Adolescent women and pelvic inflammatory disease - Do we know their importance?

The rising incidence of sexually transmitted infections (STIs) is a global public health problem. STIs in adolescent women can be complicated by the development of pelvic inflammatory disease (PID). The aim of this study was to describe the clinical and epidemiological characteristics and management of cases of PID in women under 18 years of age.

A retrospective, multicentre study was designed in which all STIs diagnosed in two tertiary hospitals in Spain between January 2016 and December 2022 were included.

There were 100 adolescent women diagnosed with an STI during the period studied. Among them, 26% (n=26) developed PID (95% CI 17.4%-34.6%). The median age at PID diagnosis was 17 years old [IQR 15-18]. All patients with PID consulted for the presence of symptoms. The most frequent form of presentation was abdominal pain (77%), pelvic pain (31%), abnormal vaginal discharge (19%) and fever (15%). Sixteen Neisseria gonorrhoeae (62%) and fifteen Chlamydia trachomatis (58%) infections were detected. Among them, six (23%) were co-infections. Imaging was performed in 92% of patients and was abnormal in 77% of them. Most patients were admitted to the hospital (77%). All of them received combined empirical antibiotic therapy. The acute complication rate was 42%. Outpatient follow-up was performed in 73% of the adolescents. A new STI was reported in 8% of them.

A high suspicion of PID is necessary in any adolescent woman who engages in unprotected vaginal sex and presented non-specific abdominal pain, especially if does not response to usual treatment or evolve unfavourably.