title: Subsequent sexually transmitted infection after outpatient treatment of pelvic inflammatory disease.
abstract: OBJECTIVE
  To determine the frequency of recurrent sexually transmitted infections (STIs) and/or pelvic inflammatory disease (PID), the average time until subsequent infection following a baseline PID diagnosis, and age- and insurance-related associations with subsequent diagnoses.
  
  
  METHODS
  This study used prospective longitudinal follow-up of STI and/or PID outcome data from electronic medical records.
  
  
  METHODS
  An urban academic hospital system.
  
  
  METHODS
  A total of 110 adolescent girls treated for PID as outpatients in pediatric ambulatory sites. Main Exposure Electronic medical records used to assess subsequent PID diagnoses and/or infections with Neisseria gonorrhoeae or Chlamydia trachomatis during the study window.
  
  
  METHODS
  Demographic, health care use, and STI and/or PID outcome data were examined. Incidence of an STI and/or PID was calculated as incident cases per person-months of exposure. Cox proportional hazard modeling was performed to evaluate the incidence of STI by age or insurance status.
  
  
  RESULTS
  The mean (SD) age was 16.8 (1.9) years, 89% of patients were black, and 39% had laboratory results that were positive for N gonorrhoeae or C trachomatis at baseline. Thirty-four percent of patients had an additional diagnosis of an STI during the 48-month follow-up window (incidence, 3.1 per 100 person-months) and the mean (SD) time to a subsequent STI and/or PID was 377 (297) days. Of those patients, 67% (n = 18) had chlamydia, 11% had gonorrhoeae, and 44% had PID. There were no differences based on age or insurance status.
  
  
  CONCLUSIONS
  Adolescents treated for PID are at risk for subsequent STI and/or PID for a 48-month period. Given the need to prevent future infections in these vulnerable youths, efforts to explore the value of ongoing strategies for risk reduction after diagnosis are warranted.
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. mtrent2@jhmi.edu
authors.forename: Maria
authors.initials: M
authors.lastname: Trent
authors.forename: Shang-en
authors.initials: SE
authors.lastname: Chung
authors.forename: Lynette
authors.initials: L
authors.lastname: Forrest
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Ellen
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D002690:Chlamydia Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006069:Gonorrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy* / Q000453:epidemiology*; D011446:Prospective Studies; D012008:Recurrence; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*