Overview and Prevalence Adolescents have the highest risk of sexually transmitted infections STIs of any other sexually active group Biological factors Behavioral factors Developmental factors ID: 784902
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In adolescents
Common Sexually Transmitted Infections
Slide2Overview and Prevalence
Adolescents have the highest risk of sexually transmitted infections (STIs) of any other sexually active group
Biological factors
Behavioral factorsDevelopmental factors
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Slide3Concerns Related to
Sexual
Risk
Taking BehaviorsInitiation of sexual activity before 16 years
of age
Poor contraceptive use
Increased alcohol and drug usePoor academic achievementLower self esteemIncreased depression
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Slide4Taking a Sexual History
Utilize a non-judgmental open manner
Discuss confidentiality
Avoid medical j argonAsk questions in a open straightforward manner“Do you have sex with men, women or both
?
”
“How many different partners have you had in the last three months ?
”
“How often do you use condoms
?”
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Slide5Prevention Guidance
Education and counseling of persons at risk on ways to avoid STIs through changes in sexual behavior
Abstinence and delaying or limiting sexual activity
Condom use with spermicidal barriersRisk of multiple partners
Identification of asymptomatic infected persons (screenings)
Effective diagnosis, treatment and counseling of infected persons including partner treatment
Pre-exposure vaccination of persons at risk
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Slide6Chlamydial Infections in Adolescents
Most frequently reported infectious disease in the United States
Caused by
Chlamydia trachomatis (bacterium)Infects the epithelium of the urogenital tract or rectum
Prevalence is highest in persons under 24
Asymptomatic infection is common for both men and women
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Slide7common symptoms
Difficulty
urinating, which includes
painful urination or burning during urinationDischarge from the penisRedness, swelling, or itching of the opening of the urethra at the tip of the penis
Swelling and tenderness of the
testicles
Pain in the lower part of the belly, possibly with feverPainful intercourseVaginal discharge or bleeding after intercourse
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Slide8Diagnostic Criteria
First-catch urine specimens
Swabs of the endocervix or vagina
Rectal or oropharyngeal testing can be done by testing at the anatomical site of exposure
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Slide9Treatment
Azithromycin 1 gm orally in a single dose
Alternatives
Doxycycline 100 mg orally twice daily for 7 days (contraindicated in pregnancy)Erythromycin 800 mg orally 4x/day for 7 days Abstinence for 7days after treatment and until all partners have been treated
Treatment of sexual partners of last 60 days and most recent partner if > 60 days
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Slide10Gonorrhea
Caused by
Neisseria gonorrhoeae (bacteria)
Co-infection with CT is commonSecond most common communicable diseaseMay be asymptomatic
Diagnostic criteria is similar to GC
Symptoms similar to CT although discharge generally more purulent with edema of the male meatus
Rectal infection is commonOral and GC conjunctivitis has been reported
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Slide11Treatment
Ceftriaxone 250 mg IM Once PLUS Azithromycin 1 gm orally in a single dose
Alternative
Cefixime 400mg orally onceAlso treat for CT due to the frequency of co-infection
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Slide12Pelvic Inflammatory Disease (PID)
Ascending infection of upper reproductive tract in women
Includes a spectrum of inflammatory disorders
Sexually active adolescents have a 7 to 10 fold greater riskMost often a complication of GC or CT
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Slide13Clinical Presentation/Complications
Lower abdominal pain, vaginal discharge, fever, nausea, vomiting and right upper quadrant abdominal pain
Usually clinical diagnosis based on cervical motion tenderness, uterine tenderness or adnexal tenderness and supportive findings
Complications include perihepatitis (Fitz-Hugh-Curtis syndrome)
Long term complications include chronic pelvic pain and infertility
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Slide14Treatment of PID
Ceftriaxone 250 mg IM PLUS Doxycycline 100mg orally twice daily for 14 days
May require hospitalization for severe symptoms or to rule out a surgical emergency such as an ectopic pregnancy
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Slide15Disease Characterized by
Vaginal Discharge
Bacterial Vaginosis (BV)
Trichomoniasis (trich)Vulvovaginal Candidiasis (yeast infection)
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Slide16Vulvovaginal Candidiasis
“yeast infection” common in adolescents
Vulvar irritation, burning on urination, thick vaginal discharge and ITCH!
Can be diagnosed with direct microscopic examPH<4.5
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Slide18Treatment
Intravaginal creams or suppositories
Oral Fluconazole
Male partners do not need treatment if asymptomatic
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Slide19Bacterial Vaginosis (BV)
Overgrowth and replacement of lactobacilli
Characteristic odor due to amine production
Thin white vaginal discharge which adheres to the wallsAssociated with a high number of sexual partners or a new sexual partner
May be asymptomatic
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Slide20Diagnosis
Amsels Criteria (3 of 4 criteria)
Thin white discharge adhering to the walls
Vaginal PH greater than 4.5Characteristic “fishy odor”Presence of “clue cells”
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Slide22Treatment
Recommended for those with symptoms
Metronidazalone (flagyl) 500 mg orally twice daily for 7 days
Metronidazalone gel once a day for 7 days
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Slide23Diseases Characterized by Genital Ulcers
Genital Herpes is the most prevalent
Chronic lifelong viral infection
HSV type-1 and HSV type-2Most recurrent genital herpes are caused by type-2
Most HSV type-2 go undiagnosed because of sub clinical or no symptoms at all but continue to intermittedly shed the virus
More viral shedding in HSV type-2
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Slide24Symptoms of HSV
Painful ulcerations
First episode often associated with fatigue, enlarged lymph nodes, fever and may cause prolonged illness
All patients with a first episode of genital herpes should be treated with antiviral medications (Acyclovir, Valacyclovir or Famcyclovir)
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Slide26Treatment
First Clinical Episode
Acyclovir 400 mg orally TID for 7-10 days
Episodic TherapyAcyclovir 400mg orally TID for 5 daysValacyclovir 500 mg BID for 3 daysSuppressive therapy for recurrent genital herpes
Valacyclovir 500mg to 1 gm orally once a day
Acyclovir 400mg orally twice a day
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Slide27Counseling Points
The risk of recurrent episodes
The effectiveness of suppressive therapy and the effect on decreasing the risk of transmission
The importance of informing present and potential future sex partners The importance of abstaining from sexual activity when lesions are present
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Slide28Counseling Points (
continued
)
The effectiveness of latex condoms to help reduce (but not eliminate) transmissionThe risk of neonatal transmission
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Slide29Human Papillomavirus (HPV)
100 types identified of which about 40 can infect the genital tract
Most sexually active persons become infected at least once in their lifetimes
Most are self limited and often unrecognizedHigh risk types 16 and 18 cause most cervical, penile, vaginal, anal, and oropharyngeal cancers
Types 6 and 11 cause genital warts
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Slide31Diagnosis and Treatment
Cervical cancer screening and management of abnormal cervical cytology
Visual inspection of warts
Untreated may resolve, remain unchanged, or increaseCyrotherapy, patient applied creams, surgical removal
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Slide32Counseling Points
Infection is VERY common. Most sexually active people get it
Most people who acquire HPV clear the infection and have no associated health problems
The type of HPV that cause genital warts are different from the types that cause cancerHPV may be transmitted through genital to genital contact
No HPV test can determine which HPV infection will clear and which will not
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Slide33Counseling Points
Women with genital warts do not need Pap tests more often then other women
Although genital warts can be treated, treatment does not cure the virus itself
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Slide34Confidentiality
The
consultation, examination, and
treatment of an STD for a minor isconfidential and must not be divulged toparents – including the sending of a bill.
DCF must be notified of a positive STD test
if the minor is 12 years of age or younger.• Care and treatment of this minor mustremain confidential, although DCF may
proceed with their own investigation.
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Slide35Mandatory DCF Reporting
DCF
Reporting Guidelines:
Child under 13 - must report to DCF/police Child b/t 13-15 engaged in consensual sexual relationship
w/partner 21 & over - must report to
DCF/police
Child under 18 in non-consensual/coerced sexual activity - must report to DCF/police Child b/t 13-15 engaged in consensual
sexual relationship
w/partner under 21
– (not mandated to report per
se)
Child under 18 engaged in sexual relations with
family member
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Slide36Barriers
Lack of knowledge of STI’s
Cost
Inconvenient services, inability of student driving themselvesShameLack of understanding of confidentiality
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Slide37Role of the School Nurse
Nurses need to advocate that sexual health should be given priority as part of the health curriculum. Nurses need to have cultural awareness and knowledge and gain competence to understand beliefs in different schools and adjust accordingly to that
Remain non-judgmental and approachable
Knowledge of community resources for screenings and treatment
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Slide38References
https://
medlineplus.gov/ency/article/000886.htm
https://www.cdc.gov/MMWR/ Sexually Transmitted Diseases Treatment Guidelines. June 5,2015/vol.64/No.3
Jay E. Sicklick, Esq
. Presentation March 27, 2014, CT AAP School Health Conference
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