Impact of new diagnostic criteria on the prevalence and incidence of pelvic inflammatory disease

Abstract

Study ObjectiveThe Centers for Disease Control and Prevention (CDC) recently changed the recommended criteria for the clinical diagnosis of pelvic inflammatory disease (PID). The purpose of this study was to assess the impact of this change on the frequency with which we made a diagnosis of PID. Designprospective cohort study. Settingjuvenile detention center. Participantsadolescent females. InterventionsWe used the new diagnostic criteria to determine the prevalence and incidence of PID. We then compared these values to those in a previous study of a similar cohort of youth who were evaluated with the CDC's old, more stringent clinical criteria. Main Outcome MeasuresPrevalence and incidence of PID. Incidence measuresIncidence density and cumulative incidence, using the Kaplan-Meier method. Results between studies were compared using prevalence and incidence ratios. ResultsIn sexually active adolescents (N=315), the prevalence of PID (95% confidence interval) at admission was 8.6% (5.7–12.2%). During the first 31 days of incarceration, the cumulative incidence was 7.9% (5.0–12.3%) and the incidence density was 11.1 cases/100 person-months (6.5–16.4). Comparison of these results with those of our previous study that used old diagnostic criteria yielded a prevalence ratio of 2.0 (1.0–4.2), a risk ratio (comparing cumulative incidence) of 3.6, and a rate ratio (comparing incidence density) of 3.4 (1.2–11.2). All differences were statistically significant (P<0.05). ConclusionThe new diagnostic criteria for PID doubled the prevalence and more than tripled the incidence of this disease in this high risk population of incarcerated adolescents.