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Adolescent STI Epidemiology, Counseling, and Treatment Strategies

Adolescent STI Epidemiology, Counseling, and Treatment Strategies. Objectives. By the end of this presentation, participants will be able to:. Epidemiology of STIs and Young People. 19 million new cases/ year ½ occur in people ages15–24 Most asymptomatic and undiagnosed.

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Adolescent STI Epidemiology, Counseling, and Treatment Strategies

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  1. Adolescent STI Epidemiology, Counseling, and Treatment Strategies

  2. Objectives By the end of this presentation, participants will be able to:

  3. Epidemiology of STIs and Young People • 19 million new cases/ year • ½ occur in people ages15–24 • Most asymptomatic and undiagnosed • New research: 1 in 4 teen has an STI • 2006: 1/3 of new infections were among people age 13-29 (may be as high as 50%) • Economic costs ~ $6.5 billion/year

  4. Adolescents Face Increased Risk for STIs • Biological • Cognitive • Behavioral • Societal • Risk for Sexual Abuse

  5. Biological Risk Factors: Females

  6. Biological Risk Factors: Males

  7. Cognitive Risk Factors for STIs in Adolescents • Early adolescence: concrete thinking • Often unable to plan ahead for condoms • Serial monogamy in relationships leading to multiple partners • Personal fable • Unable to judge risk for STIs • “Other people get STIs”

  8. Behavioral Risk Factors

  9. Behavioral Risk Factors: Older Partners

  10. Behavioral: Men Who Have Sex With Men

  11. Behavioral Risk Factors: Condom Use Percent of HS Students Who Used A Condom at Last Intercourse 2007 Youth Risk Behavior Survey

  12. Efficacy of Condoms in Preventing STIs

  13. http://www.who.int/hiv/pub/prev_care/en/Condom_statement.pdf

  14. Risk Factor: Sexual Abuse • ~ 1 in 4 girls and 1 in 6 boys may experience > 1 sexually abusive episode by adulthood • Childhood sexual abuse increases risk for: • Younger age at coitarche • STIs

  15. Risk Factor: Social/Institutional

  16. STI Protective Factors • Peer support for contraception and condoms • Communication with parents about sex • Connection to family • Connection to school and future success • Connection to community organizations

  17. Case: Erica • Erica is a 16-year-old female who presents with dysuria. • What is your initial differential diagnosis?

  18. Differential Diagnosis Dysuria Urinary Tract Infection Skin Related Abnormalities/ Mucosal Perineal Genital Tract Infection • Cervicitis • Vaginitis • Herpes • Trauma

  19. Case: Erica • Erica is a 16-year-old female who presents with dysuria. • What is your initial differential diagnosis? • What additional information do you need?

  20. History of Present Illness • Onset and duration of symptoms • Description of symptoms • Associated symptoms • Nausea • Vomiting • Fever • Chills • Back pain • Sores, lumps, bumps

  21. Case: Erica • Erica tells you she has burning with urination and a “yellowish” discharge. She reports itchiness. • She denies abdominal pain and fever and reports no bumps or lesions. • What is the differential diagnosis?

  22. Differential Diagnosis Dysuria Urinary Tract Infection Skin Related Abnormalities/ mucosal perineal Genital Tract Infection • Cervicitis • Vaginitis • Herpes • Trauma

  23. Case: Erica • What additional history do you need?

  24. Sexual History: The 5 Ps • Partners • Gender(s), Number (3 months, Lifetime) • Prevention of pregnancy • Contraception, EC • Protection from STIs • Condom use • Practices • Types of sex: anal, vaginal, oral • Past history of STIs www.stdhivtraining.net

  25. Case: Erica • Erica informs you that she has had several episodes of unprotected sex in the last few weeks with 1 male partner. • Do you need to do a pelvic exam?

  26. Pelvic Exam? • Yes… Why? • Erica is symptomatic and sexually active. • A pelvic exam in this case is a diagnostic exam not an asymptomatic screening. • If Erica had been asymptomatic, would you perform a speculum exam?

  27. When to Start Cervical Cytology

  28. Female Genital Exam • External Exam • Speculum Exam • Bimanual Exam

  29. External Exam Pubic Hair: Lice, crabs, scabies External Genitalia: Lesions, rash Urethra: Discharge Lymph Nodes: Swelling

  30. Speculum Exam 1) Put swab in os to collect specimen 2) Hold it up against white – if it is yellow = bacteria

  31. Bimanual Exam

  32. Differential Diagnosis • You observe discharge in the vault but not in the os. • You suspect vaginitis. • What are the causes of vaginitis?

  33. Differential Diagnosis Dysuria Genital Tract Infection Trichomonas Bacterial Vaginitis Vaginitis Candida Vaginitis

  34. Trichomonas • Microscopic parasite spread through sexual activity • Mainly affects women • Incidence • ~1.9 million new infections among 15–24 year olds/year Image: Courtesy of James A. McGregor, MD.

  35. PMN Yeast buds Trichomonas* Trichomonas* Squamous epithelial cells PMN Trichomonads Trichomonas: bigger than PMNs PMNs: dense nucleus; Trich: many small vacules Trich: dead once viewed with microscopy – flagella rarely seen

  36. Trichomonads in Real-Time Video: Cincinnati STD/HIV Prevention Training Center

  37. Trichomonas Infection: Symptoms

  38. Trichomonas Infection • Sequelae: • Complications are rare • Increases HIV risk Vaginitis Urethritis

  39. Differential Diagnosis Dysuria Genital Tract Infection Trichomonas Bacterial Vaginitis Vaginitis Candida Vaginitis

  40. Bacterial Vaginosis • What is it: • Fewer than normal hydrogen peroxide-producing lactobacilli and greater prevalence of other types of bacteria in the vagina. Vaginal saline prep: normal (below); clue cells (above)

  41. Bacterial Vaginosis • Symptoms • Odorous discharge • Itching • Prevalence • Found in 24 to 47% of STI clinic patients • Sequelae • pregnancy complications • possible increase in pelvic inflammatory disease (PID)

  42. Differential Diagnosis Dysuria Genital Tract Infection Trichomonas Bacterial Vaginitis Vaginitis Candida Vaginitis

  43. Vaginal Candidiasis

  44. Vaginal Candidiasis • What is it? • Overgrowth of the fungus Candida

  45. Candidiasis

  46. Vaginal Candidiasis • 70-75% of women experience at least 1 infection • Transmission • Unclear if Candidiasis can be transmitted sexually

  47. Erica’s Cervix • During the speculum exam you observe Erica’s cervix. • You suspect trichomonas. • How do you definitively diagnose the causes of Erica’s vaginitis. Image: CDC

  48. Evaluating Vaginitis Egan M, et al. Am Fam Physician 2000

  49. Trichomonas Diagnosis Available Test: Affirm™ VP III Available test: OSOM Rapid Test No good test for males so often untested

  50. Candida Diagnosis

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