Term Paper on "Pelvic Inflammatory Disease"

Term Paper 15 pages (4252 words) Sources: 5 Style: MLA

[EXCERPT] . . . .

Pelvic Inflammatory Disease

Conduct a data analysis of a problem that you perceive can be improved through health education/health promotion activities.

The research shows that today, pelvic inflammatory disease represents a significant healthcare problem in the United States with serious outcomes that can be addressed to a significant extent through the use of health promotion activities. The research will also show that pelvic inflammatory disease is a fairly common condition, but one that can cause chronic pelvic pain and even infertility if left untreated. Finally, the research will show that the majority of cases of PID today are caused by infection with Chlamydia or gonorrhea and that young women in particular are at higher risk of acquiring one of these sexually transmitted diseases. An overview of this condition and its causes and costs is provided below.

a. Explain why your identified problem is a problem. Pelvic inflammatory disease (PID) is a serious syndrome of the female reproductive system (Macdonald & Brunham 1997:161). Studies have confirmed that PID is an important risk factor for ectopic pregnancy and infertility (Mcglynn, Kerr and Damberg 2000:269). By and large, PID is a preventable disease in many cases but remains an expensive public health threat. For instance, as noted below, PID can be caused by sexually transmitted diseases, especially Chlamydia and gonorrhea. There are approximately 3 to 4 million cases of Chlamydia and 2 million cases of gonorrhea reported each year in the U.S. and, not surprisingly, about one million new cases of PID are reported in the United States each year as a result (Mcglynn et al. 269). According to these researchers, "Both gonococcal and chlamydial infections may be asymptomatic, or present with vaginal symptoms (e.g., mucopurulent vaginal discharge, vaginal itching, dyspareunia, dysuria, vague lower abdominal pain), anorectal symptoms, and pharyngeal symptoms. However, both have the potential to cause pelvic inflammatory disease, the sequelae of which include ectopic pregnancy and infertility" (Mcglynn et al. 330). Moreover, fully 30% of women who contract chlamydia will develop acute PID within 6 months of an initial infection if it is left untreated or the condition becomes acute (Mckay 2006:2). In addition, it is well documented that subclinical, asymptomtic chlamydia infection in women with no previous history of PID represents a major contributor to tubal infertility (Mckay 2006:2). According to estimates provided by Patrick (1997), somewhere between 10-40% of women who contract chlamydia will develop pelvic inflammatory disease. This author also emphasizes, "This human and fiscal tragedy is preventable because cost-effective means to dramatically reduce the burden of morbidity are at hand in almost all developed nations. All that is required is the will to deploy them" (143).

In fact, while the emotional toll of this "human tragedy" is inestimable, the pragmatic aspects of "fiscal tragedy" associated with PID are more easily discernible, with the cost of PID and associated ectopic pregnancy and infertility exceeding $2.7 billion a year in the United States alone (Mcglynn et al.). Taking into consideration as well the comorbidities associated with PID, including infertility, ectopic pregnancy, and chronic pelvic pain, the direct and indirect costs of PID are estimated to be in excess of $4.2 billion a year (Mcglynn et al.). For a largely preventable disease, these costs are extraordinary and the time to act is now. In this regard, Mckay (2006) emphasizes that, "In the face of what appears to be a rising incidence of chlamydia, particularly among youth and young adults, strategies to reduce the incidence and negative outcomes of chlamydia are needed" (2). Indeed, even a small fraction of the staggering amounts of money currently being spent on PID could be well applied towards cost-effective educational initiatives targeted at populations at risk of acquired these two STDs, and these issues are discussed further below.

b. Explain how this disease/condition is caused. Pelvic inflammatory disease is typically caused by the spread of infections (most frequently the result of sexually transmitted diseases [STDs] such as Chlamydia trachomatis and Nisseria gonnorrhoea), from the vagina and endocervix to the uterus, fallopian tubes and ovaries; in most cases, PID manifests as endometritis (e.g., infection of the lining of the uterus) or salpingitis (e.g., infection of the fallopian tubes) but also as pelvic peritonitis and/or inflammation of contiguous structures in some cases (Macdonald & Brunham 1997). Other causes of PID may be related to the types of intrauterine devices used by women. According to a study by Mckay (2000), intrauterine devices (IUDs) have long been cited as the cause of pelvic inflammatory disease (PID) which can result in tubal infertility. As this author emphasizes, "Studies that indicated an association between IUDs and PID lead to the withdrawal of many IUDs from the North American market. In particular, one IUD, the Dalkon Shield, was shown to be strongly associated with PID" (Mckay 259). Fewer than one in twenty women of reproductive age in North American currently use IUDs, but their use is more common in Asia and Europe; however, the studies assessing the association between IUDs and PID have been controversial and resulted in mixed findings (Mckay). The findings of a study by Hubacher and his colleagues (2001), though, suggest that, "The use of copper IUDs is much safer than was previously thought. Nulligravid women [e.g., a women who have never been pregnant] who are not at risk for a sexually transmitted disease are appropriate candidates for the copper IUD. Contemporary copper IUDs may be among the safest, most effective, and least expensive reversible contraceptives available" (566). While the scientific community continues to investigate the connection between IUD use and PID, what is known is that chlamydia and gonorrhea are two of the most readily apparent causes of PID among certain populations, and these issues are discussed further below.

c. The distribution of the disease/condition. One expert on PID reports that the incidence of chlamydia is highest among 15- to 24-year-old females and that, "Chlamydia is a highly prevalent STI among young people and research suggests that adolescent and young adult women living in socio-economically disadvantaged areas are likely to carry a disproportionate burden of morbidity (e.g., PID, ectopic pregnancy, infertility)" Mackay 2006:1). According to O'Keeffe (2003), "Those who have sex younger are much more likely to contract a sexually transmitted disease: among the under 16s, one in seven sexually active girls tests positive for chlamydia" (26). Likewise, the Centers for Disease Control and Prevention (CDC) report that young women aged 15 to 19 years account for almost 50% of all reported cases of chlamydia among women, and women aged 20-24-year account for yet another 33% (Screening for chlamydia infection, 2008). Although 10% of teenage girls test positive for chlamydia, infection rates differ from community to community (Screening for chlamydia infection).

Therefore, interventions intended to reduce the comorbidities such as PID that are associated with chlamydia through increased physician screening should target young people in those areas with the highest incidence of chlamydia (Mckay 2006:1). Nevertheless, even these initiatives are complicated by the insidious nature of the condition, particularly among young people. According to Macdonald and Brunham, "Clinical diagnosis of PID is difficult because of the wide variation in symptoms and signs, and the high rate of asymptomatic infection, particularly among adolescents" (161). Despite the magnitude and complexity of addressing this problem, the need is clear and the potential solutions are largely cost effective, and these issues are discussed further below.

d. Explain how the disease/condition can be prevented/controlled through health education/health promotion activities. According to Mcglynn and her colleagues (2000), "The most efficacious means of reducing the risk of acquiring STDs through sexual contact is either abstinence from sexual relations or maintenance of a mutually monogamous sexual relationship with an uninfected partner. In addition, the use of latex condoms and spermicides may reduce the risk of infection with STDs" (269). A study by Ness, Randall, Richter et al. (2004) found that women who reported consistent use of condoms (i.e., using condoms between 75% to 100% of the time) experienced the lowest rates of recurrent PID, chronic pelvic pain, and infertility; by sharp contrast, women in the Ness et al. study reporting condom use at 0% to 25% of the time experienced the highest rates. Although the use of oral contraception was not found to be associated with a significantly elevated or reduced risk of PID sequelae, Ness and his colleagues emphasizes that their findings "lend strength to the literature on condom use and the prevention of PID and its sequelae" (p. 1328).

2. Identify sources of health related information you will rely on to identify a particular need as well as sources that will assist in developing the program.

The U.S. Centers for Disease Control and Prevention's Preventive Services Task Force (USPSTF) Web site at http://www.ahrq.gov/clinic/prev/chlamwh.htm. provides some useful and timely information concerning the effectiveness of various educational programs, screening and treatment protocols for the most common causes of PID.

Timely data concerning the costs and cost savings of different screening and treatment methods is available from the Centers for Disease Control at http://www.cdc.gov/nchstp/dstd/HEDIS.htm.

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