(89) Pelvic Inflammatory Disease in the Sexually Active and Non-sexually Active Pediatric and Adolescent Population

Background: Pelvic inflammatory disease (PID) is an acute or subacute infection of the upper female genital tract, often a result of sexually transmitted infections (STIs), but some may be due to asexual causes. It is essential that PID is identified and treated, as it can lead to both life-threatening and long-term complications, like tuboovarian abscess (TOA) and infertility. Limited research exists on PID management and follow-up in the pediatric and adolescent population. Our objectives were to 1) Compare the proportion of asexual PID versus those reporting sexual activity with PID, 2) Determine any risk factors associated with asexual PID vs sexual activity PID, and 3) Compare the rates of confirmed chlamydia and/or gonorrhea vs other microorganisms in the sexually active PID group.

Methods: An IRB-approved retrospective cohort study reviewed patients diagnosed with PID and/or TOA at a single academic hospital from 8/20/2019-8/20/2024 based on ICD-10 codes for PID/TOA. Variables assessed included demographics, hospital course, and outpatient follow up. Inclusion criteria included < 21 yoa at diagnosis and confirmation of PID/TOA. PID cases associated with chlamydia, gonorrhea, and/or other microorganisms were confirmed with positive laboratory results. Descriptive statistics and Chi square tests were performed.

Results: 65 patients were identified; 47 reported sexual activity (SA) and 18 reported no SA. Younger age and prior bowel surgery was associated with asexual PID, while vaginal discharge/abnormal uterine bleeding was associated with sexually active PID patients. There was no association between SA and overweight/obese BMI percentiles, appendicitis, UTI, or bowel changes (Table 1). Of the 47 patients who reported SA, 32 had positive tests for chlamydia, gonorrhea, or both at the time of diagnosis (p=0.013) (Table 2). SA patients had significantly lower rates of post hospital follow up than non-SA patients (p=0.003).

Conclusions: Non-SA PID has been previously associated with higher BMIs in previous pediatric PID case reports, yet there was no association between BMI and SA in our patient population. Prior bowel surgery was a risk factor for PID in our non-SA population, emphasizing the importance of risk factor identification when PID is on the differential for pediatric patients. While SA PID patients had higher rates of chlamydia and/or gonorrhea PID, ~1/3 of this patient group had different microorganism profiles. Therefore, risk-factors and microorganisms associated with PID diagnoses may differ in the context of pediatric and adolescent patients, regardless of sexual activity.