Unfortunately, research has shown that these indirect measures do not accurately show if a woman has PID or not. Symptoms of PID vary enormously from woman to woman and do not accurately reflect what's happening internally. Fever is an unreliable indicator of pelvic infection because 60 percent women with PID have no fever. If chlamydia is involved, 78 percent have no fever. Blood tests such as the white blood cell count or sedimentation rate are only general indications that the body is fighting infection. One third of women with PID have normal blood tests and cultures from the cervix do not have a good correlation with cultures taken directly from the reproductive organs. Also, the symptoms of PID are similar to the symptoms of at least eight other syndromes (such as endometriosis, appendicitis, ovarian cysts, inflammatory bowel disease) and these different conditions are easily confused with each other if diagnosis is based on symptoms. For all these reasons, the clinical diagnosis of PID (ie based on symptoms and signs of infection) is extremely difficult and highly prone to error.

A recent Canadian study by Toronto researcher, Dr. John Sellors, compared the clinical diagnosis of PID (without surgery) to diagnosis using the surgical technique of laparoscopy (a procedure that allows the reproductive organs to be directly seen). Even when practitioners were very experienced and used the most careful diagnostic techniques, their clinical diagnosis was no was no more accurate than random chance. A similar result has been found by others studying the diagnosis of PID. Over ten research studies around the world have confirmed that the clinical diagnosis of PID is in error at least 30 to 40 percent of the time.

It is important to remember that the difficulty in diagnosing PID does not occur because the practitioner is not being careful. In fact, no one has been able to develop a reliable way to diagnose PID accurately from symptoms or signs of infection, and unless surgery is done, even the most skilled and careful practitioners will be in error about the diagnosis of PID a significant amount of the time.

The difficulty diagnosing PID is one of the most important reasons to prevent PID. If a laparoscopy is not performed, it is very hard to tell for sure if a woman has PID or not, and as a result, many women aren't treated until significant damage has been done. However, infections of the cervix, which are the most common cause of PID, are easy to diagnose and treat, and prompt treatment will ensure the woman does not develop PID.

Techniques To Clinically Diagnose PID

If PID is diagnosed clinically (ie without surgery), the following clinical diagnostic aids or tests can be done. However, keep in mind that none of these tests is definitive, and many diagnostic errors will result.

PELVIC EXAM: This is an essential part of the diagnosis of PID. The doctor will do a gentle bimanual examination in which two fingers are inserted into the woman's vagina while her abdomen is felt with the other hand to see if the uterus, ovaries or fallopian tubes are tender or swollen. Pain or swelling are a strong indication that a woman has PID. These may be the only indications. The doctor can also feel to see if any lumps or masses are present (can be scarring, abscesses), but many masses are not detected this way.

BLOOD TESTS:The two most common tests are the white blood cell count and the erythrocyte sedimentation rate (ESR). These are general tests to show if the body is fighting an infection or if inflammation is present, but these tests are not specific. They will not show what kind of infection is present or where the infection is located. The tests should be done because if they are positive they may mean there is an infection somewhere in the woman's body, but it is not possible to know if this infection is PID. Also, about one third of women with PID have normal blood tests, so normal blood tests don't rule out PID.

CERVICAL TESTS: These usually involve tests for chlamydia and gonorrhea. If either of these tests is positive, and if the woman has any other signs or symptoms of PID (including tenderness during the pelvic examination), many recommend treating for PID, since the cervical infection has to be treated anyway, and there's a good possibility it may have passed into the reproductive organs.

It's important to remember that a negative cervical test does not rule out the possibility that the woman has PID. The cervix is in a different area of the body than the reproductive organs, and the bacteria living in these two different places may not be the same.