What are the recommended treatments and prevention strategies for sexually transmitted infections (STIs) in adolescents?

Recommended Treatments and Prevention Strategies for STIs in Adolescents

The most effective approach to managing STIs in adolescents includes routine screening of sexually active adolescents, prompt treatment with appropriate antibiotics for bacterial STIs, and comprehensive prevention strategies including condom use, vaccination, and education. 1

Screening Recommendations

Chlamydia

• Routinely screen all sexually active female adolescents and young adults (≤25 years) annually 1
• For sexually active male adolescents, consider screening based on individual and population risk factors 1
• For men who have sex with men (MSM), screen pharyngeal, rectal, and urethral sites annually or every 3-6 months if high-risk 1

Gonorrhea

• Screen all sexually active female adolescents and young adults (≤25 years) annually 1
• For MSM, screen pharyngeal, rectal, and urethral sites annually or every 3-6 months if high-risk 1
• Screen adolescents exposed to gonorrhea in the past 60 days from an infected partner 1

Trichomoniasis

• Routine screening of asymptomatic adolescents is not recommended 1
• Consider screening females with risk factors (multiple partners, history of STIs, exchanging sex for payment, injecting drugs) 1

Syphilis

• Routine screening of heterosexual adolescents is not recommended 1
• Screen all sexually active MSM annually or every 3-6 months if high-risk 1
• Consider screening for youth with high-risk behaviors 1

HIV

• Screen adolescents with any diagnosed STI for HIV 1
• The presence of any STI puts an individual at greater risk for other STIs, including HIV 1

Treatment Recommendations

Chlamydia

• Azithromycin 1g orally in a single dose 2
• Alternative: Doxycycline 100mg orally twice daily for 7 days

Gonorrhea

• Ceftriaxone (preferred) plus azithromycin 2
• For uncomplicated urethritis and cervicitis: Azithromycin 2g as a single dose 2

Trichomoniasis

• Metronidazole 2g orally in a single dose

Syphilis

• Treatment depends on stage; consult with local health department for current recommendations 1

Rescreening Recommendations

• Rescreen all adolescents infected with chlamydia or gonorrhea 3 months after treatment, regardless of whether they believe their partners were treated 1
• Consider rescreening females previously diagnosed with trichomoniasis 3 months after treatment 1
• If retesting at 3 months is not possible, retest whenever patients next present for health care services within 12 months 1

Prevention Strategies

Education and Counseling

• Provide age-appropriate, direct, and nonjudgmental counseling about STI prevention 1
• Discussions should identify risky behaviors and be appropriate for the patient's developmental level 1
• Address the general lack of knowledge about risks and consequences of STIs 1

Barrier Methods

• Promote consistent and correct condom use 1
• Educate on proper condom use technique and importance for STI prevention

Vaccination

• Recommend HPV vaccination for all adolescents (ideally before sexual debut)
• Hepatitis B vaccination for unvaccinated adolescents

Partner Management

• Offer expedited partner therapy where legally permissible to prevent reinfection 1
• Encourage partner notification and testing

Special Considerations for Adolescents

Confidentiality

• All adolescents in the United States can consent to confidential diagnosis and treatment of STIs without parental consent 1
• Ensure adolescents understand their confidentiality rights to encourage seeking care 1

Comprehensive Sexual History

• Take a comprehensive sexual history sensitive to ethnic, racial, and cultural factors 1
• Include assessment of all types of sexual behavior (vaginal, oral, and anal) 1
• Inquire about same- and opposite-gender sexual partners regardless of reported orientation 1

High-Risk Populations

• MSM, sexually active heterosexuals, clients in STD clinics, and injecting-drug users are at high risk 1
• Younger adolescents (under 15 years) who are sexually active are at particularly high risk 1
• Youth of color and sexual minority youth bear a higher STI burden 1

Common Pitfalls to Avoid

1. Failing to screen asymptomatic patients - Most STIs in adolescents are asymptomatic but can still cause long-term complications
2. Inadequate site-specific testing - For MSM, failing to test pharyngeal and rectal sites can miss infections
3. Not rescreening after treatment - Reinfection rates are high among adolescents
4. Overlooking confidentiality concerns - Fear of breach of confidentiality is a major barrier to adolescents seeking STI care
5. Incomplete partner management - Failure to ensure partners are treated leads to reinfection

By implementing these evidence-based screening, treatment, and prevention strategies, healthcare providers can significantly reduce the burden of STIs among adolescents and prevent long-term complications that affect morbidity, mortality, and quality of life.