Girls with PID Underscreened For Syphilis and HIV in ERs Interview with:

Monika K. Goyal, M.D., M.S.C.E., senior study author Assistant professor of Pediatrics and Emergency Medicine Children’s National Health System Washington, DC

Dr. Goyal

Monika K. Goyal, M.D., M.S.C.E., senior study author
Assistant professor of Pediatrics and Emergency Medicine
Children’s National Health System
Washington, DC What is the background for this study?

Response: Patients with pelvic inflammatory disease (PID) are at an increased risk for syphilis and HIV. We know that adolescents account for 20 percent of the 1 million cases of PID that are diagnosed each year. We also know that an estimated one in four sexually active adolescent females has a sexually transmitted infection (STI). While screening for syphilis and HIV is recommended when diagnosing PID, actual screening rates among adolescents have been understudied.

This multi-center study aimed to quantify rates of HIV and syphilis screening in young women diagnosed with . pelvic inflammatory disease in pediatric emergency departments and to explore patient- and hospital-specific characteristics associated with screening for these two sexually transmitted infections. What are the main findings?

Response: We studied 10,698 patients diagnosed with pelvic inflammatory disease in emergency departments across 48 children’s hospitals. Some 22 percent underwent HIV screening, 27.7 percent underwent syphilis screening, and 18.4 percent of all patients diagnosed with PID underwent both HIV and syphilis screening. These low screening rates were a sharp contrast to these young women’s heightened risk for infection. We also were surprised by the high degree of variability in screening rates among hospitals in our study, which ranged from a low of 2 percent to a high of roughly 60 percent. What should readers take away from your report?

Response: Many adolescent women lack regular primary care providers, so it is understandable that the majority of adolescent cases of PID are diagnosed in emergency departments, rather than in primary care practices.

Our findings highlight the possible benefits of additional screening, which has the potential of safeguarding adolescents’ reproductive health and improving overall public health. After years of decline, syphilis infection rates have begun to rise steadily, and it is now most prevalent in young adults. More consistent screening across the nation’s children’s hospitals could slow these worrisome trends. What recommendations do you have for future research as a result of this work?

Response: Given that this study has documented a large gap in HIV and syphilis testing rates, future research should focus on developing  innovative methods to improve STI screening for these high-risk patients. Is there anything else you would like to add?

Response: Like previously published research, we found that STI screening rates were higher for minority patients and for young women with public, rather than private, insurance. Such screening discrepancies can erode the quality of medical care and underscores the vital importance of consistent STI screening approaches and rates across the nation.


Pediatrics July 2018

HIV and Syphilis Screening Among Adolescents Diagnosed With Pelvic Inflammatory Disease
Amanda Jichlinski, Gia Badolato, William Pastor, Monika K. Goyal


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