Relationship of abuse and pelvic inflammatory disease risk behavior in minority adolescents.

Jane Dimmitt Champion, PhDJeanna M. Piper, MDAlan E. C. Holden, PhDRochelle N. Shain, PhDSondra Perdue, PhDJeffrey E. Korte, PhDINTRODUCTIONDiagnostic procedures to document pelvic inflammatory disease (PID)have been proposed to replace a primary clinical diagnosis, but PID is nowappreciated to represent a spectrum of infection, and no single diagnosticgold standard has been established. Because none of the diagnostic tests ishighly specific and sensitive, clinicians must have a low threshold for consid-ering the diagnosis and must be prepared to initiate empiric antibiotic ther-apy. Delayed treatment for PID dramatically worsens future fertility (Hilliset al., 1993). Approximately one third to one half of women with symptom-atic PID develop chronic pelvic pain. The Centers for Disease Control andPrevention (CDC) recommend that healthcare providers should maintaina low threshold for the diagnosis of PID and that sexually active youngwomen with the combination of lower abdominal, adnexal, and cervicalmotion tenderness should receive empiric treatment (CDC, 2002).Approximately 18.9 million new cases of sexually transmitted disease(STD) were reported in 2000, of which 9.1 million (48%) were reported inpersons aged 15–24 years (Weinstock, Berman, & Cates, 2004). One in fivecases of PID occurs among younger women <19 years of age. Although onlyabout half of the adolescent women are sexually active, they have the highestage-specific rates of PID among sexually experienced women. The risk ofdeveloping PID for a 15-year-old, sexually active girl is estimated to be 10times that of a 24-year-old woman. The higher relative risk of PID for youn-ger women has been attributed to their greater behavioral and cognitive riskfactors (Ingra, 1998). This study focuses on Mexican American and AfricanAmerican adolescent women with STD. It addresses the relationship of sex-ual or physical abuse to the pathology of genitourinary symptoms thatimpact diagnoses of STD and risk for PID. These findings have relevance toclinicians who work with abused adolescent women.BACKGROUNDPrevious comparisons of Mexican American and African Americanwomen with STD found that sexually or physically abused women reportedmore PID risk behaviors than nonabused, including earlier coitus, highernumbers of sex partners, and recurrent STDs. Abused women also reportedmore severe pathologic genitourinary symptomatology and, on physicalexamination, were found to have more severe genitourinary symptoms, sub-sequently receiving more presumptive diagnoses of PID than nonabusedwomen (Champion, Piper, Shain, Holden, & Korte, 2004). This increasedPurposeLittle is known about the relationship betweenminority adolescent’s experiences of sexual orphysicalabuseandthepathologyofgynecologi-cal symptoms that mighthavean impacton thediagnosis of sexually transmitted disease (STD)or risk for pelvic inflammatory disease (PID).The objective of this study was to determinethe relationship of sexual or physical abuse tothe pathology of genitourinary symptoms thatimpact diagnoses of STD and risk for PIDamong Mexican American and African Ameri-can adolescentwomenwithacurrentSTD.MethodsMexican American and African American ado-lescent women (n = 373) with an STD under-went a targeted physical exam and questioningregardingsexualorphysicalabuse,currentgeni-tourinary symptomatology, and risk behaviorsknown to be associated with PID to determinethe relationship of sexual or physical abuse tothe pathology of genitourinary symptoms thatimpact diagnoses of STD and risk for PID.ResultsBivariate comparisons found that abused ado-lescents (n = 232) reported more behaviorsassociated with increased risk for PID, includ-ing earlier coitus, more sex partners, higherSTD recurrence, and delayed health-seekingbehavior. Multivariate comparisons found thatabused adolescents were more likely to reportpathologic genitourinary symptomatology thanthose who were not abused.Clinicians reportedmore abnormal physical exams but did notmake any more presumptive diagnoses of PIDfor abused than nonabused adolescents.