GU

Prevention of STDs in the Adolescent Population

Approaching a Pediatric Patient Concerning Sexual Health

Make sure to approach the patient with the parent out of the room, if appropriate, in order to address issues regarding sexuality, abuse, and drugs/alcohol. Once the patient has been reassured that topics discussed are private, the following strategies may be utilized by the pediatritian. 

1. "Put sexuality education into lifelong perspective."  Encourage families to begin discussions about sexuality early in childhood. Encourage consistent open communication concerning sexuality education, discussing sex-related issues at the child’s or adolescent’s level of understanding. 

2. "Provide sexuality education that respects confidentiality and acknowledges the individual patient’s and family’s issues and values."  Obtain comprehensive sexual history and personalize information accordingly.  Discuss special friendships and relationships.  Offer information to address patients’ questions or concerns about anatomy, puberty, sex and other related topics.  Discuss reasons to delay sexual activity.  Educate about the importance of barrier methods and contraception.  Acknowledge external factors, such as peers and media, that may influence sexual behaviors.  Counsel parents about manners in which they can provide guidance abstinence and responsible sexual behavior.

Remember that adolescent patients may be dealing with issues of sexual orientation that impact their psychosocial and physical health. Asking open questions about sexuality rather than assuming a teen is heterosexual can open a dialogue on family relationships, safe sex, suicide risks and other issues confronting gay, lesbian, bisexual, and transgender adolescents, in a sensitive and accepting atmosphere

3. "Provide appropriate counseling or referrals for children and adolescents with special issues and concerns." Gay, lesbian, bisexual youth.  Patients with disabilities.  Children at risk for problematic sexual behaviors: victims of abuse; substance abuse.

It is a good idea for the Pediatrician to become knowledgeable about sexuality education offered within the local community and school system. 

Additionally, remember that while adolescents may not explicitly say that they are sexually active in any way, there are many other activities that should raise your suspicion that the child either is sexually active or may soon become sexually active (sex, drugs, and rock and roll usually come as a package deal…).  Alcohol, drug use, perhaps even a track record of impulsive behaviors should alert the health care provider that the patient could use some counseling on sex.

 

Contraceptive Methods and Counseling 

  • Male condoms: not just for penile-vaginal sex but also for oral-penile sex and penile-anal sex. E
  • Female condoms: often more difficult to use and not widely used by pediatric patients, but an available alternative to male condoms. 
  • While the pediatrician may offer alternate forms of birth control (the pill, depo shot, implanon, or IUD), it is important to stress that a condom should still be worn with every sexual encounter. 
  • Dental dams and other barrier methods should be encouraged for oral-vaginal sex or oral-anal sex.
  • Remind the patient of the importance of visual inspection for suspicious lesions prior to engaging in sex.
  • Lcaimiting the number of sexual partners.
  • Review signs and symptoms of various STDs but emphasize the fact that many STDs are without obvious symptomatology--thus the importance of screening!
  • The importance of rapid diagnosis and treatment of STDs and that it is essential to get sexual partners diagnosed and treated before reinitiation of sexual activity.

 

Screening

Some points to remember for screening guidelines for  sexually active adolescents.  Remember, screening is a good time to reiterate key educational points about STD preventation.  Additionally, screening your patients prevents STDs for other doctor’s patients…

  • annual C. trachomatis all females <25yo.  Males considered if areas of high prevalence. 
  • annual N. gonorrhoeae all females <25yo.
  • chlamydia and gonorrhea reinfection rates are high, retest at 3 months after treatment regardless if partner was treated too.
  • prevalence of STDs among women who have sex with women may be higher than previously thought, so include this group too in your routine screens.
  • discuss/encourage universal HIV screening in all sexually active/IVDA
  • routine screening of other STDs(syphilis, trichomoniasis, BV, HSV, HPV, HAV, HBV) in asymptomatic adolescents is largely not recommended.  Consider in high risk populations. 
  • pap smears at 21 years old
  • encourage HPV, HAV, HBV vaccinations in young women

 

References:

  1. Tulloch, Trisha, and Miriam Kaufman. Adolescent Sexuality. Pediatrics in Review 34.1 (2013): 29-38.
  2. Rimsza, Mary E. Counseling the adolescent about contraception. Pediatrics in Review 24.5 (2003): 162-170.
  3. Galuska, Deborah A., et al. Pediatrician counseling about preventive health topics: results from the Physicians’ Practices Survey, 1998–1999. Pediatrics 109.5 (2002): e83-e83.
  4. LA Public Health Organization: Sexually Transmitted Disease Program. http://www.lapublichealth.org.
  5. Global Medical Health Centers. http://www.global.dm