What is the most effective way to deal with teenagers with repeated sexually transmitted diseases (STDs)? Should I test for HIV or syphilis in a patient who has had chlamydia or gonorrhea on multiple occasions? I always discuss prevention during well-child visits. However, infection rates continue to increase. Office results from the Rapid Assessment for Adolescent Preventive Services teenage risk assessment shows that at least 50% of teenagers in my area are having sex by the eighth grade.—PATRICE PENNYFEATHER, CPNP, Newport News, Va.
The CDC has recently published new treatment guidelines that provide a wealth of evidence-based guidance in the screening, prevention, and management of STDs (MMWR Recomm Rep. 2010;59(RR-12):1-110). While you may not have control over when teenagers become sexually active, you can provide consistent counseling to decrease their risks for pregnancy and STDs using the five Ps: Partners; Prevention of pregnancy; Protection from STDs; Practices; and Past history. It is also important to recommend any vaccination that can reduce diseases that are transmitted sexually (e.g., human papillomavirus, hepatitis B virus, and even hepatitis A virus). Per the CDC guidelines, you need to test for HIV and syphilis in patients who have acquired chlamydia and gonorrhea. Partner treatment is important as well. There are many ways to accomplish this, including patient-delivered partner therapy. This method is controversial in some states, so check the CDC’s Web site. The CDC also recommends follow-up screening for reinfection at three months post-treatment. While not a test of cure per se, this provides the clinician with the ability to determine reinfections at an earlier time and an additional opportunity for counseling.—Julee B. Waldrop, DNP (148-3)