Video Intervention May Improve Treatment for Partners of Teen Girls With Pelvic Inflammatory Disease

Laurie Barclay, MD

November 06, 2009

November 6, 2009 — A community-specific video intervention may improve rates of treatment for partners of adolescent girls with pelvic inflammatory disease (PID), according to the results of a randomized controlled trial reported online in September 4 in the Journal of Pediatric and Adolescent Gynecology.

"Although the current generation of screening programs for asymptomatic sexually transmitted infection (STI) has been successful in reducing the overall rates of [PID] in women in the United States, PID rates remain unacceptably high among adolescent minority girls," write lead author Maria Trent, MD, MPH, from Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues. "The objective of this research was to examine the effectiveness of a brief behavioral intervention, provided at the time of diagnosis of [PID], on subsequent behaviors by patients who were urban adolescents in a community in which [STI] was prevalent."

The study sample consisted of 121 adolescents aged 15 to 21 years with mild to moderate PID who were randomly assigned to either an intervention group or a control group. The intervention group watched a 6-minute, community-specific intervention video showing adolescent girls diagnosed with PID. Issues covered in the video included notifying the partner and urging him to seek treatment, completing the prescribed 2-week course of antibiotic treatment, returning for follow-up care, and abstaining from sexual activity until treatment was completed.

All participants received standardized care and full courses of medication at discharge, and all completed baseline audio computerized self-interviews and were interviewed by a disease intervention specialist after the 2-week treatment course had been completed.

Multivariate regression analysis allowed evaluation of primary study endpoints, including medication completion, temporary sexual abstinence during treatment, partner notification and treatment, and return for 72-hour follow-up.

The 2-week interview was attended by 61% of participants. Bivariate analyses revealed that compared with the control group, the intervention participants had higher rates of 72-hour follow-up (32% vs 16%) and partner treatment (71% vs 53%; P = 0.1).

Both groups had similar rates of medication completion (66% vs 66%), sexual abstinence (78% vs 89%), and partner notification (88% vs 92%). In multivariate models, only the rate of partner treatment was significantly different between groups (adjusted odds ratio, 3.10; 95% confidence interval, 1.03 – 9.39; P = .045).

"The good news is we got these girls to talk to their partners and get them treated, which is great, but there is clearly a whole lot of work to be done to prevent and treat these infections," Dr. Trent said in a news release. "In 10 or 20 years, these teen girls will come back to us as women suffering from infertility and chronic gynecologic problems."

Limitations of this study include inability to reach statistical significance for all the adherence behaviors studied, limited racial and ethnic diversity of the study sample, potential bias related to use of face-to-face interviews and self-reported adherence measures, and large loss to follow-up.

"Adolescent girls randomized to a community-specific video intervention at diagnosis of pelvic inflammatory disease were three times more likely to have their partners treated than those in the control group," the study authors conclude. "Given the value of partner treatment in secondary prevention of sexually transmitted diseases, this video may be an essential component of discharge programming in urgent care settings. Additional structural supports may be necessary to facilitate improved adherence to other key adherence behaviors."

The Robert Wood Johnson Foundation, the US Centers for Disease Control, the Thomas Wilson Sanitarium Foundation for the Children of Baltimore City, and the John and Mary McCarthy Foundation supported this study.

J Pediatr Adolesc Gynecol. Published online September 4, 2009.