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

Management of Sexually Transmitted Infections in Adolescents

Adolescents require comprehensive STI screening, confidential treatment, and age-appropriate prevention counseling to reduce the high burden of sexually transmitted infections in this vulnerable population. Adolescents bear a disproportionate burden of STIs, with those under 25 years accounting for approximately half of all new STI cases despite representing only a quarter of the sexually active population 1.

Epidemiology and Risk Factors

Adolescents are at particularly high risk for STIs due to:

• Frequent unprotected intercourse
• Biological susceptibility to infection
• Multiple barriers to healthcare utilization
• Limited knowledge about STI risks and consequences 2

High-risk adolescent populations include:

• Sexually active females under 25 years
• Men who have sex with men (MSM)
• Younger adolescents (under 15 years) who are sexually active
• Injecting drug users
• Those with multiple partners or prior STIs 3

Recommended Screening

For Females:

• Annual screening for chlamydia and gonorrhea for all sexually active females ≤25 years 3
• Consider more frequent screening (every 3-6 months) for those with multiple partners, history of STIs, or other high-risk behaviors 3

For Males:

• Targeted screening based on risk factors
• For MSM: pharyngeal, rectal, and urethral site screening annually or every 3-6 months if high-risk 3

For All Adolescents:

• Screen for HIV and syphilis based on risk assessment
• Screen for additional STIs when any STI is diagnosed 3
• Nucleic acid amplification tests (NAATs) are preferred for gonorrhea and chlamydia testing 2

Treatment Recommendations

1. Chlamydia and Gonorrhea:

   • Follow current CDC treatment guidelines
   • Rescreen all infected adolescents 3 months after treatment regardless of partner treatment status 3

2. Trichomoniasis:

   • Consider rescreening females 3 months after treatment 3

3. Sexual Assault Cases:

   • Offer comprehensive STI testing (see table below)
   • Provide emergency contraception within 120 hours of assault
   • Consider HIV prophylaxis if indicated 2

   Site	Recommended Tests
   Throat	Gonorrhea culture
   Vagina	NAAT for chlamydia/gonorrhea, microscopy for trichomoniasis/BV/candidiasis
   Cervix/Urethra	Gonorrhea culture, chlamydia culture, NAAT
   Anorectal	Gonorrhea and chlamydia culture
   Blood	HIV, hepatitis B, syphilis testing

Prevention Strategies

1. Behavioral Counseling:

   • High-intensity behavioral counseling has shown effectiveness in reducing STI incidence in adolescents 2
   • Counseling should be direct, nonjudgmental, and developmentally appropriate 2, 3
   • Address risky behaviors and promote healthy sexual behaviors 2

2. Vaccination:

   • HPV vaccination for all adolescents (ideally before sexual debut)
   • Hepatitis B vaccination for unvaccinated adolescents 2, 3

3. Barrier Methods:

   • Promote consistent and correct condom use 3
   • Discuss barrier methods with all sexually active adolescents

4. Partner Management:

   • Expedited partner therapy where legally permissible
   • Partner notification and testing 3

Confidentiality Considerations

• All adolescents in the United States can consent to confidential STI diagnosis and treatment without parental consent 2, 3
• Providers should ensure adolescents understand their confidentiality rights
• Confidentiality concerns are a major barrier to adolescents seeking STI care 3
• Medical records from sexual assault cases may be subpoenaed in legal proceedings 2

Mental Health Considerations

For sexual assault victims:

• Screen for mental health consequences including depression, suicidal ideation, and self-harm behaviors
• Immediate psychiatric assessment for any suicidal or homicidal ideation 2
• Recognize that sexual assault is associated with future high-risk behaviors 2

Common Pitfalls to Avoid

1. Failing to screen asymptomatic patients
2. Inadequate site-specific testing (especially for MSM)
3. Not rescreening after treatment
4. Overlooking confidentiality concerns
5. Incomplete partner management leading to reinfection 3
6. Using judgmental language or approaches that may alienate adolescents 2

By implementing these comprehensive screening, treatment, and prevention strategies, providers can significantly reduce the burden of STIs among adolescents and prevent long-term reproductive health consequences.