Study suggests federal guidelines for treating teen PID need clarification

April 9, 2013, Johns Hopkins University School of Medicine

A Johns Hopkins Children's Center survey of 102 clinicians who treat teenage girls with pelvic inflammatory disease (PID) has found that official guidelines designed to inform decisions about hospitalization versus outpatient care leave some clinicians scratching their heads.

The study, conducted by a team of specialists and published online in the journal Sexually Transmitted Diseases, presented the clinicians with a series of common and discovered a great deal of uncertainty among some trying to choose between inpatient and outpatient treatment for PID, a potentially damaging inflammation of the resulting from untreated, undertreated or recurrent sexually transmitted infections like chlamydia and , among others.

"The current guidelines from the leave a lot of room for interpretation and uncertainty, which can lead to considerable variability in treatment choice and outcomes from patient to patient," says study lead author Maria Trent, M.D., M.P.H., a pediatrician and teen health specialist at Johns Hopkins Children's Center.

Trent says that despite data showing that teens with PID often fail to adhere to outpatient and miss follow-up appointments, the CDC no longer recommends in-hospital treatment, although clinicians have the flexibility to hospitalize patients if they so choose.

However, the Johns Hopkins study findings suggest the guidelines fall short of informing that flexibility, particularly in cases that involve patients with recent abortions or whose make it unlikely they would comply with the complex outpatient treatment, the researchers say. Such ambivalence was particularly common when the clinicians were uncertain about patients' ability to care for themselves, their willingness to take medications or about their willingness to share diagnoses with sexual partners.

Trent says the study revealed a gender and parental bias in decision-making. Male clinicians and non-parent clinicians were more likely than their female and parent colleagues to hospitalize patients, the study found.

"We found that some clinicians are simply uncomfortable sending a teen home and asking her to follow a complicated PID treatment regimen and return for follow-up visits, despite existing guidelines stating they should do just that," Trent says.

Designed properly, Trent adds, clinical guidelines should offer clear decision-making algorithms while giving physicians autonomy and flexibility. Lack of clarity, however, can force clinicians to make decisions predicated on personal bias rather than on evidence stemming from best practices, the investigators say.

In the study, the clinicians were presented with 17 clinical vignettes involving a hypothetical 15-year-old with PID, then asked to choose between hospital and outpatient treatment for each scenario. The clinicians had to weigh various factors, such as the patient's severity of illness and age, whether the patient was pregnant, whether the patient has had recent surgical procedures, whether the patient was afraid of sharing her diagnosis with a partner and whether the patient appeared able and willing to follow outpatient treatment regimen.

Each year, 800,000 girls and women in the United States develop PID, according to the CDC, and 10 percent of them develop infertility as a result. PID can lead to an array of other long-term problems including ectopic pregnancy and chronic pelvic pain, the researchers say.

Explore further: Parents misjudge impact of pelvic inflammatory disease on teenage girls

Related Stories

Parents misjudge impact of pelvic inflammatory disease on teenage girls

October 28, 2011
(Medical Xpress) -- A Johns Hopkins Children’s Center study comparing perceptions of pelvic inflammatory disease (PID) among teen girls and parents has found that parents seriously underestimate the emotional and medical ...

M. genitalium ups risk of pelvic inflammatory disease, cervicitis

May 31, 2012
(HealthDay) -- Infection with Mycoplasma genitalium (M. genitalium) is an independent and strong risk factor for both cervicitis and pelvic inflammatory disease (PID), according to a study published in the June issue of the ...

Recommended for you

Chronic inflammation causes loss of muscle mass during aging

January 12, 2018
People start losing muscle mass at the age of 40—about some 10 percent of the total muscle mass for each 10-year period, which may lead to fall-related injuries, slowing metabolism and reduced quality of life. Today, very ...

Breathing exercises help asthma patients with quality of life

December 13, 2017
A study led by the University of Southampton has found that people who continue to get problems from their asthma, despite receiving standard treatment, experience an improved quality of life when they are taught breathing ...

Study highlights the need for research into prevention of inflammatory bowel disease

December 7, 2017
Countries in Africa, Asia, the Middle East and South America have seen a rise in incidence of inflammatory bowel disease as they have become increasingly industrialised and westernised, a new study has found.

Air pollution can increase asthma risk in adults, even at low levels

November 24, 2017
Living close to a busy road can be bad for your respiratory health if you are middle aged, new Australian research has found.

Evidence found of oral bacteria contributing to bowel disorders

October 20, 2017
(Medical Xpress)—An international team of researchers has found evidence that suggests certain types of oral bacteria may cause or exacerbate bowel disorders. In their paper published in the journal Science, the group describes ...

New compound discovered in fight against inflammatory disease

September 22, 2017
A 10-year study by University of Manchester scientists for a new chemical compound that is able to block a key component in inflammatory illness has ended in success.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.