78. Case Series: PID in Never Sexually Active Girls with Vaginal Voiding

Abstract

<h3>Background</h3> Pelvic inflammatory disease (PID) is an inflammatory disease of the upper reproductive tract primarily seen in sexually active women and often associated with sexually transmitted infections (STI). Studies demonstrate PID occurs in never sexually active girls with concomitant gastrointestinal infections or anatomical genitourinary abnormalities. We present two cases of PID attributable to vaginal voiding in never sexually active girls. <h3>Case</h3> Patient A was an 11 year old girl who presented to an outside hospital with a four day history of fever and right lower quadrant pain. Her medical history was significant for obesity and constipation. Physical exam demonstrated fever, tachycardia and diffuse abdominal tenderness with peritoneal signs. CT demonstrated a pelvic abscess. She was transferred to our facility and evaluated by Pediatric Surgery. She underwent pelvic exam under anesthesia which demonstrated purulence and diagnostic laparoscopy with drainage of a right tubo-ovarian abscess (TOA). Gynecology was consulted postoperatively. There was no disclosure of sexual abuse, and STI screening was negative. Further discussion revealed a long history of dysfunctional voiding and urine leakage. Patient B was a 9 year old girl who presented as a transfer to our pediatric hospital with fever, left lower quadrant abdominal pain and imaging findings consistent with left pyosalpinx. Gynecology was consulted. Her history was significant for obesity, constipation, malodorous urine and urinary incontinence. STI screening was negative, and she made no disclosure of sexual abuse. Physical exam revealed diffuse abdominal tenderness as well as urine trapping in the vagina. <h3>Comments</h3> PID and TOA have been demonstrated to occur in never sexually active patients. Evaluation of these patients should include a thorough social history to rule out the possibility of undisclosed sexual abuse and STI screening. Once a sexual mode of transmission is safely ruled out, clinicians must consider other infection risk factors. We present two patients with a history of dysfunctional voiding resulting in trapping of urine in the vagina. We hypothesize that urine trapping led to an ascending pelvic infection. It is important to recognize dysfunctional voiding as a risk factor for pelvic infection so patients may receive appropriate treatment as well as provide a better understanding of their diagnosis. Counseling regarding healthy bladder habits, voiding techniques for prevention of urine trapping and consultation with Urology and pelvic floor Physical Therapy when appropriate are important interventions to prevent recurrence. Treatment of this underlying condition can not only help reduce future risk of ascending infection but improve quality of life.