Bonnie M. Word, MD

With vacation season approaching, some of our patients’ families may be planning travel to areas where they could be exposed to different infectious diseases and other health risks not commonly encountered in the United States. Even more challenging, they won’t necessarily mention their plans until the last minute unless you ask.

Today more than ever, travel involves arrival at an international destination. According to the U.S. Office of Travel & Tourism Industries, about 30 million Americans traveled internationally in 2009. Of those, about 8%-9%, or 2.4 million, were children. International travel continues to rise. In 2010, the United Nations World Tourism Organization reported a 7% overall increase in international travel.

Increasingly, children are traveling with parents to visit friends and extended family members in Africa, Asia, and Central and South America, while a growing number of American adolescents are traveling to resource-limited areas doing volunteer work, adventure travel, staying with host families, or as part of religious or civic groups. Opportunities for children and adolescents with chronic medical conditions who travel are associated with additional concerns that are directly related to their underlying condition, susceptibility, and potential interventions.

Unfortunately, health precautions often are simply not on the minds of many people as they make their travel arrangements. While most people plan international trips about 90 days in advance, they often will wait until the last minute to seek advice on immunizations, preventive medications, and other precautions – if they think to do so at all.

This is the case even for families with children. This was revealed in a recent eye-opening study conducted by the GeoSentinel Surveillance Network, a global surveillance network comprised of 49 travel/tropical medicine clinics on six continents. The network has previously reported on illnesses in adults (N. Engl. J. Med. 2006;354:119-30).

The study, the first comprehensive analysis of pediatric travel illness, examined data for 1,591 children and 32,668 adults seen at a GeoSentinel clinic. To be included in the database, persons had to have crossed an international border within 10 years and have a laboratory-confirmed or probable diagnosis. Data were collected from Jan. 30, 1997, through Nov. 30, 2007 (Pediatrics 2010;125:e1072-80).

For both children and adults, the three most common world regions visited were Asia, sub-Saharan Africa, and Latin America. While ill adults were more likely than children to have visited Asia, more ill children presented after travel to Europe and the Middle East/North Africa.

Tourism was the most common reason for travel among both children and adults, but children were more likely than adults to be a "VFR," or "visiting friends and relatives." Importantly, this and other studies have demonstrated significantly increased health risks among VFR travelers who typically stay in private homes and in less-developed areas, compared with vacationers or adult business travelers who are more likely to be staying in hotels and in urban areas.

In the GeoSentinel study, ill children aged 0-17 years presented earlier than ill adults, required hospitalization more often, had shorter duration of travel, and were less likely to have received medical advice prior to travel. And, in what the authors deemed "alarming," only half of all the ill non-VFR pediatric travelers (51%) and one-third of those who were VFR (32%) had received pretravel medical advice, compared with nearly two-thirds of the non-VFR adults (59%).

The spectrum of illness also differed considerably between children and adults. The most common categories of illness among the children were diarrheal (28%), dermatologic (25%), systemic febrile (23%), and respiratory (11%). Vaccine-preventable infections accounted for 2% (38) of the diagnoses.

Dermatologic syndromes, animal bites, cutaneous larvae migrans, and respiratory disorders were significantly more common in children than adults, while adults had a significantly higher proportion of nondiarrheal gastrointestinal disorders.

Interestingly, of the 390 children with dermatologic disorders, the two most common were animal bites (24%) and cutaneous larvae migrans (17%). While not vaccine preventable, these unfortunate occurrences can be avoided with common-sense precautions. This is also true of malaria, which accounted for 35% of the systemic febrile illnesses in 358 children. While malaria is not vaccine preventable, administration of appropriate antimalarial prophylactic medications combined with mosquito avoidance measures would decrease the chance of disease acquisition.

Not surprisingly, diagnoses differed by destination. Compared with travelers returning from Europe or North America, dermatologic diagnoses were twice as common in travelers from Latin America. Travel to the Middle East/North Africa was associated with a greater risk of diarrheal disorder, while travelers to sub-Saharan Africa and Asia experienced more systemic febrile illness.

The authors noted that while this study could not determine the reason for lack of pretravel care, it is likely that limited availability of travel-specific immunizations and medications in primary care settings was a likely factor, as well as the lack of insurance coverage for such measures and a lack of perceived risk, particularly among VFR travelers.

It can be a challenging task for a busy practitioner to stay abreast of the latest developments in non-routinely administered vaccines, disease outbreaks, areas of political instability, or country-specific entry requirements. However, it is important to ask parents who come from other countries if they are planning to visit their homelands and if so, when. Also, asking families with teens whether they plan on traveling for spring break or summer can be incorporated into routine office visits.

Ideally, patients planning international travel should be referred to a travel medicine clinic 1 month prior to travel. Some vaccines take up to 2 weeks to become effective, while others such as yellow fever should be received at least 10 days prior to travel and can be administered only at government-designated sites. Many vaccines, such as those against typhoid or rabies, are not routinely available at the patient’s medical home.

While the first thought is to focus on vaccine-preventable diseases, counseling about strategies to avoid insect and animal bites, food and water precautions, motor vehicle and water-related accidents, and interventions as simple as wearing shoes while walking on the beach is as much a part of a pretravel evaluation as are immunizations.

Indeed, international travel has become so commonplace that it behooves every primary care physician to identify a travel medicine clinic in their area that can provide pretravel advice and immunizations to their patients, and to inquire about potential international travel during patient visits. Making sure the patients’ routine immunizations are up to date is another way providers can assist their patients in preparing for international travel.

Note that not all travel medicine clinics provide services for children, so it’s a good idea to find out which ones do in your area. If you are having difficulty locating a clinic, the International Society of Travel Medicine offers a travel clinic locator on its Web site, while the American Society of Tropical Medicine & Hygiene offers the public a directory of providers who are society members.

The Centers for Disease Control and Prevention’s travel site also offers a clinic locator, as well as other resources for practitioners and travelers.

Dr. Word is a pediatric infectious disease specialist and director of the Houston Travel Medicine Clinic. Dr. Word said she had no relevant financial disclosures.

With vacation season approaching, some of our patients’ families may be planning travel to areas where they could be exposed to different infectious diseases and other health risks not commonly encountered in the United States. Even more challenging, they won’t necessarily mention their plans until the last minute unless you ask.

Today more than ever, travel involves arrival at an international destination. According to the U.S. Office of Travel & Tourism Industries, about 30 million Americans traveled internationally in 2009. Of those, about 8%-9%, or 2.4 million, were children. International travel continues to rise. In 2010, the United Nations World Tourism Organization reported a 7% overall increase in international travel.

Increasingly, children are traveling with parents to visit friends and extended family members in Africa, Asia, and Central and South America, while a growing number of American adolescents are traveling to resource-limited areas doing volunteer work, adventure travel, staying with host families, or as part of religious or civic groups. Opportunities for children and adolescents with chronic medical conditions who travel are associated with additional concerns that are directly related to their underlying condition, susceptibility, and potential interventions.

Unfortunately, health precautions often are simply not on the minds of many people as they make their travel arrangements. While most people plan international trips about 90 days in advance, they often will wait until the last minute to seek advice on immunizations, preventive medications, and other precautions – if they think to do so at all.

This is the case even for families with children. This was revealed in a recent eye-opening study conducted by the GeoSentinel Surveillance Network, a global surveillance network comprised of 49 travel/tropical medicine clinics on six continents. The network has previously reported on illnesses in adults (N. Engl. J. Med. 2006;354:119-30).

The study, the first comprehensive analysis of pediatric travel illness, examined data for 1,591 children and 32,668 adults seen at a GeoSentinel clinic. To be included in the database, persons had to have crossed an international border within 10 years and have a laboratory-confirmed or probable diagnosis. Data were collected from Jan. 30, 1997, through Nov. 30, 2007 (Pediatrics 2010;125:e1072-80).

For both children and adults, the three most common world regions visited were Asia, sub-Saharan Africa, and Latin America. While ill adults were more likely than children to have visited Asia, more ill children presented after travel to Europe and the Middle East/North Africa.

Tourism was the most common reason for travel among both children and adults, but children were more likely than adults to be a "VFR," or "visiting friends and relatives." Importantly, this and other studies have demonstrated significantly increased health risks among VFR travelers who typically stay in private homes and in less-developed areas, compared with vacationers or adult business travelers who are more likely to be staying in hotels and in urban areas.

In the GeoSentinel study, ill children aged 0-17 years presented earlier than ill adults, required hospitalization more often, had shorter duration of travel, and were less likely to have received medical advice prior to travel. And, in what the authors deemed "alarming," only half of all the ill non-VFR pediatric travelers (51%) and one-third of those who were VFR (32%) had received pretravel medical advice, compared with nearly two-thirds of the non-VFR adults (59%).

The spectrum of illness also differed considerably between children and adults. The most common categories of illness among the children were diarrheal (28%), dermatologic (25%), systemic febrile (23%), and respiratory (11%). Vaccine-preventable infections accounted for 2% (38) of the diagnoses.

Dermatologic syndromes, animal bites, cutaneous larvae migrans, and respiratory disorders were significantly more common in children than adults, while adults had a significantly higher proportion of nondiarrheal gastrointestinal disorders.

Interestingly, of the 390 children with dermatologic disorders, the two most common were animal bites (24%) and cutaneous larvae migrans (17%). While not vaccine preventable, these unfortunate occurrences can be avoided with common-sense precautions. This is also true of malaria, which accounted for 35% of the systemic febrile illnesses in 358 children. While malaria is not vaccine preventable, administration of appropriate antimalarial prophylactic medications combined with mosquito avoidance measures would decrease the chance of disease acquisition.

Not surprisingly, diagnoses differed by destination. Compared with travelers returning from Europe or North America, dermatologic diagnoses were twice as common in travelers from Latin America. Travel to the Middle East/North Africa was associated with a greater risk of diarrheal disorder, while travelers to sub-Saharan Africa and Asia experienced more systemic febrile illness.

The authors noted that while this study could not determine the reason for lack of pretravel care, it is likely that limited availability of travel-specific immunizations and medications in primary care settings was a likely factor, as well as the lack of insurance coverage for such measures and a lack of perceived risk, particularly among VFR travelers.

It can be a challenging task for a busy practitioner to stay abreast of the latest developments in non-routinely administered vaccines, disease outbreaks, areas of political instability, or country-specific entry requirements. However, it is important to ask parents who come from other countries if they are planning to visit their homelands and if so, when. Also, asking families with teens whether they plan on traveling for spring break or summer can be incorporated into routine office visits.

Ideally, patients planning international travel should be referred to a travel medicine clinic 1 month prior to travel. Some vaccines take up to 2 weeks to become effective, while others such as yellow fever should be received at least 10 days prior to travel and can be administered only at government-designated sites. Many vaccines, such as those against typhoid or rabies, are not routinely available at the patient’s medical home.

While the first thought is to focus on vaccine-preventable diseases, counseling about strategies to avoid insect and animal bites, food and water precautions, motor vehicle and water-related accidents, and interventions as simple as wearing shoes while walking on the beach is as much a part of a pretravel evaluation as are immunizations.

Indeed, international travel has become so commonplace that it behooves every primary care physician to identify a travel medicine clinic in their area that can provide pretravel advice and immunizations to their patients, and to inquire about potential international travel during patient visits. Making sure the patients’ routine immunizations are up to date is another way providers can assist their patients in preparing for international travel.

Note that not all travel medicine clinics provide services for children, so it’s a good idea to find out which ones do in your area. If you are having difficulty locating a clinic, the International Society of Travel Medicine offers a travel clinic locator on its Web site, while the American Society of Tropical Medicine & Hygiene offers the public a directory of providers who are society members.

The Centers for Disease Control and Prevention’s travel site also offers a clinic locator, as well as other resources for practitioners and travelers.

Dr. Word is a pediatric infectious disease specialist and director of the Houston Travel Medicine Clinic. Dr. Word said she had no relevant financial disclosures.

With vacation season approaching, some of our patients’ families may be planning travel to areas where they could be exposed to different infectious diseases and other health risks not commonly encountered in the United States. Even more challenging, they won’t necessarily mention their plans until the last minute unless you ask.

Today more than ever, travel involves arrival at an international destination. According to the U.S. Office of Travel & Tourism Industries, about 30 million Americans traveled internationally in 2009. Of those, about 8%-9%, or 2.4 million, were children. International travel continues to rise. In 2010, the United Nations World Tourism Organization reported a 7% overall increase in international travel.

Increasingly, children are traveling with parents to visit friends and extended family members in Africa, Asia, and Central and South America, while a growing number of American adolescents are traveling to resource-limited areas doing volunteer work, adventure travel, staying with host families, or as part of religious or civic groups. Opportunities for children and adolescents with chronic medical conditions who travel are associated with additional concerns that are directly related to their underlying condition, susceptibility, and potential interventions.

Unfortunately, health precautions often are simply not on the minds of many people as they make their travel arrangements. While most people plan international trips about 90 days in advance, they often will wait until the last minute to seek advice on immunizations, preventive medications, and other precautions – if they think to do so at all.

This is the case even for families with children. This was revealed in a recent eye-opening study conducted by the GeoSentinel Surveillance Network, a global surveillance network comprised of 49 travel/tropical medicine clinics on six continents. The network has previously reported on illnesses in adults (N. Engl. J. Med. 2006;354:119-30).

The study, the first comprehensive analysis of pediatric travel illness, examined data for 1,591 children and 32,668 adults seen at a GeoSentinel clinic. To be included in the database, persons had to have crossed an international border within 10 years and have a laboratory-confirmed or probable diagnosis. Data were collected from Jan. 30, 1997, through Nov. 30, 2007 (Pediatrics 2010;125:e1072-80).

For both children and adults, the three most common world regions visited were Asia, sub-Saharan Africa, and Latin America. While ill adults were more likely than children to have visited Asia, more ill children presented after travel to Europe and the Middle East/North Africa.

Tourism was the most common reason for travel among both children and adults, but children were more likely than adults to be a "VFR," or "visiting friends and relatives." Importantly, this and other studies have demonstrated significantly increased health risks among VFR travelers who typically stay in private homes and in less-developed areas, compared with vacationers or adult business travelers who are more likely to be staying in hotels and in urban areas.

In the GeoSentinel study, ill children aged 0-17 years presented earlier than ill adults, required hospitalization more often, had shorter duration of travel, and were less likely to have received medical advice prior to travel. And, in what the authors deemed "alarming," only half of all the ill non-VFR pediatric travelers (51%) and one-third of those who were VFR (32%) had received pretravel medical advice, compared with nearly two-thirds of the non-VFR adults (59%).

The spectrum of illness also differed considerably between children and adults. The most common categories of illness among the children were diarrheal (28%), dermatologic (25%), systemic febrile (23%), and respiratory (11%). Vaccine-preventable infections accounted for 2% (38) of the diagnoses.

Dermatologic syndromes, animal bites, cutaneous larvae migrans, and respiratory disorders were significantly more common in children than adults, while adults had a significantly higher proportion of nondiarrheal gastrointestinal disorders.

Interestingly, of the 390 children with dermatologic disorders, the two most common were animal bites (24%) and cutaneous larvae migrans (17%). While not vaccine preventable, these unfortunate occurrences can be avoided with common-sense precautions. This is also true of malaria, which accounted for 35% of the systemic febrile illnesses in 358 children. While malaria is not vaccine preventable, administration of appropriate antimalarial prophylactic medications combined with mosquito avoidance measures would decrease the chance of disease acquisition.

Not surprisingly, diagnoses differed by destination. Compared with travelers returning from Europe or North America, dermatologic diagnoses were twice as common in travelers from Latin America. Travel to the Middle East/North Africa was associated with a greater risk of diarrheal disorder, while travelers to sub-Saharan Africa and Asia experienced more systemic febrile illness.

The authors noted that while this study could not determine the reason for lack of pretravel care, it is likely that limited availability of travel-specific immunizations and medications in primary care settings was a likely factor, as well as the lack of insurance coverage for such measures and a lack of perceived risk, particularly among VFR travelers.

It can be a challenging task for a busy practitioner to stay abreast of the latest developments in non-routinely administered vaccines, disease outbreaks, areas of political instability, or country-specific entry requirements. However, it is important to ask parents who come from other countries if they are planning to visit their homelands and if so, when. Also, asking families with teens whether they plan on traveling for spring break or summer can be incorporated into routine office visits.

Ideally, patients planning international travel should be referred to a travel medicine clinic 1 month prior to travel. Some vaccines take up to 2 weeks to become effective, while others such as yellow fever should be received at least 10 days prior to travel and can be administered only at government-designated sites. Many vaccines, such as those against typhoid or rabies, are not routinely available at the patient’s medical home.

While the first thought is to focus on vaccine-preventable diseases, counseling about strategies to avoid insect and animal bites, food and water precautions, motor vehicle and water-related accidents, and interventions as simple as wearing shoes while walking on the beach is as much a part of a pretravel evaluation as are immunizations.

Indeed, international travel has become so commonplace that it behooves every primary care physician to identify a travel medicine clinic in their area that can provide pretravel advice and immunizations to their patients, and to inquire about potential international travel during patient visits. Making sure the patients’ routine immunizations are up to date is another way providers can assist their patients in preparing for international travel.

Note that not all travel medicine clinics provide services for children, so it’s a good idea to find out which ones do in your area. If you are having difficulty locating a clinic, the International Society of Travel Medicine offers a travel clinic locator on its Web site, while the American Society of Tropical Medicine & Hygiene offers the public a directory of providers who are society members.

The Centers for Disease Control and Prevention’s travel site also offers a clinic locator, as well as other resources for practitioners and travelers.

Dr. Word is a pediatric infectious disease specialist and director of the Houston Travel Medicine Clinic. Dr. Word said she had no relevant financial disclosures.

Screening and treatment of sexually transmitted disease is essential to the clinical repertoire of all physicians who care for adolescents.

Any doctor who provides primary health care to teens – whether trained as a pediatrician, family physician, obstetrician-gynecologist, or internist – should assume the responsibility of STD screening and counseling of all adolescent patients as part of anticipatory guidance, along with treatment if necessary.

Recommendations for routine counseling and screening of sexually active adolescents for specific STDs have been made over the last few years by various government agency and professional organizations, but have only now been included in the "Sexually Transmitted Diseases Treatment Guidelines, 2010" published in December by the Centers for Disease Control and Prevention (MMWR 2010;59:[RR-12]).

Of the 11 identified updates in the guidelines (last published in 2006), I would like to focus on those affecting the adolescent. Prevalence of several STDs is highest among this group. Specifically, rates of chlamydia and gonorrhea are highest among females aged 15-19 years, according to the CDC report. Adolescence is also the time when many are first exposed to human papillomavirus virus (HPV).

Why are adolescents at such a high risk for STDs? Risk increases when sexual activity is initiated at a young age, when injected drug use is present, and if male, the sexual encounters are with another male. Additional contributing factors include multiple sexual partners, sequential partners of brief duration (serially monogamous), inconsistent and/or inappropriate use of barrier methods, and challenges to accessing health care.

According to the new CDC STD guidelines, routine screening of Chlamydia trachomatis is recommended annually for all sexually active females aged 25 years and younger. While routine chlamydia screening is not recommended for sexually active young men – based on feasibility, efficacy, and cost-effectiveness – such screening should be considered in high-risk clinical settings such as adolescent clinics, correctional facilities, and STD clinics.

This recommendation, originally from the U.S. Preventive Services Task Force (USPSTF), was published in an internal medicine journal where many pediatricians were not likely to have seen it (Ann. Intern. Med. 2007;147:128-34).

Similarly, routine screening for Neisseria gonorrhoeae also is recommended for all sexually active women less than 25 years of age, the group at greatest risk for the infection. The screening recommendation – also originally from the USPSTF – also applies to women with other risk factors including a previous gonorrhea infection, the presence of other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use.

Screening for HIV is not routinely advised, but it should be discussed with all adolescents and encouraged for those who are sexually active and those who use injection drugs. It is also recommended for all diagnosed with an STD.

Routine screening of adolescents who are asymptomatic for certain STDs – such as syphilis, trichomoniasis, bacterial vaginosis, herpes simplex virus, and hepatitis B virus – is not recommended. However, young males who have sex with males and pregnant adolescent females might require more thorough evaluation, according to the current CDC recommendations.

It might make us uncomfortable to think about, but our patients are growing up and are not immune to any of these high-risk situations. We have to be prepared to assist them as they transition from childhood to adolescence and ultimately adulthood.

Screening and counseling for sexual activity, STDs, and pregnancy prevention is just one of the quality measures now recommended to assess health services for adolescents. Many adolescents report that they do not have the opportunity to speak privately with their care provider. Confidentiality is paramount to any discussion, which also should be developmentally appropriate.

Health care providers additionally must feel comfortable obtaining and discussing their patients’ sexual history, while at the same time being culturally sensitive and nonjudgmental. They also should be knowledgeable about risky behavior interventions and treatments. All states and the District of Columbia allow adolescents to seek treatment for a presumed STD without parental consent.

But a recent study illustrates why testing must accompany those discussions. Of 14,012 young adults (mean age 21.9 years) who had been interviewed and screened three times beginning in adolescence as part of the National Longitudinal Study of Adolescent Health, 964 tested positive for C. trachomatis, N. gonorrhoeae, and/or Trichomonas vaginalis. Of those, 10.5% reported having abstained from sexual activity during the prior 12 months and, of those, nearly half (5.9% of the total) said they had never had penile/vaginal intercourse in their lives (Pediatrics 2011 Jan. 3 [doi: 10.1542/peds.2009-0892]).

The researchers found no correlation with any sociodemographic factor including age, gender, educational level, or race for discrepancies between STD test results and self-reports among the STD-positive participants. This is the first study that attempts to correlate responses to objective findings.

While self-reported behavior is the mainstay of evaluating intervention strategies, this study suggests the numbers of affected adolescents may be underestimated. The study has several limitations. The participants’ baseline STD status was unknown, responses were based on recall, and it only dealt with one type of sexual contact – just to mention a few of the limitations. This is also not the ideal way to evaluate behavioral intervention programs, and such was never the intent of the study.

Other sections of the CDC guidelines address vaccination and counseling, again based on previous published guidelines from federal agencies and medical professional organizations. These include providing the HPV vaccine to 11- to 12-year old females, hepatitis B vaccine to all adolescents unless already vaccinated, and the hepatitis A vaccine in areas with existing vaccination programs.

Importantly, health care providers who care for children and adolescents should integrate sexuality education into clinical practice. This includes a discussion of both abstinence and consistent, correct condom use. Information regarding HIV infection, testing, transmission, and implications of infection also should be regarded as an essential component of the anticipatory guidance provided to all adolescents as part of health care.

The CDC guidelines include a box with suggested language for initiating a sexual history by asking about the "Five P’s": Partners, Prevention of pregnancy, and Protection from STDs, Practices, and Past history of STDs.

Obtaining a sexual history, educating patients, and/or treating STDs should not have to be referred to other specialists. As primary care physicians, you have a unique opportunity to educate and counsel young patients with whom you already have a well-established relationship. It’s not the easiest topic to tackle, but doing so is vital to the health of your patients on their journey to adulthood. The updated treatment guidelines are an excellent resource for every practitioner.

Dr. Word is an infectious disease specialist in Houston. She said she has no relevant financial disclosures.

Screening and treatment of sexually transmitted disease is essential to the clinical repertoire of all physicians who care for adolescents.

Any doctor who provides primary health care to teens – whether trained as a pediatrician, family physician, obstetrician-gynecologist, or internist – should assume the responsibility of STD screening and counseling of all adolescent patients as part of anticipatory guidance, along with treatment if necessary.

Recommendations for routine counseling and screening of sexually active adolescents for specific STDs have been made over the last few years by various government agency and professional organizations, but have only now been included in the "Sexually Transmitted Diseases Treatment Guidelines, 2010" published in December by the Centers for Disease Control and Prevention (MMWR 2010;59:[RR-12]).

Of the 11 identified updates in the guidelines (last published in 2006), I would like to focus on those affecting the adolescent. Prevalence of several STDs is highest among this group. Specifically, rates of chlamydia and gonorrhea are highest among females aged 15-19 years, according to the CDC report. Adolescence is also the time when many are first exposed to human papillomavirus virus (HPV).

Why are adolescents at such a high risk for STDs? Risk increases when sexual activity is initiated at a young age, when injected drug use is present, and if male, the sexual encounters are with another male. Additional contributing factors include multiple sexual partners, sequential partners of brief duration (serially monogamous), inconsistent and/or inappropriate use of barrier methods, and challenges to accessing health care.

According to the new CDC STD guidelines, routine screening of Chlamydia trachomatis is recommended annually for all sexually active females aged 25 years and younger. While routine chlamydia screening is not recommended for sexually active young men – based on feasibility, efficacy, and cost-effectiveness – such screening should be considered in high-risk clinical settings such as adolescent clinics, correctional facilities, and STD clinics.

This recommendation, originally from the U.S. Preventive Services Task Force (USPSTF), was published in an internal medicine journal where many pediatricians were not likely to have seen it (Ann. Intern. Med. 2007;147:128-34).

Similarly, routine screening for Neisseria gonorrhoeae also is recommended for all sexually active women less than 25 years of age, the group at greatest risk for the infection. The screening recommendation – also originally from the USPSTF – also applies to women with other risk factors including a previous gonorrhea infection, the presence of other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use.

Screening for HIV is not routinely advised, but it should be discussed with all adolescents and encouraged for those who are sexually active and those who use injection drugs. It is also recommended for all diagnosed with an STD.

Routine screening of adolescents who are asymptomatic for certain STDs – such as syphilis, trichomoniasis, bacterial vaginosis, herpes simplex virus, and hepatitis B virus – is not recommended. However, young males who have sex with males and pregnant adolescent females might require more thorough evaluation, according to the current CDC recommendations.

It might make us uncomfortable to think about, but our patients are growing up and are not immune to any of these high-risk situations. We have to be prepared to assist them as they transition from childhood to adolescence and ultimately adulthood.

Screening and counseling for sexual activity, STDs, and pregnancy prevention is just one of the quality measures now recommended to assess health services for adolescents. Many adolescents report that they do not have the opportunity to speak privately with their care provider. Confidentiality is paramount to any discussion, which also should be developmentally appropriate.

Health care providers additionally must feel comfortable obtaining and discussing their patients’ sexual history, while at the same time being culturally sensitive and nonjudgmental. They also should be knowledgeable about risky behavior interventions and treatments. All states and the District of Columbia allow adolescents to seek treatment for a presumed STD without parental consent.

But a recent study illustrates why testing must accompany those discussions. Of 14,012 young adults (mean age 21.9 years) who had been interviewed and screened three times beginning in adolescence as part of the National Longitudinal Study of Adolescent Health, 964 tested positive for C. trachomatis, N. gonorrhoeae, and/or Trichomonas vaginalis. Of those, 10.5% reported having abstained from sexual activity during the prior 12 months and, of those, nearly half (5.9% of the total) said they had never had penile/vaginal intercourse in their lives (Pediatrics 2011 Jan. 3 [doi: 10.1542/peds.2009-0892]).

The researchers found no correlation with any sociodemographic factor including age, gender, educational level, or race for discrepancies between STD test results and self-reports among the STD-positive participants. This is the first study that attempts to correlate responses to objective findings.

While self-reported behavior is the mainstay of evaluating intervention strategies, this study suggests the numbers of affected adolescents may be underestimated. The study has several limitations. The participants’ baseline STD status was unknown, responses were based on recall, and it only dealt with one type of sexual contact – just to mention a few of the limitations. This is also not the ideal way to evaluate behavioral intervention programs, and such was never the intent of the study.

Other sections of the CDC guidelines address vaccination and counseling, again based on previous published guidelines from federal agencies and medical professional organizations. These include providing the HPV vaccine to 11- to 12-year old females, hepatitis B vaccine to all adolescents unless already vaccinated, and the hepatitis A vaccine in areas with existing vaccination programs.

Importantly, health care providers who care for children and adolescents should integrate sexuality education into clinical practice. This includes a discussion of both abstinence and consistent, correct condom use. Information regarding HIV infection, testing, transmission, and implications of infection also should be regarded as an essential component of the anticipatory guidance provided to all adolescents as part of health care.

The CDC guidelines include a box with suggested language for initiating a sexual history by asking about the "Five P’s": Partners, Prevention of pregnancy, and Protection from STDs, Practices, and Past history of STDs.

Obtaining a sexual history, educating patients, and/or treating STDs should not have to be referred to other specialists. As primary care physicians, you have a unique opportunity to educate and counsel young patients with whom you already have a well-established relationship. It’s not the easiest topic to tackle, but doing so is vital to the health of your patients on their journey to adulthood. The updated treatment guidelines are an excellent resource for every practitioner.

Dr. Word is an infectious disease specialist in Houston. She said she has no relevant financial disclosures.

Screening and treatment of sexually transmitted disease is essential to the clinical repertoire of all physicians who care for adolescents.

Any doctor who provides primary health care to teens – whether trained as a pediatrician, family physician, obstetrician-gynecologist, or internist – should assume the responsibility of STD screening and counseling of all adolescent patients as part of anticipatory guidance, along with treatment if necessary.

Recommendations for routine counseling and screening of sexually active adolescents for specific STDs have been made over the last few years by various government agency and professional organizations, but have only now been included in the "Sexually Transmitted Diseases Treatment Guidelines, 2010" published in December by the Centers for Disease Control and Prevention (MMWR 2010;59:[RR-12]).

Of the 11 identified updates in the guidelines (last published in 2006), I would like to focus on those affecting the adolescent. Prevalence of several STDs is highest among this group. Specifically, rates of chlamydia and gonorrhea are highest among females aged 15-19 years, according to the CDC report. Adolescence is also the time when many are first exposed to human papillomavirus virus (HPV).

Why are adolescents at such a high risk for STDs? Risk increases when sexual activity is initiated at a young age, when injected drug use is present, and if male, the sexual encounters are with another male. Additional contributing factors include multiple sexual partners, sequential partners of brief duration (serially monogamous), inconsistent and/or inappropriate use of barrier methods, and challenges to accessing health care.

According to the new CDC STD guidelines, routine screening of Chlamydia trachomatis is recommended annually for all sexually active females aged 25 years and younger. While routine chlamydia screening is not recommended for sexually active young men – based on feasibility, efficacy, and cost-effectiveness – such screening should be considered in high-risk clinical settings such as adolescent clinics, correctional facilities, and STD clinics.

This recommendation, originally from the U.S. Preventive Services Task Force (USPSTF), was published in an internal medicine journal where many pediatricians were not likely to have seen it (Ann. Intern. Med. 2007;147:128-34).

Similarly, routine screening for Neisseria gonorrhoeae also is recommended for all sexually active women less than 25 years of age, the group at greatest risk for the infection. The screening recommendation – also originally from the USPSTF – also applies to women with other risk factors including a previous gonorrhea infection, the presence of other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use.

Screening for HIV is not routinely advised, but it should be discussed with all adolescents and encouraged for those who are sexually active and those who use injection drugs. It is also recommended for all diagnosed with an STD.

Routine screening of adolescents who are asymptomatic for certain STDs – such as syphilis, trichomoniasis, bacterial vaginosis, herpes simplex virus, and hepatitis B virus – is not recommended. However, young males who have sex with males and pregnant adolescent females might require more thorough evaluation, according to the current CDC recommendations.

It might make us uncomfortable to think about, but our patients are growing up and are not immune to any of these high-risk situations. We have to be prepared to assist them as they transition from childhood to adolescence and ultimately adulthood.

Screening and counseling for sexual activity, STDs, and pregnancy prevention is just one of the quality measures now recommended to assess health services for adolescents. Many adolescents report that they do not have the opportunity to speak privately with their care provider. Confidentiality is paramount to any discussion, which also should be developmentally appropriate.

Health care providers additionally must feel comfortable obtaining and discussing their patients’ sexual history, while at the same time being culturally sensitive and nonjudgmental. They also should be knowledgeable about risky behavior interventions and treatments. All states and the District of Columbia allow adolescents to seek treatment for a presumed STD without parental consent.

But a recent study illustrates why testing must accompany those discussions. Of 14,012 young adults (mean age 21.9 years) who had been interviewed and screened three times beginning in adolescence as part of the National Longitudinal Study of Adolescent Health, 964 tested positive for C. trachomatis, N. gonorrhoeae, and/or Trichomonas vaginalis. Of those, 10.5% reported having abstained from sexual activity during the prior 12 months and, of those, nearly half (5.9% of the total) said they had never had penile/vaginal intercourse in their lives (Pediatrics 2011 Jan. 3 [doi: 10.1542/peds.2009-0892]).

The researchers found no correlation with any sociodemographic factor including age, gender, educational level, or race for discrepancies between STD test results and self-reports among the STD-positive participants. This is the first study that attempts to correlate responses to objective findings.

While self-reported behavior is the mainstay of evaluating intervention strategies, this study suggests the numbers of affected adolescents may be underestimated. The study has several limitations. The participants’ baseline STD status was unknown, responses were based on recall, and it only dealt with one type of sexual contact – just to mention a few of the limitations. This is also not the ideal way to evaluate behavioral intervention programs, and such was never the intent of the study.

Other sections of the CDC guidelines address vaccination and counseling, again based on previous published guidelines from federal agencies and medical professional organizations. These include providing the HPV vaccine to 11- to 12-year old females, hepatitis B vaccine to all adolescents unless already vaccinated, and the hepatitis A vaccine in areas with existing vaccination programs.

Importantly, health care providers who care for children and adolescents should integrate sexuality education into clinical practice. This includes a discussion of both abstinence and consistent, correct condom use. Information regarding HIV infection, testing, transmission, and implications of infection also should be regarded as an essential component of the anticipatory guidance provided to all adolescents as part of health care.

The CDC guidelines include a box with suggested language for initiating a sexual history by asking about the "Five P’s": Partners, Prevention of pregnancy, and Protection from STDs, Practices, and Past history of STDs.

Obtaining a sexual history, educating patients, and/or treating STDs should not have to be referred to other specialists. As primary care physicians, you have a unique opportunity to educate and counsel young patients with whom you already have a well-established relationship. It’s not the easiest topic to tackle, but doing so is vital to the health of your patients on their journey to adulthood. The updated treatment guidelines are an excellent resource for every practitioner.

Dr. Word is an infectious disease specialist in Houston. She said she has no relevant financial disclosures.

Screening and treatment of sexually transmitted disease is essential to the clinical repertoire of all physicians who care for adolescents.

Any doctor who provides primary health care to teens – whether trained as a pediatrician, family physician, obstetrician-gynecologist, or internist – should assume the responsibility of STD screening and counseling of all adolescent patients as part of anticipatory guidance, along with treatment if necessary.

Recommendations for routine counseling and screening of sexually active adolescents for specific STDs have been made over the last few years by various government agency and professional organizations, but have only now been included in the "Sexually Transmitted Diseases Treatment Guidelines, 2010" published in December by the Centers for Disease Control and Prevention (MMWR 2010;59:[RR-12]).

Of the 11 identified updates in the guidelines (last published in 2006), I would like to focus on those affecting the adolescent. Prevalence of several STDs is highest among this group. Specifically, rates of chlamydia and gonorrhea are highest among females aged 15-19 years, according to the CDC report. Adolescence is also the time when many are first exposed to human papillomavirus virus (HPV).

Why are adolescents at such a high risk for STDs? Risk increases when sexual activity is initiated at a young age, when injected drug use is present, and if male, the sexual encounters are with another male. Additional contributing factors include multiple sexual partners, sequential partners of brief duration (serially monogamous), inconsistent and/or inappropriate use of barrier methods, and challenges to accessing health care.

According to the new CDC STD guidelines, routine screening of Chlamydia trachomatis is recommended annually for all sexually active females aged 25 years and younger. While routine chlamydia screening is not recommended for sexually active young men – based on feasibility, efficacy, and cost-effectiveness – such screening should be considered in high-risk clinical settings such as adolescent clinics, correctional facilities, and STD clinics.

This recommendation, originally from the U.S. Preventive Services Task Force (USPSTF), was published in an internal medicine journal where many pediatricians were not likely to have seen it (Ann. Intern. Med. 2007;147:128-34).

Similarly, routine screening for Neisseria gonorrhoeae also is recommended for all sexually active women less than 25 years of age, the group at greatest risk for the infection. The screening recommendation – also originally from the USPSTF – also applies to women with other risk factors including a previous gonorrhea infection, the presence of other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use.

Screening for HIV is not routinely advised, but it should be discussed with all adolescents and encouraged for those who are sexually active and those who use injection drugs. It is also recommended for all diagnosed with an STD.

Routine screening of adolescents who are asymptomatic for certain STDs – such as syphilis, trichomoniasis, bacterial vaginosis, herpes simplex virus, and hepatitis B virus – is not recommended. However, young males who have sex with males and pregnant adolescent females might require more thorough evaluation, according to the current CDC recommendations.

It might make us uncomfortable to think about, but our patients are growing up and are not immune to any of these high-risk situations. We have to be prepared to assist them as they transition from childhood to adolescence and ultimately adulthood.

Screening and counseling for sexual activity, STDs, and pregnancy prevention is just one of the quality measures now recommended to assess health services for adolescents. Many adolescents report that they do not have the opportunity to speak privately with their care provider. Confidentiality is paramount to any discussion, which also should be developmentally appropriate.

Health care providers additionally must feel comfortable obtaining and discussing their patients’ sexual history, while at the same time being culturally sensitive and nonjudgmental. They also should be knowledgeable about risky behavior interventions and treatments. All states and the District of Columbia allow adolescents to seek treatment for a presumed STD without parental consent.

But a recent study illustrates why testing must accompany those discussions. Of 14,012 young adults (mean age 21.9 years) who had been interviewed and screened three times beginning in adolescence as part of the National Longitudinal Study of Adolescent Health, 964 tested positive for C. trachomatis, N. gonorrhoeae, and/or Trichomonas vaginalis. Of those, 10.5% reported having abstained from sexual activity during the prior 12 months and, of those, nearly half (5.9% of the total) said they had never had penile/vaginal intercourse in their lives (Pediatrics 2011 Jan. 3 [doi: 10.1542/peds.2009-0892]).

The researchers found no correlation with any sociodemographic factor including age, gender, educational level, or race for discrepancies between STD test results and self-reports among the STD-positive participants. This is the first study that attempts to correlate responses to objective findings.

While self-reported behavior is the mainstay of evaluating intervention strategies, this study suggests the numbers of affected adolescents may be underestimated. The study has several limitations. The participants’ baseline STD status was unknown, responses were based on recall, and it only dealt with one type of sexual contact – just to mention a few of the limitations. This is also not the ideal way to evaluate behavioral intervention programs, and such was never the intent of the study.

Other sections of the CDC guidelines address vaccination and counseling, again based on previous published guidelines from federal agencies and medical professional organizations. These include providing the HPV vaccine to 11- to 12-year old females, hepatitis B vaccine to all adolescents unless already vaccinated, and the hepatitis A vaccine in areas with existing vaccination programs.

Importantly, health care providers who care for children and adolescents should integrate sexuality education into clinical practice. This includes a discussion of both abstinence and consistent, correct condom use. Information regarding HIV infection, testing, transmission, and implications of infection also should be regarded as an essential component of the anticipatory guidance provided to all adolescents as part of health care.

The CDC guidelines include a box with suggested language for initiating a sexual history by asking about the "Five P’s": Partners, Prevention of pregnancy, and Protection from STDs, Practices, and Past history of STDs.

Obtaining a sexual history, educating patients, and/or treating STDs should not have to be referred to other specialists. As primary care physicians, you have a unique opportunity to educate and counsel young patients with whom you already have a well-established relationship. It’s not the easiest topic to tackle, but doing so is vital to the health of your patients on their journey to adulthood. The updated treatment guidelines are an excellent resource for every practitioner.

Dr. Word is an infectious disease specialist in Houston. She said she has no relevant financial disclosures.

Screening and treatment of sexually transmitted disease is essential to the clinical repertoire of all physicians who care for adolescents.

Any doctor who provides primary health care to teens – whether trained as a pediatrician, family physician, obstetrician-gynecologist, or internist – should assume the responsibility of STD screening and counseling of all adolescent patients as part of anticipatory guidance, along with treatment if necessary.

Recommendations for routine counseling and screening of sexually active adolescents for specific STDs have been made over the last few years by various government agency and professional organizations, but have only now been included in the "Sexually Transmitted Diseases Treatment Guidelines, 2010" published in December by the Centers for Disease Control and Prevention (MMWR 2010;59:[RR-12]).

Of the 11 identified updates in the guidelines (last published in 2006), I would like to focus on those affecting the adolescent. Prevalence of several STDs is highest among this group. Specifically, rates of chlamydia and gonorrhea are highest among females aged 15-19 years, according to the CDC report. Adolescence is also the time when many are first exposed to human papillomavirus virus (HPV).

Why are adolescents at such a high risk for STDs? Risk increases when sexual activity is initiated at a young age, when injected drug use is present, and if male, the sexual encounters are with another male. Additional contributing factors include multiple sexual partners, sequential partners of brief duration (serially monogamous), inconsistent and/or inappropriate use of barrier methods, and challenges to accessing health care.

According to the new CDC STD guidelines, routine screening of Chlamydia trachomatis is recommended annually for all sexually active females aged 25 years and younger. While routine chlamydia screening is not recommended for sexually active young men – based on feasibility, efficacy, and cost-effectiveness – such screening should be considered in high-risk clinical settings such as adolescent clinics, correctional facilities, and STD clinics.

This recommendation, originally from the U.S. Preventive Services Task Force (USPSTF), was published in an internal medicine journal where many pediatricians were not likely to have seen it (Ann. Intern. Med. 2007;147:128-34).

Similarly, routine screening for Neisseria gonorrhoeae also is recommended for all sexually active women less than 25 years of age, the group at greatest risk for the infection. The screening recommendation – also originally from the USPSTF – also applies to women with other risk factors including a previous gonorrhea infection, the presence of other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use.

Screening for HIV is not routinely advised, but it should be discussed with all adolescents and encouraged for those who are sexually active and those who use injection drugs. It is also recommended for all diagnosed with an STD.

Routine screening of adolescents who are asymptomatic for certain STDs – such as syphilis, trichomoniasis, bacterial vaginosis, herpes simplex virus, and hepatitis B virus – is not recommended. However, young males who have sex with males and pregnant adolescent females might require more thorough evaluation, according to the current CDC recommendations.

It might make us uncomfortable to think about, but our patients are growing up and are not immune to any of these high-risk situations. We have to be prepared to assist them as they transition from childhood to adolescence and ultimately adulthood.

Screening and counseling for sexual activity, STDs, and pregnancy prevention is just one of the quality measures now recommended to assess health services for adolescents. Many adolescents report that they do not have the opportunity to speak privately with their care provider. Confidentiality is paramount to any discussion, which also should be developmentally appropriate.

Health care providers additionally must feel comfortable obtaining and discussing their patients’ sexual history, while at the same time being culturally sensitive and nonjudgmental. They also should be knowledgeable about risky behavior interventions and treatments. All states and the District of Columbia allow adolescents to seek treatment for a presumed STD without parental consent.

But a recent study illustrates why testing must accompany those discussions. Of 14,012 young adults (mean age 21.9 years) who had been interviewed and screened three times beginning in adolescence as part of the National Longitudinal Study of Adolescent Health, 964 tested positive for C. trachomatis, N. gonorrhoeae, and/or Trichomonas vaginalis. Of those, 10.5% reported having abstained from sexual activity during the prior 12 months and, of those, nearly half (5.9% of the total) said they had never had penile/vaginal intercourse in their lives (Pediatrics 2011 Jan. 3 [doi: 10.1542/peds.2009-0892]).

The researchers found no correlation with any sociodemographic factor including age, gender, educational level, or race for discrepancies between STD test results and self-reports among the STD-positive participants. This is the first study that attempts to correlate responses to objective findings.

While self-reported behavior is the mainstay of evaluating intervention strategies, this study suggests the numbers of affected adolescents may be underestimated. The study has several limitations. The participants’ baseline STD status was unknown, responses were based on recall, and it only dealt with one type of sexual contact – just to mention a few of the limitations. This is also not the ideal way to evaluate behavioral intervention programs, and such was never the intent of the study.

Other sections of the CDC guidelines address vaccination and counseling, again based on previous published guidelines from federal agencies and medical professional organizations. These include providing the HPV vaccine to 11- to 12-year old females, hepatitis B vaccine to all adolescents unless already vaccinated, and the hepatitis A vaccine in areas with existing vaccination programs.

Importantly, health care providers who care for children and adolescents should integrate sexuality education into clinical practice. This includes a discussion of both abstinence and consistent, correct condom use. Information regarding HIV infection, testing, transmission, and implications of infection also should be regarded as an essential component of the anticipatory guidance provided to all adolescents as part of health care.

The CDC guidelines include a box with suggested language for initiating a sexual history by asking about the "Five P’s": Partners, Prevention of pregnancy, and Protection from STDs, Practices, and Past history of STDs.

Obtaining a sexual history, educating patients, and/or treating STDs should not have to be referred to other specialists. As primary care physicians, you have a unique opportunity to educate and counsel young patients with whom you already have a well-established relationship. It’s not the easiest topic to tackle, but doing so is vital to the health of your patients on their journey to adulthood. The updated treatment guidelines are an excellent resource for every practitioner.

Dr. Word is an infectious disease specialist in Houston. She said she has no relevant financial disclosures.

Screening and treatment of sexually transmitted disease is essential to the clinical repertoire of all physicians who care for adolescents.

Any doctor who provides primary health care to teens – whether trained as a pediatrician, family physician, obstetrician-gynecologist, or internist – should assume the responsibility of STD screening and counseling of all adolescent patients as part of anticipatory guidance, along with treatment if necessary.

Recommendations for routine counseling and screening of sexually active adolescents for specific STDs have been made over the last few years by various government agency and professional organizations, but have only now been included in the "Sexually Transmitted Diseases Treatment Guidelines, 2010" published in December by the Centers for Disease Control and Prevention (MMWR 2010;59:[RR-12]).

Of the 11 identified updates in the guidelines (last published in 2006), I would like to focus on those affecting the adolescent. Prevalence of several STDs is highest among this group. Specifically, rates of chlamydia and gonorrhea are highest among females aged 15-19 years, according to the CDC report. Adolescence is also the time when many are first exposed to human papillomavirus virus (HPV).

Why are adolescents at such a high risk for STDs? Risk increases when sexual activity is initiated at a young age, when injected drug use is present, and if male, the sexual encounters are with another male. Additional contributing factors include multiple sexual partners, sequential partners of brief duration (serially monogamous), inconsistent and/or inappropriate use of barrier methods, and challenges to accessing health care.

According to the new CDC STD guidelines, routine screening of Chlamydia trachomatis is recommended annually for all sexually active females aged 25 years and younger. While routine chlamydia screening is not recommended for sexually active young men – based on feasibility, efficacy, and cost-effectiveness – such screening should be considered in high-risk clinical settings such as adolescent clinics, correctional facilities, and STD clinics.

This recommendation, originally from the U.S. Preventive Services Task Force (USPSTF), was published in an internal medicine journal where many pediatricians were not likely to have seen it (Ann. Intern. Med. 2007;147:128-34).

Similarly, routine screening for Neisseria gonorrhoeae also is recommended for all sexually active women less than 25 years of age, the group at greatest risk for the infection. The screening recommendation – also originally from the USPSTF – also applies to women with other risk factors including a previous gonorrhea infection, the presence of other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use.

Screening for HIV is not routinely advised, but it should be discussed with all adolescents and encouraged for those who are sexually active and those who use injection drugs. It is also recommended for all diagnosed with an STD.

Routine screening of adolescents who are asymptomatic for certain STDs – such as syphilis, trichomoniasis, bacterial vaginosis, herpes simplex virus, and hepatitis B virus – is not recommended. However, young males who have sex with males and pregnant adolescent females might require more thorough evaluation, according to the current CDC recommendations.

It might make us uncomfortable to think about, but our patients are growing up and are not immune to any of these high-risk situations. We have to be prepared to assist them as they transition from childhood to adolescence and ultimately adulthood.

Screening and counseling for sexual activity, STDs, and pregnancy prevention is just one of the quality measures now recommended to assess health services for adolescents. Many adolescents report that they do not have the opportunity to speak privately with their care provider. Confidentiality is paramount to any discussion, which also should be developmentally appropriate.

Health care providers additionally must feel comfortable obtaining and discussing their patients’ sexual history, while at the same time being culturally sensitive and nonjudgmental. They also should be knowledgeable about risky behavior interventions and treatments. All states and the District of Columbia allow adolescents to seek treatment for a presumed STD without parental consent.

But a recent study illustrates why testing must accompany those discussions. Of 14,012 young adults (mean age 21.9 years) who had been interviewed and screened three times beginning in adolescence as part of the National Longitudinal Study of Adolescent Health, 964 tested positive for C. trachomatis, N. gonorrhoeae, and/or Trichomonas vaginalis. Of those, 10.5% reported having abstained from sexual activity during the prior 12 months and, of those, nearly half (5.9% of the total) said they had never had penile/vaginal intercourse in their lives (Pediatrics 2011 Jan. 3 [doi: 10.1542/peds.2009-0892]).

The researchers found no correlation with any sociodemographic factor including age, gender, educational level, or race for discrepancies between STD test results and self-reports among the STD-positive participants. This is the first study that attempts to correlate responses to objective findings.

While self-reported behavior is the mainstay of evaluating intervention strategies, this study suggests the numbers of affected adolescents may be underestimated. The study has several limitations. The participants’ baseline STD status was unknown, responses were based on recall, and it only dealt with one type of sexual contact – just to mention a few of the limitations. This is also not the ideal way to evaluate behavioral intervention programs, and such was never the intent of the study.

Other sections of the CDC guidelines address vaccination and counseling, again based on previous published guidelines from federal agencies and medical professional organizations. These include providing the HPV vaccine to 11- to 12-year old females, hepatitis B vaccine to all adolescents unless already vaccinated, and the hepatitis A vaccine in areas with existing vaccination programs.

Importantly, health care providers who care for children and adolescents should integrate sexuality education into clinical practice. This includes a discussion of both abstinence and consistent, correct condom use. Information regarding HIV infection, testing, transmission, and implications of infection also should be regarded as an essential component of the anticipatory guidance provided to all adolescents as part of health care.

The CDC guidelines include a box with suggested language for initiating a sexual history by asking about the "Five P’s": Partners, Prevention of pregnancy, and Protection from STDs, Practices, and Past history of STDs.

Obtaining a sexual history, educating patients, and/or treating STDs should not have to be referred to other specialists. As primary care physicians, you have a unique opportunity to educate and counsel young patients with whom you already have a well-established relationship. It’s not the easiest topic to tackle, but doing so is vital to the health of your patients on their journey to adulthood. The updated treatment guidelines are an excellent resource for every practitioner.

Dr. Word is an infectious disease specialist in Houston. She said she has no relevant financial disclosures.