Prevention and treatment strategies should be tailored to age group
Teenage girls with pelvic inflammatory disease (PID) are more likely than adult women to have repeated sexually transmitted infections shortly after the initial diagnosis and to develop recurrent PID sooner, according to a new study from Johns Hopkins Children’s Center and other institutions.
Because recurrent STI infections and PID compound a girl’s long-term risk for chronic pelvic pain and infertility, these findings emphasize the need for more aggressive prevention, counseling and treatment of teenagers with PID, the investigators write in the January issue of Archives of Pediatrics & Adolescent Medicine.
The research team analyzed 831 patient records of women, ages 14 to 38, treated for mild and moderate PID in eight hospitals across the United States. The study compared subsequent infections, chronic pelvic pain, pregnancy and infertility between girls (19 years and younger) and women.
At the three-year follow-up, 17 percent of teenage girls reported having another PID episode, compared to less than 14 percent of adult women. At the seven-year checkup, one in four girls reported second PID compared to one in five adult women.
Teens were more likely to test positive for gonorrhea or Chlamydia at the time of the diagnosis (63 percent vs. 41 percent) and 30 days after the diagnosis (20 percent vs. 5.2 percent).
The girls’ higher infection rates also appear to contradict their claims of using condoms more consistently than adult women and suggest that they may over-report safe-sex practices.
PID, an inflammation of the reproductive organs, is a complication of untreated sexually transmitted infections like Chlamydia and gonorrhea, among other bacterial infections, and affects more than 1 million women in the United States each year, according to the U.S. Centers for Disease Control. More than 100,000 of these women develop fertility problems as a result of their infections.
“Right now we are treating teenage girls and adult women with PID in the exact same way but we really shouldn’t,” says lead researcher Maria Trent, M.D., M.P.H., a pediatrician and adolescent medicine specialist at Hopkins Children’s. “Psychological and social dynamics typical of adolescence may explain some of the differences in infection rates, and we need to factor them into the way we design prevention and treatment.”
For example, the researchers say, teenagers tend to change partners more often than adult women, a pattern that increases teen girls’ STI risk.
Patients with moderate and mild disease are sent home with a course of antibiotics and asked to return for a check-up in 72 hours. However, in light of the new findings, the researchers say, a more structured and vigilant approach is needed with rigorous follow-up and closer monitoring of a “vulnerable population.”
Regardless of age, many of the women in the study suffered significant consequences, such as chronic abdominal pain and infertility. Indeed, the analysis found no difference in these outcomes between the age groups at three-year and seven-year follow-ups. Overall, nearly one in five of all patients experienced fertility problems and 40 percent reported chronic pelvic pain, both “alarming findings,” the researchers say, given that none of the patients in the study had experienced severe PID.
At the three-year follow-up, 44 percent of patients had chronic abdominal pain, 22 percent were infertile, 41 percent became pregnant and 14 percent had another episode of PID. At the seven-year mark, 41 percent reported chronic abdominal pain, 18 percent were categorized as infertile, 57 percent got pregnant and 20 percent had another PID episode.
The researchers say that even though the majority of those in the study were low-income African-American females, the findings shed light on important age differences that likely hold true across the board. African-American women also are disproportionately affected by PID and infertility, the researchers say.
Co-investigators on the study included Jacky Jennings, Ph.D. M.P.H., of Hopkins; Catherine Haggerty, Ph.D., M.P.H., Sunghee Lee, M.P.H., and Debra Bass, M.S., of the University of Pittsburgh; and Roberta Ness, M.D. M.P.H., of the University of Texas. The research was funded by the CDC and the Agency for Healthcare Research and Quality Development.