Johns Hopkins Gazette | January 20, 2009
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The newspaper of The Johns Hopkins University January 20, 2009 | Vol. 38 No. 18
Diagnosis of Pelvic Inflammation Predicts Infection

Writing a prescription and cursory follow-up won't help, researchers warn

By Katerina Pesheva
Johns Hopkins Medicine

A study among Baltimore inner-city teenage girls treated for pelvic inflammatory disease shows that they are highly vulnerable to subsequent sexually transmitted infections, sometimes within a few weeks or months of their treatment.

Results of the research by Johns Hopkins Children's Center investigators, reported in the November issue of Archives of Pediatric and Adolescent Medicine, suggest that treating pelvic inflammatory disease, or PID, "with a prescription and a brochure" is simply not enough to change behavior and prevent future infections, according to lead investigator Maria Trent, a pediatrician and adolescent medicine specialist at Johns Hopkins Children's Center.

Repeat infections can increase a teenager's risk for chronic pelvic pain, ectopic pregnancies and infertility.

"Because our findings show that PID is not a single isolated incident, doctors should look for ways to change behaviors in these girls and not just treat the acute clinical episode," Trent said. "We are talking counseling, we are talking strict follow-up, and, most importantly, we need to develop new strategies that actually work."

While cautioning that the study was limited to Baltimore City girls, the researchers said that teenage girls across the country's urban areas likely face similar problems linked to inner-city life and practice behaviors that put them at high risk for repeat sexually transmitted infections.

In the four-year study of 110 girls ages 15 to 21 and diagnosed with PID, 80 girls returned for follow-up during the study period. Under the Johns Hopkins protocol, those with confirmed diagnosis of PID are given a course of free medication, asked to return within 72 hours and advised to follow up at three and six months with a primary-care provider.

Of the 80 girls, 27 (34 percent) were diagnosed with at least one subsequent sexually transmitted infection over a six-month period. Of the 27, eight (30 percent) had two or more sexually transmitted infections in the six-month period.

Getting girls to come back is challenging, the researchers said. An earlier study by the Johns Hopkins group found that only 38 percent of girls diagnosed with PID could be reached, and, of these, only 43 percent returned for follow-up care.

The best — and narrow — window of opportunity to counsel girls, researchers said, may be at the time of diagnosis or when they return for the repeat screening in 72 hours. This counseling, moreover, must be more thorough, not just admonitions to practice safe sex or not to have sex at all.

"What we think we need is individually tailored counseling by a clinical provider that is done after an in-depth interview with each patient to determine what aspects of her behavior put her at risk and must change," Trent said.

Researchers are currently testing a pilot program that involves showing an educational video to teenage girls coming to the Emergency Department with PID. The Johns Hopkins team also plans to test the value of house calls to patients by a nurse within 72 hours of diagnosis.

Funding for this research came from the Thomas Wilson Sanitarium Foundation for the Children of Baltimore City, the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention.

Other investigators in the study are Jonathan Ellen, Shang-en Chung and Lynette Forrest, all of Johns Hopkins.


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