Gynecologists and pelvic inflammatory disease: do we actually know what to do? Original paper

What was studied?

This observational cross-sectional study aimed to assess the knowledge, awareness, and clinical practice of Jordanian gynecologists concerning Pelvic Inflammatory Disease (PID). Researchers evaluated gynecologists’ understanding of PID diagnosis, treatment, and management through an online questionnaire involving 172 gynecologists practicing in Jordan. The study specifically examined gynecologists’ awareness of PID’s clinical presentation, diagnostic investigations, therapeutic strategies, and the perceived prevalence and implications of PID within the Jordanian cultural context.

Who was studied?

The participants were 172 gynecologists practicing in Jordan. The study included various demographics, with 57% female and 43% male respondents, ranging widely in age and educational backgrounds. Over half (55.8%) were under the age of 45, reflecting a younger medical cohort actively practicing in Jordan.

What were the most important findings?

The study revealed several crucial insights regarding gynecologists’ perceptions and clinical handling of PID. Although 68.6% recognized PID as a significant health issue in Jordan, there was notable confusion around its clinical presentation, diagnosis, and appropriate management. Major microbial associations identified by participants were anaerobic bacteria such as Escherichia coli and Streptococcus, followed by Chlamydia trachomatis, and rarely Neisseria gonorrhoeae. Surprisingly, despite these pathogens being critical in PID, clinicians rarely requested targeted tests for C. trachomatis and N. gonorrhoeae. Significant gaps emerged regarding adherence to international guidelines, with only 51% correctly identifying laparoscopy as a diagnostic tool, and fewer employing recommended treatment durations. While CDC guidelines suggest a minimum 14-day antibiotic regimen, many gynecologists treated for shorter periods. Gynecologists frequently identified IUCD insertion as a major PID risk factor, despite modern IUCDs having minimal association.

What are the greatest implications of this study?

This study underscores the urgent need for clearer, culturally adapted clinical guidelines and enhanced physician education on PID in Jordan and similar conservative societies. The findings highlight significant discrepancies between current clinical practice and established international standards, potentially leading to suboptimal patient outcomes and complications like infertility and chronic pelvic pain. Additionally, it draws attention to updating perceptions regarding IUCD risks, employing proper diagnostic tests (including C. trachomatis and N. gonorrhoeae testing), and adopting appropriate treatment protocols. The study strongly recommends targeted educational programs and continuous professional development efforts for gynecologists, emphasizing accurate diagnosis, informed therapeutic approaches, and heightened awareness of PID’s diverse clinical presentations.