title: Pelvic inflammatory disease in the adolescent: understanding diagnosis and treatment as a health care provider.
abstract: BACKGROUND
  Pelvic inflammatory disease (PID) is a common clinical syndrome with highest rates in adolescents, but no studies have singularly focused on this population in relationship to established guidelines for diagnosis and treatment. The study objective was to assess knowledge of diagnosis and treatment criteria for PID within an adolescent population and to compare factors associated with adherence to Centers for Disease Control and Prevention guidelines in outpatient settings.
  
  
  METHODS
  Data were collected as part of a retrospective chart review of evaluation, diagnosis, and treatment of sexually transmitted infections in adolescent women in an outpatient setting. Participant charts were eligible for review if they were 12 to 21 years of age and were given an International Classification of Diseases, Ninth Revision/chart diagnosis of PID. Two primary outcome variables were utilized: meeting PID diagnosis guidelines (no/yes) and correct treatment for subject meeting criteria with guidelines (no/yes). The study controlled for race, age, medical venue, and current/past infection with gonorrhea/chlamydia.
  
  
  RESULTS
  Subjects (n = 150) were examined for the primary outcome variables; 78% (117/150) met at least 1 criterion for PID diagnosis. Nearly 75% (111/150) had cervical motion tenderness, 34% (51/150) adnexal tenderness, and 5% (7/150) had uterine tenderness; nearly 11% (16/150) were positive for all 3 criteria. Symptoms associated with PID were compared for subjects meeting diagnosis criteria versus subjects not meeting diagnosis criteria: abdominal pain and vomiting were significantly associated with PID diagnosis at P < 0.05.
  
  
  CONCLUSIONS
  Our findings show that PID diagnosis/treatment often does not follow guidelines in the adolescent population. Pelvic inflammatory disease and cervicitis appear to be confused by providers in the diagnosis process, and educational tools may be necessary to increase the knowledge base of practitioners in regard to PID.
authors.affiliation: Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. jennifer.woods1@cchmc.org
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Woods
authors.forename: Amy M
authors.initials: AM
authors.lastname: Scurlock
authors.forename: Devon J
authors.initials: DJ
authors.lastname: Hensel
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001131:Arkansas / Q000453:epidemiology; D002443:Ceftriaxone / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004318:Doxycycline / Q000627:therapeutic use; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D038801:International Classification of Diseases; D064704:Levofloxacin / Q000627:therapeutic use; D008795:Metronidazole / Q000627:therapeutic use; D015242:Ofloxacin / Q000627:therapeutic use; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010146:Pain / Q000209:etiology; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology; D063189:Symptom Assessment; D014481:United States; D002575:Uterine Cervicitis / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D064704:Levofloxacin; D002443:Ceftriaxone; D015242:Ofloxacin; D004318:Doxycycline