Prevention of STDs in the Adolescent Population
American Academy of Pediatrics have made specific recommendations for Pediatricians who, they have stated, are "in an ideal position to provide longitudinal sexuality education to children and adolescents as part of preventive care..."
First off, for some up-to-date and concise stats on the sexual health of young adults in the US, go to http://www.kff.org/womenshealth/3040.cfm
Thoughts on the approach of the pediatrician concerning sexual health topics
1. "Put sexuality education into lifelong perspective." Encourage families to begin discussions about sexuality early in childhood.
2. "Encourage parents to offer sexuality education and discuss sex-related issues that are appropriate for the child’s or adolescent’s developmental level." Encourage consistent open communication concerning sexuality education, discussing sex-related issues at the child’s or adolescent’s level of understanding.
-A precocious understanding of sexual acts or age inappropriate seductive behaviors should raise a red flag of sexual abuse.
3. "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
4. "Provide specific, confidential, culturally sensitive, and nonjudgemental counseling about key issues of sexuality." Provide general counsel as warranted. Educate about preventing unwanted pregnancy and resources available. Educate about strategies to avoid STDs: ABSTINENCE should be presented as the most effective manner of prevention followed by open communication concerning effective communication skills with sexual partners and the importance of using barrier methods (i.e. condoms) with EVERY SEXUAL ENCOUNTER.
5. "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.
6. "Routine gynecologic services should be provided for female adolescents who have become sexually active." Along with routine STD screening for both males and females.
7. "Become knowledgeable about sexuality education offered" within the community.
8. "Work with local public planners... Physicians, teachers, religious leaders, and community workers should work together to help implement sex education along with prevention strategies for STDs and unplanned pregnancies.
9. 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.
-Never assume that an adolescent is not sexually active. It is important to define what sexual activity is as well. Granted, the conversation is most often uncomfortable and the adolescent will likely be reticent to divulge all of the details. Given the brief encounter with patients in the outpatient setting, for the adolescent who claims not to be sexually active, brief general counseling is appropriate. Just as important is forming a relationship that provides confidentiality and acceptance in which the patient can vocalize concerns should they arise at later visits. Forceful prying into their sexual activity will most often damage the doctor patient relationship.
Points to get across to adolescent patients (and their families):
* ABSTINENCE is the safest way to prevent STDs!
* Sexual activity requires responsibility and should not be taken lightly!
* Whenever possible teach (and encourage parents to teach) skills necessary for discussing sex and methods for preventing STDs with potentional partners.
* Educate about the complexity and depth of sexual activity! Provide definitions and clarifications concerning other sexaul behaviors that are sometimes not included in the patient’s definition of being sexually active (ie. Oral sex).
* If you have any type of sex, MUST use a condom or other barrier method (ie. Dental dams) correctly EACH AND EVERY TIME.
EDUCATE ABOUT VARIOUS METHODS OF SAFER SEX!
+ Male condoms: not just for penile-vaginal sex but also for oral-penile sex and penile-anal sex.
+ Female condoms: empowers females!
+ Dental dams and other barrier methods for oral-vaginal sex or oral-anal sex.
* Routine visual inspection prior to engaging in sex.
* Limit the number of sexual partners.
* Realize that drugs & alcohol can severely reduce one’s ability to make responsible decisions about sex.
* STD checkups! Routine gynecologic exams for females; STD screenings as required (6 months-1year).
* 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.
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
Adolescent. Pediatric Clinics of North America. August
1999.