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
Repeat infections can increase a teenager's risk for
chronic pelvic pain, ectopic pregnancies and
"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
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
Other investigators in the study are Jonathan Ellen,
Shang-en Chung and Lynette Forrest, all of