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Sexually Transmitted Infections (STI) in Adolescents — Signs and Symptoms Consistent with STI — Clinical Pathway: Emergency and Primary Care

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

Signs and Symptoms Consistent with STI

Prevalence of STIs is highest among adolescents and young adults.

Asymptomatic infection is common in men and women, presumptive treatment prevents complications.

  • Chlamydia: 70% of infections in women and 50% in men are asymptomatic at the time of diagnosis Chlamydial infection has also been associated with BV and HPV infection
  • GC: Commonly asymptomatic or presents with non-specific symptoms until complications occur, e.g., PID

Therefore, it is necessary to consider patients’ at-risk behaviors and biological risks obtained by patient history to screen and test for asymptomatic infections (refer to Screening Recommendations).

Lower Genital Tract Symptoms

Symptoms Diseases Organisms
  • Mucoid or mucopurulent discharge
  • Dysuria
  • Vulvar itching, burning, swelling
  • Vaginal odor
  • Genital rash, sores
  • Vaginal bleeding
  • Scrotal pain, swelling
  • Urethritis
  • Cervicitis
  • Vaginitis
  • Epididymitis
  • Bacterial vaginosis
  • Trichomoniasis
  • Vulvovaginal candidiasis
  • N. gonorrhoeae
  • C. trachomatis
  • M. genitalium
  • HSV
  • T. vaginalis
  • G. vaginalis
  • Prevotella, Mobiluncis sp
  • T. pallidum

Upper Genital Tract Symptoms

Symptoms Diseases Organisms
  • Abdominal pain
    • Lower
    • Right upper quadrant
  • PID
  • Tubo-ovarian abscess
  • Fitz-Hughes Curtis
  • N. gonorrhoeae
  • C. trachomatis
  • Polymicrobial infection with microorganisms from vaginal flora (such as facultative anaerobes, G. vaginalis, enteric gram-negative rods)
  • Streptococcus agalactiae
  • T. vaginalis
  • M. hominis
  • U. urealyticum
  • M. genitalium

Extra-genital Symptoms

Symptoms Diseases Organisms
  • Sore throat
  • Rash
  • Rectal pain, bleeding
  • Fever
  • Headache
  • Malaise
  • Adenopathy
  • Diarrhea
  • Pharyngitis
  • Proctitis
  • Septic arthritis
  • Meningoencephalitis
  • Hepatitis
  • N. gonorrhoeae
  • C. trachomatis
  • HSV
  • T. Pallidum
  • HIV

STI Diagnostic Guidance

 

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