Acute pelvic inflammatory disease in adolescents

Timely diagnosis and early treatment of pelvic inflammatory disease (PID) in the adolescent is essential, as it occurs with great frequency in this age group, and may result in severe long-term morbidity, including infertility. Study Objective: Previous reports have described that the onset of symptoms in this illness typically begins within the first week of the menstrual cycle. This study was undertaken to determine the relationship between timing of symptom onset and the bacterial etiology of acute PID in female adolescents. Design: A retrospective chart review was performed on 164 inpatients (mean age 19 years old) with the diagnosis of PID, and data were analyzed based on whether the patients were infected with gonorrhea, chlamydia, neither of these bacteria, or both. Results: Eighty-three percent of the patients with gonorrhea had onset of symptoms within the first menstrual week, which was significantly greater than those with chlamydia (31.7%) p=0.004, or those with neither (29.7%) p=0.001. Patients with concurrent gonorrhea and chlamydia developed symptoms on the average of menstrual cycle day 12. A greater proportion of those positive for gonorrhea had a leukocyte count >10,000 than the other three groups (p=0.02), but 33-71% of patients in all groups had a normal leukocyte count. Temperature and sedimentation rate were not helpful in distinguishing the bacterial etiology of the PID. Conclusions: Among adolescents, only gonococcal PID results in onset of symptoms within the first week after onset of menses whereas nongonococcal disease occurs significantly later. Fever and leukocytosis are inconsistently present with PID. Their absence, therefore, should not discourage consideration of this diagnosis.