Background We conducted a prospective study to confirm our impression that incarcerated adolescents sometimes developed pelvic inflammatory disease (PID) during the brief interval between testing and treatment for gonorrhoeal and chlamydial cervicitis.
Methods We performed the study at the Harris County Juvenile Detention Center, Texas, where PID in females is relatively common and where the prevalence of gonorrhoea and chlamydia infections is high. At the time of their mandated medical assessment, all incarcerated adolescents submitted first-catch urine samples for chlamydia and gonorrhoea testing. We used Gen-Probe NAAT assays. If at the time of testing a patient had symptoms suggestive of PID, we performed a bimanual pelvic examination and treated those who met the criteria for PID. For the diagnosis of PID, we used the criteria of the US Centers for Disease Control and Prevention: the presence of adnexal or cervical motion or uterine tenderness. The pelvic examinations were performed by one of three experienced physicians. For the patients who did not have PID at the time of testing, we re-assessed them when we learnt that their urine test was positive. The tests were run in batches by the city health department, so that a variable length of time elapsed between the day of testing and the day that we received test results. At re-assessment, patients received a PID diagnosis if they had lower abdominal pain and met the PID diagnostic criteria on bimanual pelvic examination.
Results We evaluated 99 subjects between 29 March 2010 and 27 December 2010. Their mean age was 15.8 (SD 1.1) years. Their race/ethnicity was 43% black, 32% Hispanic, and 25% white; 74% had chlamydia, 14% gonorrhoea, and 12% both. The interval between testing and treatment ranged from 2 to 17 days; the mean (SD) was 7.5 (2.9) days. During this interval, 13 of 99 (13%) developed lower abdominal pain and had bimanual pelvic examination findings that supported the diagnosis of PID. Of these 13, 10 (77%) had chlamydia, 2 (15%) had gonorrhoea, and 1 (8%) had both infections. Time from initial urine testing to treatment for PID ranged from 7 to 15 days.
Conclusion In incarcerated adolescents infected with gonorrhoea and/or chlamydia, a surprisingly large proportion (13%) developed PID during the brief period between testing and treatment.