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

History and Physical

Tips for Adolescent Interview

Review Confidentiality and Consent laws with patient and parent/guardian
Interview adolescent privately, use open-ended questions
Set the stage about the personal nature of the questions
- “May I ask you a few questions about your sexual health and sexual practices?”
- “I understand that these questions are personal, but they are important to your overall health.”
- “We ask these questions to all patients. Like the rest of our visits, this information is in strict confidence unless you or someone else is being hurt or is in danger.”
- “Do you have any questions before we get started?”
Review Chaperone recommendations prior to genital exam, it is optimal to perform with Attending present
- Offer patients and parents/guardians the option of having a chaperone during sensitive parts of the exam
- A parent, family member, friend, or clinical staff can serve as a chaperone, document chaperone use note
  - Use of Chaperones During Sensitive Area Physical Examination Job Aid
  - Use of Chaperone During Sensitive Area Physical Examinations Policy

History

Detailed Sexual History	Identifying at-Risk Behaviors Use open-ended questions as much as possible Guide to Taking a Sexual History The Five P's of the Sexual History Partners Number, genders of sexual partners New partners Partners' risk factors for STIs Practices Kind of sexual contact is necessary to guide appropriate testing Includes vaginal, anal, oral, receptive Transactional sex e.g., sex for drugs, money, housing, etc. Coercion Protection from STIs Use of condoms or other barrier methods Consistency of use Circumstances when used/not used Use of emergency post-exposure HIV prophylaxis or pre-exposure prophylaxis (PrEP) Past History of STIs Personal and partner (current, past) STI testing history Personal and partner (current, past) STI diagnosis treatment history Recurrent symptoms or STI diagnoses Signs and Symptoms Consistent with STI HIV or hepatitis C status of current, past partners Personal or partner history of IV drug use History of emotional or physical abuse by partner Pregnancy Information Pregnancy intentions Contraception or other birth control methods Resources for pregnancy prevention
Pertinent Past Medical and Surgical History	Past history of STIs as above Substance use disorder Behavioral health history, past, current treatment Pregnancy, abortion Gender affirmation surgery History of Hepatitis A, Hepatitis B, Human Papilloma Virus vaccination
Social History	Pertinent SSHADESS assessment Strengths School Home Activities Drugs Emotions/eating Sexuality Safety Substance use/abuse Living arrangement, safety, DHS, law enforcement
Medications	Oral contraception PrEP Gender-affirming hormonal treatment
Allergies	Penicillin allergy
ROS	Pertinent ROS by Chief Complaint Signs and Symptoms Consistent with STI

Physical

Signs and Symptoms Consistent with STI

Physical Exam	Complete VS, weight, PE Genital, anal exam with fellow/attending Bi-manual exam as indicated to assess CMT, uterine size, adnexal tenderness, mass Consider speculum exam to investigate source of excessive bleeding, or for FB as indicated Avoid internal exam if concern for external HSV or HPV

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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

History and Physical

Tips for Adolescent Interview

History

Physical

Find a research study

Innovation and your child

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Sexually Transmitted Infections (STI) in Adolescents — History and Physical — Clinical Pathway: Emergency and Primary Care

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

History and Physical

Tips for Adolescent Interview

History

Physical