KidBits: Pelvic Inflammatory Disease in Adolescents
Adolescents are more susceptible to PID for several reasons. Many adolescents are less diligent about using barrier contraception. Additionally, cervical ectropion exposes a large area of columnar epithelial cells, which are less resistant to infection by N gonorrhoeae and C trachomatis.111 Maintain a high level of suspicion for PID in adolescents, as serious sequelae like infertility can develop after a single episode of PID.112 Many clinicians fail to inquire about sexual activity in adolescents and thus fail to consider PID as an etiology for pelvic pain. There are no adjustments for the treatment of the adolescent with PID, and the decision to refer adolescents to the ED should be based on the same criteria as for adult patients.11
Risk Management Pitfalls for Management of Pelvic Inflammatory Disease
1.“Yes, she could have had PID, but she looked so well that I discharged her and deferred treatment to primary care.” All patients who have the clinical diagnosis of PID should have empiric therapy started. Initial presentation does not predict progression of the disease and, therefore, should not be used to determine who should have treatment initiated.
11.* Workowski KA, Bachman LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-180. (CDC guidelines)
Excerpted from: Pochick K. Pelvic inflammatory disease: diagnosis and treatment in Urgent Care. Evidence-Based Urgent Care. 2023 October;2(10):1-23. Reprinted with permission of EB Medicine.