• Sexual Health Shanghai

Adolescents

In the United States, prevalence rates of many sexually acquired infections are highest among adolescents and young adults. For example, the reported rates of chlamydia and gonorrhea are highest among females during their adolescent and young adult years, and many persons acquire HPV infection at this time.

Persons who initiate sex early in adolescence are at higher risk for STDs, along with adolescents residing in detention facilities, those who use injection drugs, adolescents attending STD clinics, and young men who have sex with men (YMSM). Factors contributing to this increased risk during adolescence include having multiple sexual partners concurrently, having sequential sexual partnerships of limited duration, failing to use barrier protection consistently and correctly, having increased biologic susceptibility to infection, and facing multiple obstacles to accessing health care.Despite the high rates of infections documented in the adolescent population, providers frequently fail to inquire about sexual behaviors, assess STD risks, provide risk-reduction counseling, and ultimately, screen for asymptomatic infections during clinical encounters. Discussions concerning sexual behavior should be appropriate for the patient’s developmental level and should be aimed at identifying risk behaviors (e.g., multiple partners; unprotected oral, anal, or vaginal sex; and drug-use behaviors). Careful, nonjudgmental, and thorough counseling is particularly vital for adolescents who might not feel comfortable acknowledging their engagement in behaviors that place them at high risk for STDs.Screening RecommendationsRoutine laboratory screening for common STDs is indicated for sexually active adolescents.

The following screening recommendations summarize published federal agency and medical professional organizations’ clinical guidelines for sexually active adolescents.

• Routine screening for C. trachomatis on an annual basis is recommended for all sexually active females aged <25 years. Evidence is insufficient to recommend routine screening for C. trachomatis in sexually active young men based on efficacy and cost-effectiveness. However, screening of sexually active young males should be considered in clinical settings serving populations of young males with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, and STD clinics) and should be offered to YMSM (see Special Populations, MSM).

• Routine screening for N. gonorrhoeae on an annual basis is recommended for all sexually active females <25 years of age. Gonococcal infection is concentrated in specific geographic locations and communities. Clinicians should consider the communities they serve and might choose to consult local public health authorities for guidance on identifying groups that are at increased risk. Screening should be offered to YMSM (see MSM section).HIV screening should be discussed and offered to all adolescents. Frequency of repeat screenings of those who are at risk for HIV infection should be based on level of risk. Persons who test positive for HIV should receive prevention counseling and referral to care before leaving the testing site.• The routine screening of adolescents who are asymptomatic for certain STDs (e.g., syphilis, trichomoniasis, BV, HSV, HPV, HAV, and HBV) is not generally recommended. However, YMSM and pregnant adolescent females should be screened for syphilis.• Guidelines from USPSTF, ACOG, and ACS recommend that cervical cancer screening begin at age 21 years. This recommendation is based on the low incidence of cervical cancer and limited utility of screening for cervical cancer in adolescents.Primary Prevention RecommendationsPrimary prevention and anticipatory guidance to recognize symptoms and behaviors associated with STDs are strategies that can be incorporated into any or all types of health-care visits for adolescents and young adults. The following recommendations for primary prevention of STDs (i.e., vaccination and counseling) are based on published federal agency and medical professional organizations’ clinical guidelines for sexually active adolescents and young adults.

• The HPV vaccine, bivalent, quadrivalent, or 9-valent, is recommended routinely for females aged 11 and 12 years and can be administered beginning at 9 years of age. Vaccination is also recommended for females aged 13–26 years who have not yet received all doses or completed the vaccine series. The quadrivalent or 9-valent HPV vaccine is recommended routinely for males aged 11 and 12 years and also can be administered beginning at 9 years of age. Vaccination with quadrivalent or the 9-valent HPV vaccine is recommended for males aged 13–21 years who have not yet received all doses or completed the vaccine series, although males aged 22–26 years also can be vaccinated. For persons with HIV infection and for MSM, vaccination is recommended through age 26. HPV vaccination has not been associated with a change in perceptions about risks posed by sexual behavior.

• The HBV vaccination series is recommended for all adolescents and young adults who have not previously received the hepatitis B vaccine.• The HAV vaccination series should be offered to adolescents and young adults who have not previously received the HAV vaccine series.• Information regarding HIV infection, testing, transmission, and implications of infection should be regarded as an essential component of the anticipatory guidance provided to all adolescents and young adults as part of health care.

• Health-care providers who care for adolescents and young adults should integrate sexuality education into clinical practice. Providers should counsel adolescents about the sexual behaviors that are associated with risk for acquiring STDs and educate patients regarding evidence-based prevention strategies, all of which include a discussion about abstinence and other risk-reduction behaviors (e.g., consistent and correct condom use and reduction in the number of sex partners). Interactive counseling approaches, such as high-intensity behavioral counseling (HIBC) and motivational interviewing, are effective STD/HIV prevention strategies. USPSTF recommends high-intensity behavioral counseling for all sexually active adolescents to prevent sexually transmitted infections*. Educational materials (e.g., handouts, pamphlets, and videos) can reinforce office-based educational efforts.

* STI is the term used by USPSTF to describe the syndromes caused by various pathogens that can be acquired and transmitted through sexual activity.

Useful Resource

  • Shanghai Public Health Clinical Center | shaphc.org
  • Shanghai Municipal Center For Disease Control & Prevention | scdc.sh.cn
  • Shanghai Skin Disease and STD Hospital | shskin.com

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