Adverse adolescent reproductive health outcomes after pelvic inflammatory disease

Abstract

Objective: To compare longitudinal adolescent and adult reproductive outcomes after pelvic inflammatory disease (PID).

Design: Secondary analysis of longitudinal data from the Pelvic Inflammatory Disease Evaluation and Clinical Health study.

Setting: A large multicenter randomized clinical trial assessing PID treatment strategies in the United States.

Participants: Eight hundred thirty-one female patients aged 14 to 38 years with a diagnosis of PID.

Main exposure: Adverse longitudinal outcomes were compared in adolescents (≤19 years) and adults (>19 years).

Outcome measures: Primary outcome measures included recurrent sexually transmitted infection at 30 days, recurrent PID, chronic abdominal pain, infertility, pregnancy, and times to recurrent PID and pregnancy. Cox proportional hazards modeling was used to examine the effect of young age on times to pregnancy and recurrent PID.

Results: Adolescents were more likely than adults to have positive results of sexually transmitted infection testing at baseline and at 30 days. There were no significant group differences in chronic abdominal pain, infertility, and recurrent PID at 35 or 84 months, but adolescents were more likely to have a pregnancy at both time points. Adjusted hazard ratios (95% confidence intervals) also demonstrated that adolescents had shorter times to pregnancy (1.48 [1.18-1.87]) and recurrent pelvic inflammatory disease (1.54 [1.03-2.30]).

Conclusion: Adolescents may require a different approach to clinical care and follow-up after PID to prevent recurrent sexually transmitted infections, recurrent PID, and unwanted pregnancies.

Figure 1

Approach to analysis in the context of the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) study design. PID indicates pelvic inflammatory disease.

Figure 2

Survival curves depicting time to pregnancy by age group status (adults >19 years and adolescents ≤19 years). Circles indicate censored individuals.

Figure 3

Survival curve depicting time to recurrent pelvic inflammatory disease (PID) by age group status (adults >19 years and adolescents ≤19 years). Circles indicate censored individuals.