New research in Pediatrics finds low rates of HIV and syphilis screening among adolescents with pelvic inflammatory disease (PID), with high variability across locations.
Women diagnosed with PID are at increased risk for syphilis and HIV, but screening rates among female adolescents remain understudied. A retrospective cohort study employing the Pediatric Health Information System (PHIS) from 2010 to 2015 identified 10,698 female adolescents visiting emergency departments in 48 hospitals who were diagnosed with PID. Rates of screening were assessed for this group, as well as factors associated with likelihood for screening.
A total of 22.0% of patients with PID (95% CI, 21.2%-22.8%) received screening for HIV, 27.7% (95% CI, 26.9%-28.6%) were screened for syphilis, and 18.4% (95% CI, 17.6%-19.1%) received screening for both infections. Screening rates for both conditions varied by hospital. For HIV, this range was between 2.6% and 60.4% and 2.9% and 62.2% for syphilis. HIV screening was more likely to occur for adolescents who were younger (adjusted odds ratio [aOR], 1.2; 95% CI, 1.0-1.3), non-Hispanic African American (aOR, 1.4; 95% CI, 1.2-1.7), publicly insured (aOR, 1.3; 95% CI, 1.1-1.5), uninsured (aOR 1.6; 95% CI, 1.2-2.0), admitted patients (aOR, 7.0; 95% CI, 5.1-9.4), or at smaller hospitals (aOR, 1.4; 95% CI, 1.0-1.8). For syphilis, the characteristics for higher likelihood of screening included individuals who were younger (aOR, 1.1; 95% CI, 1.0-1.3), non-Hispanic African American (aOR, 1.8; 95% CI, 1.2-2.8), publicly insured (aOR, 1.4; 95% CI, 1.2-1.6), uninsured (aOR, 1.6; 95% CI, 1.2-1.9, and admitted patients (aOR, 4.6; 95% CI, 3.3-6.4).
Using data from the PHIS system meant patients previously diagnosed with HIV, who should be excluded from the study, may not have been omitted. Investigators believe this to be a small population, however, and thus to have minimal effect on the results. Further, the use of the PHIS database means coding errors and misclassification bias may be present in the data, and results may not be generalizable to patients treated at non-pediatric hospitals. The study also could not capture any screening a patient may have received at facilities outside the pediatric hospital emergency department.
The findings here demonstrate that screening in this high-risk group remains low, with considerable variation among hospitals. Investigators note that it is possible that clinician concerns about their abilities to confidentially inform adolescent patients of test results is influencing the lower rates of screening when compared with adults. In addition, higher screening in uninsured and minority patients may be a result of “a bias among clinicians who associate [sexually transmitted infections] with minority populations.” They recommend further research investigating the difference in screening practices between pediatric and general emergency departments and in the prevalence of HIV and syphilis among adolescents diagnosed with PID.
Jichlinski A, Badolato G, Pastor W, Goyal M. HIV and syphilis screening among adolescents diagnosed with pelvic inflammatory disease [published online July 24, 2018]. Pediatrics. doi: 10.1542/peds.2017-4061