Background We did a prospective study of incarcerated adolescents who had been treated for gonorrhoeal and/or chlamydial cervicitis to determine what proportion subsequently developed PID.
Methods We performed the study at the Harris County Juvenile Detention Center, Texas, where PID is relatively common. At the time of their mandated medical assessment, all incarcerated women submitted first-catch urine samples for chlamydia and gonorrhoea testing. We used Gen-Probe NAAT assays. At the time of treatment among those infected, we performed bimanual pelvic examinations to determine if they had PID. We used the PID diagnostic criteria of the US Centers for Disease Control and Prevention: the presence of adnexal or cervical motion or uterine tenderness. The bimanual examinations were performed by one of three experienced practitioners. We treated infected patients with no evidence of PID for chlamydial and gonococcal cervicitis with 1 gm of azithromycin and 400 mg of cefixime, even if they were positive for only one of the two organisms. We treated for both organisms in case that one test was falsely negative. Treatment was observed by clinic staff; if the medicine was vomited, treatment was repeated following the administration of an anti-emetic. We followed all treated women for 30 days or until released, to determine if they developed PID after treatment for cervicitis. During incarceration, they had no opportunity for sexual intercourse.
Results We evaluated 61 adolescents with no evidence of PID, who were treated for chlamydia and gonorrhoea between 29 March 2010 and 27 December 2010. Their mean age was 15.6 (SD 1.2) years; 45% were black, 31% Hispanic, and 24% white. Duration of follow-up after treatment ranged from 6 to 30 days. During follow-up, 8 of 62 (13%) developed lower abdominal pain and had bimanual pelvic examination findings that supported the diagnosis of PID. All but one patient developed PID at least 10 days after cervicitis treatment (range 3−30 days).
Conclusion In incarcerated adolescents treated for gonorrhoeal and/or chlamydial cervicitis, 13% met the criteria for PID in the month subsequent to treatment, even though their therapy was directly observed, and they were not re-exposed to these organisms. Our data suggest that appropriate treatment for cervicitis does not rule out the possibility of subsequent PID even without exposure to gonorrhoea or chlamydia.
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