Pelvic inflammatory disease in adolescents: a review

Pelvic inflammatory disease is relatively common in sexually active adolescents. Most cases are only mildly symptomatic, and criteria for diagnosis should not be stringent. Although chlamydial or gonorrheal infections or both are common in pelvic inflammatory disease, other aerobic and anaerobic organisms are often also present and may be the only causative agents. Commonly used initial therapy, e.g., ceftriaxone and doxycycline, treats some but not all of these organisms. Patients should be seen within 48 to 72 hours after initiating therapy; lack of improvement suggests noncompliance with antibiotic therapy, the need for broader-spectrum antibiotic coverage, a tubo-ovarian abscess, or a mistake in diagnosis. Important preventive measures include screening of sexually active, asymptomatic adolescents for gonorrheal and chlamydial infections, not only in clinics for sexually transmitted diseases and family planning but also in primary care settings. Urine tests that amplify chlamydial and gonococcal nucleic acid are noninvasive and very accurate.