- Pediatric Annals
- February 2013 - Volume 42 · Issue 2: 26-33
CME Educational Objectives
1. Determine and discuss issues surrounding consent, confidentiality, and billing for sexually transmitted infection (STI) care delivery in the adolescent population.
2. Review currently available testing modalities for STIs and their applicability in the adolescent population.
3. Provide treatment and prevention strategies for the most commonly encountered STIs in the adolescent demographic.
Adolescents and young adults carry the highest rates of infection for the majority of sexually transmitted infections. Primary care providers are an important resource to assist in the diagnosis and treatment of these potentially physically and emotionally damaging infections; the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP) and the Society of Adolescent Health and Medicine (SAHM) have developed a variety of tools to assist providers in obtaining an accurate sexual health history in a busy primary care practice.
Chlamydia trachomatis remains the most common reported STI with its highest prevalence among adolescents. It is often asymptomatic, making routine screening an essential component of diagnosis. Many states have adopted laws permitting “expedited partner therapy” to help decrease transmission and increase treatment of sexual contacts. Guidelines for follow-up screening have also been updated to assess for re-infection.
Neisseria gonorrhoeae rates among adolescents are again increasing. Resistance to oral cephalosporins has prompted the CDC to change its treatment recommendations to dual therapy with intramuscular ceftriaxone plus either oral azithromycin or doxycycline the new standard of care. Subpopulations at increased risk for infection include black and Hispanic adolescents and young adults.
Trichomonas vaginalis infections are often asymptomatic but also may present as urethritis or vaginitis. Newer screening methods, such as nucleic acid amplifi cation testing, permit diagnosis of gonorrhea, chlamydia, and trichomonas without the need for a full genital exam and with greater sensitivity and specifi city than earlier screening methods.
Meera S. Beharry, MD, FAAP, is Adolescent Medicine Section Chief, Department of Pediatrics, McLane Children’s Hospital; and and Assistant Professor, Texas A & M Health Science Center College of Medicine. Taraneh Shafii, MD, MPH, is Assistant Professor of Pediatrics, Division of Adolescent Medicine, University of Washington School of Medicine. Gale R. Burstein, MD, MPH, FAAP, FSAHM, is Clinical Associate Professor of Pediatrics, SUNY at Buffalo School of Medicine and Biomedical Sciences Department of Pediatrics; and Commissioner, Erie County Department of Health, Buffalo, NY.
Address correspondence to: Meera S. Beharry, MD, FAAP, Adolescent Medicine Section Chief, Department of Pediatrics, McLane Children’s Hospital, Scott & White, 2401 S. 31 Street, MS-09-CW403, Temple, TX 76508, USA; email: firstname.lastname@example.org.
Disclosure: The authors have no relevant financial relationships to disclose.