Adolescent girls and pid: Treatment in the pediatric emergency department

Abstract

Background Sexually transmitted diseases (STDs) are epidemic among adolescents. Girls suffer more serious health consequences than boys yet they are often inadequately treated. Many girls with pelvic inflammatory disease (PID) are initially evaluated in Pediatric Emergency Departments. The Centers for Disease Control (CDC) recommend hospital admission for adolescents with PID, a leading cause of infertility, reflecting the need for aggressive management in these patients. This study surveyed physician members of the Section on Pediatric Emergency Medicine of the American Academy of Pediatrics by telephone and mail to determine attitudes and practices related to the management of PID in adolescent girls. Methods Of a total membership of 501, 96 pediatricians were randomly selected and 54 (56%) completed the survey (78% by telephone & 22% by follow up mail questionnaire); most (95%) had teaching responsibilities and were fellowship trained (61%). Geographic distribution included: East 33%;South 24%; Midwest 28%; West 15%. All saw patients up to age 18 years and 31% saw patients to age 21; most (70%) worked in an urban setting and estimated that the large majority of their patients were from poor minority groups. Results 51 (94%) had diagnosed PID within the past 2 years and 37 (69%) diagnosed PID, on average, once a month or more. Nearly two thirds of physicians surveyed indicated that they thought that the care of an adolescent with an STD should be different from that of an adult and that this age group was more prone to medical complications. However, the majority, 28 (52%), did not routinely admit girls with PID. Among those treating on an outpatient basis, just over half arrange follow up within 72 hours of initial treatment as recommended in CDC guidelines for adults, and most do this by providing a phone number. While most emergency physicians routinely suggest condom use (87%) and HN testing (63%) after diagnosing an STD, a minority routinely provide contraceptive counseling (43%) or partner notification (32%). Conclusions The results of this survey suggest that pediatric emergency department physicians frequently diagnose PID in adolescent girls yet many do not follow CDC management guidelines for inpatient admi and provide less than optimal counseling for high risk adolescents. Physician education regarding CDC guidelines and an appreciation of the concerns which lead to their formulation may improve the care of adolescent girls with PID.