-But adherence to medication and follow-up remain poor
A study at Johns Hopkins Children’s Center found that girls diagnosed with pelvic inflammatory disease (PID) who watched a short educational video were three times more likely to discuss their condition with their partners and to ensure partner treatment than girls diagnosed and treated without seeing the film.
Reporting online ahead of print in the Journal of Pediatric and Adolescent Gynecology, the Hopkins team says disclosure and partner treatment are critical in preventing the sexually transmitted infection that causes PID from getting passed back and forth between the two partners, minimizing the risk for repeat and chronic infections and preventing further spread outside the original pair.
The six-minute video, produced by Hopkins Children’s, shows teen girls diagnosed with PID coping with various aspects of care and discussing such issues as notifying one’s partner, urging him to get treated, completing a two-week course of antibiotic treatment, returning for follow-up care and abstaining from sexual activity during the treatment.
Girls who saw the video before they were discharged from the ED or the urgent care center were no more likely to finish their medication, return for follow-up and abstain from sex during treatment than those who didn’t see it. However, researchers report that a full two-thirds of the 121 girls, ages 15 to 21, did finish their medication — which they got free of charge before they left the medical treatment site — a marked improvement from the times when girls with PID were discharged and just sent to a pharmacy with a prescription.
“The good news is we got these girls to talk to their partners and get them treated, which is great, but there is clearly a whole lot of work to be done to prevent and treat these infections,” says lead investigator Maria Trent, M.D., M.P.H., pediatrician and adolescent medicine specialist at Hopkins Children’s.
The most alarming finding was the abysmal follow-up rate — 24 percent overall — among this subset of female teens who are at high-risk for repeat STIs and unwanted pregnancies, researchers say. Indeed, fewer than one-fourth of the girls in this study reported using contraception, while nearly half had been pregnant in the past and more than half had a history of STIs.
“In 10 or 20 years, these teen girls will come back to us as women suffering from infertility and chronic gynecologic problems,” Trent says.
PID, an infection of the reproductive organs and a complication of sexually transmitted infections like Chlamydia and gonorrhea, affects 1 million U.S. women each year, according to the CDC, with more than 100,000 of them experiencing fertility problems as a result. Left untreated it can lead to infertility and chronic pelvic pain.
Trent recommends that physicians who diagnose and treat PID refer girls for in-depth counseling that is thorough and non-judgmental.
Girls who watched the video had higher rates of follow-up at 72 hours after diagnosis (32 percent vs. 16 percent), lower rate of sexual abstinence during treatment (78 percent vs. 89 percent) and equal medication adherence at 66 percent for both groups. However, only partner notification and treatment (71 percent vs. 51 percent) remained statistically different when analyzed with more powerful statistical tools, researchers say.
The study was limited to the Baltimore metro area, but the researchers say the pattern is not unique to Baltimore, and teenage girls from urban areas across the country likely face similar problems.
Co-investigators include Shang-en Chung, M.Sc., Michael Burke, M.D., M.B.A., Allen Walker, M.D., and Jonathan Ellen, M.D., all from Hopkins.
The research was funded by the Robert Wood Johnson Foundation, the CDC, the Thomas Wilson Sanitarium Foundation for the Children of Baltimore City and the John and Mary McCarthy Foundation.