What are the recommended screening and preventive measures for a healthy 17‑year‑old male?

Screening Recommendations for a 17-Year-Old Male

A 17-year-old male should receive universal lipid screening once during ages 17-21, screening for sexually transmitted infections if sexually active, blood pressure measurement, and assessment for behavioral health risks. 1

Lipid Screening

Universal lipid screening is recommended once between ages 17-21 years, regardless of family history or risk factors. 1

• Non-fasting lipid panel is acceptable and should include total cholesterol (TC), HDL cholesterol, LDL cholesterol, and triglycerides 1
• Calculate non-HDL cholesterol (TC minus HDL cholesterol) from the results 1
• For ages 17-19 years, abnormal values requiring repeat testing include:
  • Non-HDL cholesterol ≥145 mg/dL 1
  • LDL cholesterol ≥130 mg/dL 1
  • HDL cholesterol <40 mg/dL 1
  • Triglycerides ≥130 mg/dL 1
• If any abnormal values are found, repeat the fasting lipid panel twice and average the results 1
• This universal screening approach identifies significantly more adolescents with dyslipidemia than selective screening based only on family history or BMI 2, 3

Additional Lipid Screening Indications

Even outside the universal screening window, screen immediately if the patient has: 1

• Family history of premature cardiovascular disease or known dyslipidemia 1
• Diabetes, hypertension, or BMI ≥85th percentile 1
• Cigarette smoking 1
• Moderate- or high-risk medical conditions (diabetes, chronic kidney disease, post-transplant, Kawasaki disease with aneurysms, chronic inflammatory diseases, HIV, nephrotic syndrome) 1

Sexually Transmitted Infection Screening

STI screening is essential for all sexually active 17-year-old males and should be guided by sexual behavior, not assumed sexual orientation. 1

Chlamydia Screening

• Screen all sexually active males annually for urethral chlamydia using nucleic acid amplification testing (NAAT) 1
• For men who have sex with men (MSM), screen urethral, pharyngeal, and rectal sites based on sexual practices (receptive oral, receptive anal, or insertive intercourse) 1
• Screen every 3-6 months if high-risk (multiple or anonymous partners, sex with drug use, or partners who engage in these activities) 1

Gonorrhea Screening

• Screen all sexually active MSM annually for pharyngeal, rectal, and urethral gonorrhea based on sexual exposure sites 1
• Screen every 3-6 months if high-risk 1
• Consider screening other sexually active males based on individual and local population risk factors (consult local health department for prevalence data) 1

Syphilis Screening

• Routine screening is NOT recommended for heterosexual adolescents 1
• Screen all sexually active MSM annually, or every 3-6 months if high-risk 1

Rescreening After Treatment

• Rescreen all adolescents with chlamydia or gonorrhea 3 months after treatment, regardless of partner treatment status 1
• If 3-month retesting is not possible, retest at the next healthcare visit within 12 months 1

Blood Pressure Screening

• Measure blood pressure at every healthcare visit 1
• This is particularly important given the association between elevated blood pressure and overweight status in adolescents 3

Behavioral and Mental Health Screening

Comprehensive behavioral risk assessment should be conducted annually and includes: 1

• Depression and suicidality screening 1
• Substance use assessment (tobacco, alcohol, other drugs) 1
• Sexual activity and sexual orientation (inquire about same- and opposite-gender partners regardless of stated orientation) 1
• School performance and learning difficulties 1
• Violence exposure or perpetration 1
• Safety practices (seat belts, helmets, firearms access) 1

Preventive Counseling

Provide anticipatory guidance on: 1

• Healthy eating and physical activity 1
• Tobacco, alcohol, and substance use avoidance 1
• Safe sexual practices and condom use 1
• Injury prevention (motor vehicle safety, violence avoidance) 1

Important Clinical Considerations

• Confidentiality is critical for adolescent screening, particularly for sexual health and behavioral risk assessment 1
• Non-invasive NAAT testing (urine-based) improves acceptability and uptake of STI screening 1
• The presence of any STI increases risk for other STIs, including HIV, warranting comprehensive evaluation 1
• Overweight adolescents (BMI ≥85th percentile) have significantly higher rates of dyslipidemia and hypertension and warrant more intensive screening 1, 3
• Family history alone misses 57-62% of adolescents with dyslipidemia, supporting the universal screening approach 2