Sexually Transmitted Infections (STI) in Adolescents Clinical Pathway — Emergency Department and Primary Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Provider Resources

Related Pathways
- Abuse, Sexual, ED
- Uterine Bleeding, ED

Identifying Adolescents ≥ 13 Years at Risk for STI
Screening, Treatment, Prevention

ED Triage

Nursing Considerations

Primary Care Rooming: Consider HCG, UA

History
- Identifying At-risk Behaviors to Guide STI Screening
- Confidentiality and Consent
- Five P’s approach for obtaining sexual histories:
  - Partners
  - Practices
  - Protection from STIs
  - Past history of STIs (HIV, Viral Hepatitis Risk)
  - Pregnancy Intention
Physical Examination Identifying Signs of STI
Consider completing GU exam with Attending presence
Chaperone Considerations, Documentation

Testing for STI to Identify Biological Markers
HIV Consent
Review Testing and Results Communication Plan with Adolescent
- Confirm, document result communication plan
- Obtain confidential contact number

Asymptomatic and/or
concern for STI based on history

Signs, Symptoms Consistent with Possible STI
Pelvic Inflammatory Disease
- Diagnostic Criteria
- Differential Diagnosis
- Evaluation
- Treatment

Review
- Screening Recommendations
- Last documented testing
- Patient request
- Primary Prevention

Diagnostic Testing: Screening and Symptom Evaluation

STI Treatment Recommendations
Consider empiric treatment to avoid complications

Disposition Planning, Education, Follow-up
- STI Treatment Guidance
- Follow-up
- Pregnancy Prophylaxis
- Partner Prophylaxis
- Prevention
- Pre-Exposure Prophylaxis
Discharge Instructions
Communicating STI Results
Guidance for Delivering HIV Test Results

Posted: May 2022
Revised: May 2023

Authors:
- G. Kelly, CRNP;
- C. Mollen, MD;
- J. Lavelle, MD;
- S. Wood MD;
- A. Bailer, CRNP;
- M. Siddharth, MD;
- C. Sweeney, CRNP

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Emergency Department and Primary Care Clinical Pathway for Evaluation/Treatment of Sexually Transmitted Infections in Adolescents

Evidence