Sexually Transmitted Infections (STI) in Adolescents — Identifying At-Risk Behaviors — Clinical Pathway: Emergency and Primary Care

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

Identifying At-Risk Behaviors

Background

  • Prevalence of STI's is highest among adolescents and young adults. Assume all sexually active adolescents are vulnerable to STIs.
  • Asymptomatic infection is common in all people. Presumptive treatment prevents complications.
    • Chlamydia: 70% of infections in persons with vaginas and 50% in persons with penises 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.
  • Consider individual sexual behavior and biological risks obtained by patient history to screen and test more frequently than annually for asymptomatic infections. Screening Recommendations.
  • The following characteristics increase vulnerability to STIs:
    • New sex partner, > 1 sex partner, multiple sequential sex partnerships of limited duration
    • Sex partner with concurrent sex partners, sex partner with STI
    • Inconsistent use of condoms/barrier protection
    • Multiple barriers to accessing health care
    • Residing in detention facility
    • Commercial sex exploitation
    • Survival sex: exchanging sex for money, drug, food
    • High prevalence demographic group, sexual and gender minority individuals, including young men who have sex with males (YMSM), bisexual youth, and transgender youth
    • Presence of disabilities, substance abuse, mental health disorder
    • History of recent STI

STI Testing

Screening and Symptom Evaluation by Population and Frequency
Chlamydia and Gonorrhea
  • Annually for all sexually active people at anatomic sites of contact
  • Important to screen the appropriate anatomic sites based on reported behavior and symptoms:
    • Urethral (urine) or vaginal/cervical swab: Chlamydia, GC
    • Rectal: Chlamydia, GC
    • Pharyngeal: Chlamydia, GC
  • Consider increased screening interval (every 3-6 mos) based on risk:
    • Young men who have sex with men or transgender women
    • Persons living with HIV
  • Retest 3 mos after treatment of a Chlamydia or GC infection
Syphilis
  • All at least annually based on behaviors, exposure, and risk:
    • YMSM, Pregnant People, Transgender/Gender Diverse Youth, Persons Living with HIV
HIV
Hepatitis B
  • Persons born in high-risk country
  • Consider for unvaccinated individuals
Hepatitis C
  • All individuals ≥ 18 years of age
  • Consider based on individual patient behavior
HSV
  • Persons with Suspicion for HSV
    • HSV PCR testing of lesion
Trichomonas
  • Persons with Vaginas
    • Based on reported behavior and symptoms
    • Consider screening:
      • Combine with GC, chlamydia screening in high prevalence areas such as Philadelphia

Adolescent Screening, STI Treatment Guidelines, 2021, CDC