 silent PID.

Silent PID does not seem to be as common among infertile women as previously thought. This study suggests that in the future, more extensive questions about medical history are needed than have been asked in the past.