Women presenting with lower abdominal pain: A missed opportunity for chlamydia screening?

Introduction: Many young women presenting with lower abdominal pain are referred to general surgeons with possible appendicitis. For some of these patients there will be a gynaecological cause for their pain. There has been a steady increase in the incidence of Chlamydia infections and pelvic inflam...

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Veröffentlicht in:The surgeon (Edinburgh) 2006-02, Vol.4 (1), p.15-19
Hauptverfasser: Lloyd, T.D.R., Malin, G., Pugsley, H., Garcea, A., Garcea, G., Dennison, A., Berry, D.P., Kelly, M.J.
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container_end_page 19
container_issue 1
container_start_page 15
container_title The surgeon (Edinburgh)
container_volume 4
creator Lloyd, T.D.R.
Malin, G.
Pugsley, H.
Garcea, A.
Garcea, G.
Dennison, A.
Berry, D.P.
Kelly, M.J.
description Introduction: Many young women presenting with lower abdominal pain are referred to general surgeons with possible appendicitis. For some of these patients there will be a gynaecological cause for their pain. There has been a steady increase in the incidence of Chlamydia infections and pelvic inflammatory disease (PID) among the general population. Therefore, are general surgeons considering this as a diagnosis for lower abdominal pain in women? Methods: One hundred and ninety three women who had been admitted with lower abdominal pain to a single hospital between 1999 and 2001 were identified using computerised records and the notes were examined. One hundred and eighty six women were included in the audit. Investigations and treatments instigated for these patients were then carefully recorded. Results: Seventy-four patients underwent appendicectomy, of which 59 were histologically confirmed. Eighty-nine patients (47.8%) of admissions had no final diagnosis and were not screened for Chlamydia trachomatis. Sexual history was recorded in only 51% of admissions. Vaginal swabs were sent in only 7.3% of admissions. Conclusion: Current guidelines for Chlamydia trachomatis screening produced by the Chief Medical Off cer (CMO) include screening in women presenting with lower abdominal pain as well as those with post-coital or intermenstrual bleeding. Most women who present with classical symptoms of PID will present to gynaecological specialities for further management. However, a signif cant number of women presenting atypically will be referred to surgeons to exclude gastrointestinal causes for their lower abdominal pain. These women could and probably should be screened for Chlamydia trachomatis
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For some of these patients there will be a gynaecological cause for their pain. There has been a steady increase in the incidence of Chlamydia infections and pelvic inflammatory disease (PID) among the general population. Therefore, are general surgeons considering this as a diagnosis for lower abdominal pain in women? Methods: One hundred and ninety three women who had been admitted with lower abdominal pain to a single hospital between 1999 and 2001 were identified using computerised records and the notes were examined. One hundred and eighty six women were included in the audit. Investigations and treatments instigated for these patients were then carefully recorded. Results: Seventy-four patients underwent appendicectomy, of which 59 were histologically confirmed. Eighty-nine patients (47.8%) of admissions had no final diagnosis and were not screened for Chlamydia trachomatis. Sexual history was recorded in only 51% of admissions. Vaginal swabs were sent in only 7.3% of admissions. Conclusion: Current guidelines for Chlamydia trachomatis screening produced by the Chief Medical Off cer (CMO) include screening in women presenting with lower abdominal pain as well as those with post-coital or intermenstrual bleeding. Most women who present with classical symptoms of PID will present to gynaecological specialities for further management. However, a signif cant number of women presenting atypically will be referred to surgeons to exclude gastrointestinal causes for their lower abdominal pain. These women could and probably should be screened for Chlamydia trachomatis</description><identifier>ISSN: 1479-666X</identifier><identifier>EISSN: 2405-5840</identifier><identifier>DOI: 10.1016/S1479-666X(06)80016-8</identifier><identifier>PMID: 16459495</identifier><language>eng</language><publisher>Edinburgh: Elsevier Ltd</publisher><subject>Abdominal Pain - diagnosis ; Abdominal Pain - epidemiology ; Abdominal Pain - surgery ; acute admissions ; Adolescent ; Adult ; Appendicitis - diagnosis ; Appendicitis - epidemiology ; Appendicitis - surgery ; Bacterial diseases ; Bacterial diseases of the genital system ; Biological and medical sciences ; Chlamydia ; Chlamydia Infections - diagnosis ; Chlamydia Infections - epidemiology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; General aspects ; Human bacterial diseases ; Humans ; Incidence ; Infectious diseases ; Mass Screening - standards ; Medical sciences ; Middle Aged ; pelvic inflammatory disease ; Pelvic Inflammatory Disease - diagnosis ; Pelvic Inflammatory Disease - epidemiology ; Pelvic Inflammatory Disease - surgery ; Preoperative Care - methods ; Registries ; Retrospective Studies ; right iliac fossa pain ; Risk Assessment ; Severity of Illness Index ; surgery ; Treatment Outcome ; United Kingdom - epidemiology</subject><ispartof>The surgeon (Edinburgh), 2006-02, Vol.4 (1), p.15-19</ispartof><rights>2006 Royal College of Surgeons of Edinburgh and Royal College of Surgeons in Ireland</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c308t-8a02954aef7409c7c591ed337858ca48e03f2193057a2664a6ac91eaf5fb46c23</citedby><cites>FETCH-LOGICAL-c308t-8a02954aef7409c7c591ed337858ca48e03f2193057a2664a6ac91eaf5fb46c23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S1479-666X(06)80016-8$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,45978</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=17693641$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16459495$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lloyd, T.D.R.</creatorcontrib><creatorcontrib>Malin, G.</creatorcontrib><creatorcontrib>Pugsley, H.</creatorcontrib><creatorcontrib>Garcea, A.</creatorcontrib><creatorcontrib>Garcea, G.</creatorcontrib><creatorcontrib>Dennison, A.</creatorcontrib><creatorcontrib>Berry, D.P.</creatorcontrib><creatorcontrib>Kelly, M.J.</creatorcontrib><title>Women presenting with lower abdominal pain: A missed opportunity for chlamydia screening?</title><title>The surgeon (Edinburgh)</title><addtitle>Surgeon</addtitle><description>Introduction: Many young women presenting with lower abdominal pain are referred to general surgeons with possible appendicitis. For some of these patients there will be a gynaecological cause for their pain. There has been a steady increase in the incidence of Chlamydia infections and pelvic inflammatory disease (PID) among the general population. Therefore, are general surgeons considering this as a diagnosis for lower abdominal pain in women? Methods: One hundred and ninety three women who had been admitted with lower abdominal pain to a single hospital between 1999 and 2001 were identified using computerised records and the notes were examined. One hundred and eighty six women were included in the audit. Investigations and treatments instigated for these patients were then carefully recorded. Results: Seventy-four patients underwent appendicectomy, of which 59 were histologically confirmed. Eighty-nine patients (47.8%) of admissions had no final diagnosis and were not screened for Chlamydia trachomatis. Sexual history was recorded in only 51% of admissions. Vaginal swabs were sent in only 7.3% of admissions. Conclusion: Current guidelines for Chlamydia trachomatis screening produced by the Chief Medical Off cer (CMO) include screening in women presenting with lower abdominal pain as well as those with post-coital or intermenstrual bleeding. Most women who present with classical symptoms of PID will present to gynaecological specialities for further management. However, a signif cant number of women presenting atypically will be referred to surgeons to exclude gastrointestinal causes for their lower abdominal pain. 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For some of these patients there will be a gynaecological cause for their pain. There has been a steady increase in the incidence of Chlamydia infections and pelvic inflammatory disease (PID) among the general population. Therefore, are general surgeons considering this as a diagnosis for lower abdominal pain in women? Methods: One hundred and ninety three women who had been admitted with lower abdominal pain to a single hospital between 1999 and 2001 were identified using computerised records and the notes were examined. One hundred and eighty six women were included in the audit. Investigations and treatments instigated for these patients were then carefully recorded. Results: Seventy-four patients underwent appendicectomy, of which 59 were histologically confirmed. Eighty-nine patients (47.8%) of admissions had no final diagnosis and were not screened for Chlamydia trachomatis. Sexual history was recorded in only 51% of admissions. Vaginal swabs were sent in only 7.3% of admissions. Conclusion: Current guidelines for Chlamydia trachomatis screening produced by the Chief Medical Off cer (CMO) include screening in women presenting with lower abdominal pain as well as those with post-coital or intermenstrual bleeding. Most women who present with classical symptoms of PID will present to gynaecological specialities for further management. However, a signif cant number of women presenting atypically will be referred to surgeons to exclude gastrointestinal causes for their lower abdominal pain. These women could and probably should be screened for Chlamydia trachomatis</abstract><cop>Edinburgh</cop><pub>Elsevier Ltd</pub><pmid>16459495</pmid><doi>10.1016/S1479-666X(06)80016-8</doi><tpages>5</tpages></addata></record>
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subjects Abdominal Pain - diagnosis
Abdominal Pain - epidemiology
Abdominal Pain - surgery
acute admissions
Adolescent
Adult
Appendicitis - diagnosis
Appendicitis - epidemiology
Appendicitis - surgery
Bacterial diseases
Bacterial diseases of the genital system
Biological and medical sciences
Chlamydia
Chlamydia Infections - diagnosis
Chlamydia Infections - epidemiology
Diagnosis, Differential
Female
Follow-Up Studies
General aspects
Human bacterial diseases
Humans
Incidence
Infectious diseases
Mass Screening - standards
Medical sciences
Middle Aged
pelvic inflammatory disease
Pelvic Inflammatory Disease - diagnosis
Pelvic Inflammatory Disease - epidemiology
Pelvic Inflammatory Disease - surgery
Preoperative Care - methods
Registries
Retrospective Studies
right iliac fossa pain
Risk Assessment
Severity of Illness Index
surgery
Treatment Outcome
United Kingdom - epidemiology
title Women presenting with lower abdominal pain: A missed opportunity for chlamydia screening?
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