Pelvic inflammatory disease in the adolescent.

Pelvic inflammatory disease is one of the most serious complications of sexually transmitted diseases. It is a medical and public health problem of great magnitude, and adolescents are at greater risk for its development than any other age group. Its sequelae of infertility, ectopic pregnancy, chronic pelvic pain, and dyspareunia may have a devastating impact upon a teenager's life. The epidemiology, pathogenesis, clinical features, differential diagnosis, and management and prevention of this clinical syndrome are presented.

Evidence of infection with Chlamydia trachomatis in patients with pelvic inflammatory disease: value of partner investigation.

A retrospective analysis was made of the records of 71 women with clinically diagnosed PID presenting to the Department of Genito Urinary Medicine in Doncaster. Twenty-nine of the 71 women (40.8%) showed evidence of active chlamydial infection. Six women (8.5%) had infection with N. gonorrhoeae. Of the 45 male partners investigated, 16 (35.6%) had recoverable C. trachomatis in the anterior urethra. Only four (8.9%) had gonorrhea.

Pelvic inflammatory disease and the intrauterine device: a causal relationship?

PIP: IUD use in the U.S. has been declining in the past 5 years partly because of the adverse publicity given to the increased risk of pelvic inflammatory disease (PID) of IUD users. In 1977, the U.S. Food and Drug Administration recommended, on the basis of results from epidemiologic studies, that IUD labeling include the statement that "IUD use is associated with a 3-5 fold increase in infection rate." A review of the major results and some of the features of epidemiologic studies in which the contraceptive practices of PID cases were compared with controls (those without PID) showed that there is indeed an increased risk of PID among IUD users. The studies, except that of Vessey et al. however, do not provide any estimate of the magnitude of increased risk of PID to the IUD users nor ascertain whether there is a cause-and-effect relationship between IUD use and PID. Vessey found that the increased incidence of PID among IUD users was only 1.65/1000 woman-years and when compared with nonusers, the IUD user was at a 3.5-fold increased risk of PID. There is yet no evidence that any one type of IUD is associated with a higher rate of PID. Overall, although available evidence suggests that there is an increased risk of PID among IUD users compared to nonusers, the magnitude of the risk is small. It is possible that a woman's lifestyle has a greater influence on the risk of PID than the IUD per se.^ieng

Prepubertal infections with Neisseria gonorrhoeae: clinical and epidemiologic significance.

The family constellations and epidemiologic circumstances of three prepubertal girls with vulvovaginitis due to Neisseria gonorrhoeae are reported. In each instance, an infected asymptomatic man, himself a contact to a woman with pelvic inflammatory disease, could be implicated as the potential source of infection. In one instance, asymptomatic infection in a child was uncovered through epidemiologic investigation. Prepubertal gonococcal vaginitis is important not only as a potential indicator of child abuse, but also as a possible link to important transmitters of gonococcal infection. The need for meticulous epidemiologic investigation of these cases is stressed.