Pelvic inflammatory disease in adolescents.

Over one million women experience an episode of pelvic inflammatory disease (PID) each year. It is the most common serious complication of STDs; long-term sequelae include ectopic pregnancy, chronic pelvic pain, and tubal infertility. One in five cases of PID occurs among younger women < 19 years of age. Although only about half of female adolescents are sexually active, they have the highest age-specific rates of PID among sexually experienced women. The risk of developing PID for a 15-year-old sexually active girl is estimated to be 10 times that of a 24-year-old woman. The higher relative risk of PID for younger women has been attributed to their greater biologic vulnerability and their behavioral and cognitive risk factors. In addition, HIV-infected women with PID may be at increased risk for more severe pelvic disease, a growing concern as rates of HIV infection among adolescent girls continue to rise. This article reviews the epidemiology, risk factors, pathogenesis, clinical assessment, and management of PID in adolescent females, including age-specific information when available.

Delivery of STD/HIV preventive services to adolescents by primary care physicians.

PURPOSE: To document the rates of STD/HIV preventive services delivered to adolescents by primary care physicians in California, and to identify variation owing to physician and practice-related factors. METHODS: A stratified random sample of California internists, family physicians, obstetricians-gynecologists, and pediatricians was drawn from the AMA Masterfile and surveyed by mail about their practices with regard to STD/HIV prevention for 15-18-year-old adolescent patients. Sixty percent of eligible physicians responded; the final sample was 1217 physicians. RESULTS: Results showed that 40% of physicians reported screening all of their adolescent patients for sexual activity and 31% reported educating all of their adolescent patients about STD/HIV transmission. For their sexually active adolescent patients, 36% of physicians always provided STD/HIV education, 17% always screened for number of previous sexual partners; 12% always screened for sexual orientation; and 10% always screened for frequency of casual sex. Four percent of the physicians reported that they always provided condoms for their sexually active adolescent patients; 81% never provided condoms. Higher levels of preventive services delivery were associated with female physician gender, specialization in obstetrics-gynecology, and more recent date of medical school graduation. Physicians practicing in health maintenance organizations reported providing significantly higher rates of preventive services to sexually active adolescents than did physicians in private practice. CONCLUSIONS: Primary care physicians provide STD/HIV preventive services to adolescents at rates far below those recommended by current guidelines. Areas where additional research would be informative are highlighted.