Trent M. Arch Pediatr Adolesc Med. 2011;165:49-54.
A recent study compared adolescent and adult
reproductive health outcomes after pelvic inflammatory disease and found that
“adolescents may require a different approach to clinical care and
follow-up after pelvic inflammatory disease to prevent recurrent sexually
transmitted infections, recurrent pelvic inflammatory disease and unwanted
pregnancies.”
This study is a secondary analysis of longitudinal data
from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH)
study, which is a large multicenter, randomized clinical trial assessing pelvic
inflammatory disease (PID) treatment strategies. The study included 831 female
patients between the ages of 14 and 38 years with a diagnosis of PID. Those
patients who were 19 years or younger were considered adolescents and
represented 25% of the total sample size. The mean age of the adolescents was
17.9 years, and the mean age of adults was 25.3 years. Patients were otherwise
demographically similar.
The study found that adolescents were more likely to
have a sexually transmitted infection at baseline and at 30 days. At 35 or 84
months, there were no significant differences between the groups with regard to
chronic abdominal pain, infertility and recurrent PID; however, adolescents
were more likely to be pregnant at both time points and had shorter times to
pregnancy and recurrent PID, although adolescents reported more consistent
condom use than adults at baseline and at follow-up.
“The pregnancy finding is not surprising because
previous studies have suggested that girls who perceive an impairment of their
fertility are less likely to use contraception, that few adolescents diagnosed
as having PID in observational trials are using contraception, and that
adolescents often believe that prevention of infertility is beyond their
control,” the study researchers wrote.
The CDC recommends that clinicians working with
adolescents with PID “should engage in careful, developmentally
appropriate, and nonjudgmental discussions aimed at reduction of high-risk
behaviors.”