Pelvic Inflammatory Disease In Adolescents Research Articles

Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents.

In this review, the epidemiology, diagnosis, and treatment of pelvic inflammatory disease (PID) are discussed from a USA perspective and the difficulties that USA adolescents face in recognizing and seeking care for PID and other sexually transmitted infections (STIs) are emphasized. Females aged 15–24 years have the highest incidence of cervical infection with Chlamydia trachomatis and Neisseria gonorrheae, the principal causes of PID. PID is common in this age group. However, the incidence of PID in the USA is not known, because it is not a reportable disease, and because clinicians vary in the criteria used for the diagnosis. The Centers for Disease Control and Prevention (CDC) recommended the following diagnostic criteria that include lower abdominal or pelvic pain and at least one of the following: adnexal tenderness or cervical motion tenderness or uterine tenderness. Because PID can have serious sequelae, the criteria emphasize sensitivity (few false-negatives) at the expense of specificity (some false-positives). Patients who have PID are usually treated in the outpatient setting, following the CDC’s Guidelines for the Treatment of Sexually Transmitted Diseases 2015. They receive one dose of an intramuscular cephalosporin, together with 2 weeks of oral doxy cycline, and sometimes oral metronidazole. Improvement should usually be evident in 3 days. The USA does not offer comprehensive sex education for adolescents in public or private schools. Adolescents are unlikely to recognize the symptoms of PID and seek medical treatment. Confidentiality is important to adolescents, and low cost or free sources of confidential care are uncommon, making it unlikely that an adolescent would seek care even if she suspected an STI. The CDC has concluded that screening programs for chlamydia and gonorrhea infection help prevent PID; however, the lack of appropriate sources of care makes adolescents’ participation in screening programs unlikely.

Improving Adolescent Pelvic Inflammatory Disease Follow-up From the Emergency Department: Randomized Controlled Trial With Text Messages

Centers for Disease Control and Prevention guidelines recommend follow-up within 72 hours of diagnosis of pelvic inflammatory disease because patients with inadequate treatment are at increased risk of acute and chronic complications. Follow-up rates in adolescents after diagnosis range between 10% and 16%. The primary objective is to assess the effect of text message reminders to adolescent patients receiving a diagnosis of pelvic inflammatory disease on obtaining follow-up care within 72 hours of emergency department (ED) discharge. This was a single-blinded randomized controlled trial of adolescents receiving a diagnosis of pelvic inflammatory disease in the ED. Patients received standard discharge instructions or standard discharge instructions plus text message reminders. Patients in the text message group received daily, tailored text messages for 4 days, with a reminder to schedule and attend primary care provider follow-up. The primary outcome was follow-up within 72 hours of ED discharge. Ninety-five patients (48 standard; 47 text message) were randomized. Three patients were excluded, leaving 92 patients (46 standard; 46 text message) for analysis. Baseline characteristics were similar between treatment groups. Follow-up was 15.2% in the standard group and 43.5% in the text message group. Patients receiving text message reminders were more likely to follow up compared with the standard group (relative risk 2.9; 95% confidence interval [CI] 1.4 to 5.7). The absolute efficacy difference was 28.3% (95% CI 9.5% to 46.9%), yielding number needed to treat of 4 (95% CI 2.2 to 9.5). Personalized text message reminders were efficacious in improving follow-up for adolescents after ED diagnosis of pelvic inflammatory disease.

Status of adolescent pelvic inflammatory disease management in the United States

Pelvic inflammatory disease (PID) is a common and serious reproductive health disorder and disease rates remain unacceptably high among adolescent girls and young adult women in the United States. Despite data demonstrating that women experience major adverse health outcomes after PID, national recommendations for management of adolescents have become increasingly less cautious in an era of cost-containment. In this review, we take an alternative look at published data on adolescents with PID to frame the next steps for optimizing management for this vulnerable population. Several findings emerge from review of the literature. First, there is limited evidence to guide the best practice strategies for adolescents with PID due to low enrolment of early and middle adolescents in national trials. Second, adolescents and adult women in the United States receive suboptimal treatment regimens per Centers for Disease Control and Prevention (CDC) standards. Third, available evidence suggests that adolescents are at an increased risk for poor adherence to CDC recommendations for self-care, reacquisition of sexually transmitted infections (STIs) and PID, and subsequent adverse reproductive health outcomes. Efforts to develop and integrate adolescent-focused, evidence-based strategies for PID management and prevention of subsequent STIs and recurrent PID are warranted.

P2.162 Health-Related Quality of Life and Biological Test Results as Predictors of Adverse Adolescent Pelvic Inflammatory Disease Outcomes

BackgroundAdolescents who experience pelvic inflammatory disease (PID) are highly likely to experience adverse reproductive health outcomes. Some adolescents might benefit from intensive clinical services to prevent recurrent disease and/or associated...

Intrauterine Devices and Pelvic Inflammatory Disease Among Adolescents

Adolescents may be ideal candidates for intrauterine device (IUD) use, given high rates of unintended pregnancy and less successful use of short-acting contraceptive methods. Concerns about elevated risks of pelvic inflammatory disease in adolescents, with the consequences of infertility, ectopic pregnancy, and pelvic pain, prevent many clinicians from inserting IUDs in adolescents. The body of evidence examining risks of pelvic infection related to IUD use specifically in adolescents is limited, but is reassuring that the absolute risk of pelvic infection is small and that the benefits of IUD use likely outweigh the risks.

Beyond “safe sex”—can we fight adolescent pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is a common disorder affecting sexually active adolescents. The Centers for Disease Control and Prevention (CDC) and European CDC report Chlamydia trachomatis as the most common sexually transmitted infection and one of the main etiological agents causing PID. C. trachomatis' and PID's high prevalence may be attributed to multiple factors including high-risk sexual behaviors, sensitive laboratory diagnostics (polymerase chain reaction), and the introduction of chlamydia screening programs. The pathogenesis of C. trachomatis infection is complex with recent data highlighting the role of toll-like receptor 2 and four in the mediation of the inflammatory cascade. The authors review the etiology of the disease, explore its pathogenesis, and discuss a variety of strategies that may be implemented to reduce the prevalence of C. trachomatis including: (a) behavioral risk reduction, (b) effective screening of asymptomatic females, (c) targeted male screening, (d) implementation of a sensitive, rapid, self-administered point-of-care testing, and (e) development of an effective vaccine.

Pelvic inflammatory disease in adolescents between the time of testing and treatment and after treatment for gonorrhoeal and chlamydial infection

In incarcerated adolescents, 13% developed pelvic inflammatory disease (PID) between the time of testing and treatment for chlamydial and gonorrhoeal infection, and 13% developed PID in the 30 days following single-dose treatment for one or both of these infections.

Adolescents, IUDs, PID, and Enterococcus: A Report of Two Cases

BackgroundIntrauterine devices are being used more frequently in adolescents requiring long-term reversible contraception. This population of sexually active adolescents is also at risk for pelvic inflammatory disease (PID). CasesWe report two cases of PID in adolescents with IUDs in place, both of whom had symptom resolution with removal of their IUDs, and in whom both IUDs were culture positive for Enterococcus. Summary and ConclusionWhether these results indicate vaginal contamination or a causative agent for PID is unclear, but one should consider alternative causes of PID in adolescents with IUDs, particularly in those with prolonged symptoms.

A Case of Adolescent Pelvic Inflammatory Disease Caused by a Rare Bacterium: The who, what, when, where and how of Fusobacterium Nucleatum

A Case of Adolescent Pelvic Inflammatory Disease Caused by a Rare Bacterium: The who, what, when, where and how of Fusobacterium Nucleatum

Adolescent and parental utilities for the health states associated with pelvic inflammatory disease

PurposeThere is limited information about how the consumers of adolescent pelvic inflammatory disease (PID) care value health states associated with the disorder. The aim of this study is to determine...

Results of a Randomized Controlled Trial of a Brief Behavioral Intervention for Pelvic Inflammatory Disease in Adolescents

Results of a Randomized Controlled Trial of a Brief Behavioral Intervention for Pelvic Inflammatory Disease in Adolescents

Pelvic Inflammatory Disease in Adolescents: Do We Know Correct Diagnosis and Treatment Guidelines?

Pelvic Inflammatory Disease in Adolescents: Do We Know Correct Diagnosis and Treatment Guidelines?

Toward Improving the Diagnosis and the Treatment of Adolescent Pelvic Inflammatory Disease in Emergency Departments

To assess the utility of an abbreviated teaching tool (ATT) in improving emergency medicine pediatricians' knowledge of the diagnosis and the treatment of pelvic inflammatory disease (PID). An 18-question internet-based survey, which included questions about the diagnosis and the treatment of PID, was administered to members of the American Academy of Pediatrics Section on Emergency Medicine. Participants were randomized to receive either a weblink to the Centers for Disease Control and Prevention (CDC) sexually transmitted disease treatment guidelines (weblink group) or a 1-page ATT that summarized the CDC guidelines (ATT group) to assist with completion of the survey. We compared the accuracy of responses between the 2 groups. Two hundred thirty-seven subjects responded to the survey (109 from the weblink group and 128 from ATT group). There were no significant differences between the groups with respect to sex, geographic location, practice setting, years of experience, or reported frequency of recent PID diagnoses. Ninety-seven percent of the ATT group correctly identified the appropriate antibiotic regimen in compliance with the CDC guidelines compared with 61% of the weblink group (OR, 19.4; 95% confidence interval, 6.6-76.9); the ATT group was also more likely to correctly identify appropriate treatment options overall (OR, 9.6; 95% confidence interval, 4.9-19.3). Although the overall PID knowledge in our sample was low, the physicians with access to a 1-page teaching tool summarizing the CDC treatment recommendations for PID performed significantly better when asked questions involving PID treatment as compared with providers with access to the CDC Web site. Further studies should investigate whether access to a similar tool can improve patient care.

Results of a Randomized Controlled Trial of a Brief Behavioral Intervention for Pelvic Inflammatory Disease in Adolescents

Objective The objective of this research was to examine the effectiveness of a brief behavioral intervention, provided at the time of diagnosis of pelvic inflammatory disease, on subsequent behaviors by patients who were urban adolescents in a community in which sexually transmitted infection was prevalent. Methods 121 adolescents aged 15 to 21 years with mild to moderate pelvic inflammatory disease were enrolled in a randomized trial. All participants received standardized care, completed baseline audio computerized self-interviews, received full courses of medication at discharge, and were interviewed after the 2-week treatment course. The intervention group also watched a 6-minute intervention video. Main Outcome Measures Medication completion, temporary sexual abstinence during the 14-day treatment period, partner notification, partner treatment, and return for 72-hour follow-up were studied. Data were evaluated using multivariate regression analysis. Results Of the participants, 61% were located and could participate in the 2-week interview by the disease intervention specialist. The intervention participants had higher rates of 72-hour follow-up (32% vs. 16%) and partner treatment (71% vs. 53%) in bivariate analyses at a P = 0.1 level. There were no differences in medication completion (66% vs. 66%), sexual abstinence (78% vs. 89%), or partner notification (88% vs. 92%). Only the partner-treatment finding persisted in multivariate models (AOR = 3.10; 95% CI, 1.03-9.39, P = .045). Conclusions Adolescent girls randomized to a community-specific video intervention at diagnosis of pelvic inflammatory disease were three times more likely to have their partners treated than those in the control group. Given the value of partner treatment in secondary prevention of sexually transmitted diseases, this video may be an essential component of discharge programming in urgent care settings. Additional structural supports may be necessary to facilitate improved adherence to other key adherence behaviors.

Results of a Randomized Controlled Trial of a Brief Behavioral Intervention for Pelvic Inflammatory Disease in Adolescents

Purpose: Centers for Disease Control and Prevention's (CDC) outpatient treatment recommendations for pelvic inflammatory disease (PID) require that the patient and provider engage in a complex set of behaviors. In 2003, we instituted a systems-level intervention aimed at improving provider diagnosis, counseling, and treatment for PID. The intervention significantly improved provider behavior but only minimally affected patient adherence behaviors (72-hour follow-up and medication completion). The objective of this research is to examine the effectiveness of a brief behavioral intervention at the time of PID diagnosis on subsequent patient adherence behaviors among urban adolescents from an STI prevalent community.

Adolescent Pelvic Inflammatory Disease Problem Based Learning (PBL)

OPEN ACCESSMarch 12, 2007Adolescent Pelvic Inflammatory Disease Problem Based Learning (PBL) Maurice Clifton, MD, MSEd Maurice Clifton, MD, MSEd University of Pittsburgh School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.264 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: Understanding the differential diagnosis of lower abdominal pain is complex, especially with an adolescent patient. We created this problem-based learning (PBL) exercise to facilitate teaching about pelvic inflammatory disease (PID) in an adolescent during a 1-hour rounds-type format within a clinical curriculum. Methods: This resource contains a facilitator guide that outlines the case and provides question prompts which may be used to guide the students’ experience of the case. A learner version of the case and a handout containing useful reference information are also provided. This group works through each page followed by a very short summary of the learning points that are on the facilitator copy. It is important that the facilitator has a basic understanding of talking with adolescents and is comfortable with the PBL format. The diagnosis and treatment for PID is based on 2006 CDC Guidelines. Results: This case has been used multiple times. No formal studies have been done, but it has been used multiple times with a pediatric inpatient team made up of multiple levels of learners. Informal feedback has been uniformly positive supporting that the case is realistic, useful, and practical. Discussion: This case is appropriate for both undergraduate and graduate medical education settings and has been successful when utilized with a pediatric inpatient team made up of multiple levels of learners. While used in a rounds-type format it can be adapted to other PBL or case-based formats. Educational Objectives By the end of this session, learners will be able to: Demonstrate understanding of differential diagnosis of lower abdominal pain.Describe how to diagnose pelvic inflammatory disease (PID).Formulate a plan to treat a patient with PID. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Adolescent PID Facilitator's Guide.doc Adolescent PID Handout.doc Adolescent PID Learner Sheets.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Related Teen Substance Abuse Problem Based Learning (PBL) Adolescent Pelvic Inflammatory Disease Problem Based Learning (PBL) Copyright & Permissions© 2007 Clifton. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsSTDsPelvic Inflammatory DiseaseLower Abdominal PainSexually Transmitted InfectionsSTIsPIDAdolescence Disclosures None to report. Funding/Support None to report. Loading ...

Pelvic inflammatory disease in adolescents

We discuss the epidemiology, risk factors, microbiology, diagnosis, treatment and prevention of pelvic inflammatory disease in adolescents. Young age is one of the most important risk factors for sexually transmitted diseases and pelvic inflammatory disease. Sexually active adolescents have the highest incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and pelvic inflammatory disease of any sexually active age group. Long-term sequelae of pelvic inflammatory disease include ectopic pregnancy, tubal factor infertility, tubo-ovarian abscesses and chronic pelvic pain. Subclinical pelvic inflammatory disease is responsible for a significant portion of these long-term sequelae. New (2006) Centers for Disease Control and Prevention treatment guidelines for pelvic inflammatory disease are available. One of the best methods of prevention of pelvic inflammatory disease is to screen and treat sexually active adolescents for chlamydial infection. Implementation of nucleic acid amplification assays allows screening of adolescents via self-collected urine or vaginal swab samples. Pelvic inflammatory disease is a highly preventable source of reproductive morbidity for adolescents. It is prudent that clinicians provide counseling regarding healthy sexual behaviors, STD prevention, and contraception whenever an adolescent presents in need of STD screening or evaluation for pelvic inflammatory disease.

Enfermedad inflamatoria pelviana en adolescentes

Objective A cross sectional descriptive study to determine the consequences and risk factors of pelvic inflammatory disease in adolescents was carried out over a 12-month period at the Hospital Materno Provincial in Camagüey (Cuba). Material and method Fifty-five adolescents who were admitted to our hospital with a diagnosis of pelvic inflammatory disease were selected. The parameters studied included age, first sexual relationship, birth control method used, diagnosis, and treatment. Results Of the group studied, age was less than 15 years in 54.5%. The first sexual relationship occurred before the age of 15 years in 69.1% and 76.4% used no contraception. Notably, pelvic inflammatory disease was resolved by medical treatment in 87.3%. Radical surgery was required in 3 patients.

Pelvic inflammatory disease in adolescents: high incidence and recurrence rates in an urban teen clinic

Study objective To determine pelvic inflammatory disease (PID) incidence and recurrence rates in an urban teen clinic. Design/Setting A retrospective chart review of female patients seen as outpatients over an 18-month period at an urban teen clinic. 192 patients were diagnosed with PID, and the charts of these patients were reviewed in depth. Main outcome measures PID incidence and recurrence rates. Results A PID incidence of 9.7% was identified. Of the adolescent females diagnosed with PID, 47% had recurrent PID. Of the females with recurrent PID, 27% had three or more episodes. Only 36% of adolescent females diagnosed with PID ever reported that their partners had been treated. Conclusions This study suggests a higher incidence of PID as well as PID recurrence in the present clinic-based adolescent population than previously reported. More accurate monitoring of incidence and recurrence rates in well-defined populations of adolescents should be conducted with the hope of identifying effective avenues of intervention.

Management of pelvic inflammatory disease in adolescents.

Pelvic inflammatory disease (PID) is highly prevalent among sexually active adolescent females. The major organisms are N gonorrhoeae and C trachomatis. Diagnosis is based on historical information and clinical findings. Early diagnosis and treatment effectively reduce the incidence of complications associated with PID. Highly effective treatment regimens are available and main antimicrobials used include quinolones, cephalosporins, metronidazole, doxycycline, and azithromycin. Delay or inadequate treatment is associated with long term sequelae including tubal infertility and chronic pelvic pain. Prevention efforts should be directed towards routine screening and treatment for sexually transmissible infections, public education and provision of resources for treatment and follow-up.