What are the guidelines for screening and treating sexually transmitted infections (STIs) in adolescents in India?

Screening and Treatment Guidelines for STIs in Adolescents in India

All sexually active adolescents in India should receive comprehensive STI screening, with annual testing for chlamydia and gonorrhea for females ≤25 years, and targeted screening for males based on risk factors, along with appropriate education and prevention counseling. 1

Recommended Screening Approach

Who to Screen

• All sexually active female adolescents: Annual screening for chlamydia and gonorrhea 1
• Sexually active males:
  • Screen in high-prevalence settings (jails, juvenile correction facilities, STD clinics) 2, 1
  • Screen MSM (men who have sex with men) at all exposed anatomical sites based on sexual practices 1
• Pregnant adolescents: Screen for hepatitis B, HIV, syphilis, chlamydia, and gonorrhea at first prenatal visit 1

What Tests to Perform

• Chlamydia/Gonorrhea: Nucleic acid amplification test (NAAT) of appropriate sites 1
  • Urogenital testing for all with genital exposure
  • Pharyngeal testing for gonorrhea if engaged in receptive oral sex
  • Rectal testing for both if engaged in receptive anal intercourse
• Syphilis: Serum testing (both treponemal and non-treponemal tests) 2, 1
• HIV: Serum antibody testing 1

When to Screen/Rescreen

• Initial screening as soon as possible after high-risk exposure 1
• Rescreen all adolescents infected with chlamydia or gonorrhea 3 months after treatment 1
• More frequent screening (every 3-6 months) for high-risk individuals 1

Risk Assessment and Prevention

Risk Factors Requiring Special Attention

• Multiple or anonymous sexual partners 1
• Inconsistent condom use 1
• Sex under influence of drugs/alcohol 1
• Previous STI history 1
• Sex in exchange for money or drugs 1
• Injection drug use 1

Prevention Strategies

1. Education tailored for adolescents: Age-appropriate counseling about STI risks and relationship to complications like PID 2
2. Barrier contraceptive promotion: Regular, consistent condom use should be strongly encouraged 2
3. HPV vaccination: Recommended through age 21 for males 1
4. Partner treatment: Essential for preventing reinfection 2

Special Considerations for India

Studies from India highlight significant knowledge gaps among adolescents regarding STIs:

• More than one-third of adolescent girls in South Delhi had no accurate understanding of STI signs and symptoms 3
• Misconceptions exist about HIV/AIDS treatment (30% believed it could be cured) and contraceptive methods 3
• Cultural barriers may limit access to information and services 3

Implementation Challenges

Common Pitfalls to Avoid

• Incomplete site testing: Failure to test all exposed anatomical sites based on sexual practices 1
• Inadequate follow-up: Not rescreening after treatment can miss persistent infections 1
• Partner treatment failures: Not ensuring partners are treated leads to reinfection 2, 1
• Sexual history assumptions: Not inquiring about both same- and opposite-gender partners 1

Recommendations for Indian Context

• Implement gender-based sex education in schools 3
• Develop non-judgmental, culturally sensitive counseling approaches 2
• Ensure STI services are accessible and adolescent-friendly 2
• Consider school-based clinics to provide convenient STI services 2

Treatment Approach

When an STI is detected:

1. Treat the infected adolescent promptly with appropriate antibiotics
2. Ensure evaluation and treatment of sex partners 2
3. Provide comprehensive counseling on risk reduction
4. Schedule follow-up testing to confirm cure 1
5. Consider testing for other STIs, as the presence of one STI increases risk for others 1

Early and effective intervention for adolescents with STIs will reduce their likelihood of developing complications and prevent further transmission within the community 2.