Issue: August 2014
July 01, 2014
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AAP releases non-viral STI screening recommendations

Issue: August 2014
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The AAP’s Committee on Adolescence and Society for Adolescent Health and Medicine published recommendations on screening adolescents for non-viral sexually transmitted infections.

The policy statement discusses the clinical importance of non-viral STIs, which highlights the significance of screening among adolescents who may have a higher risk for STIs.

Chlamydia trachomatis is the most common reportable communicable disease in the United States, according to the statement. Females aged 20 to 24 years have the highest rates of chlamydia, followed by females aged 15 to 19 years. Chlamydia has significant racial disparities; its prevalence is five times higher among non-Hispanic black teens aged 15 to 19 years compared with prevalence among non-Hispanic whites. Rates have increased every year since 2006 among males aged 15 to 19 years, and the rate among non-Hispanic blacks is 10 times the rate among non-Hispanic whites.

Gonorrhea is the second most common reportable communicable disease in the United States. Females aged 20 to 24 years and 15 to 19 years have the highest and second highest rates compared with any other age or gender. Gonorrhea has substantial racial disparity; rates among male and female blacks aged 15 to 19 years are 26 times and 15 times the rates of male and female non-Hispanics in the same age group. A recent study has indicated residential segregation of black populations may contribute to the large racial disparity by creating distinct social networks.

Trichomonas vaginalis infection may be the most common non-viral STI, according to population studies. Unlike chlamydia and gonorrhea, trichomoniasis is common among older women as well. Trichomoniasis has been associated with vaginitis and pelvic inflammatory disease, and may cause preterm labor or increase HIV transmission.

Syphilis, which was nearly eradicated by 2000, according to researchers, has re-emerged as a public health threat, particularly among men who have sex with men. From 2008 to 2012, rates increased significantly among males aged 20 to 24 years. In 2006, the highest reported syphilis rates were among males aged 35 to 39 years. Now rates are highest among males aged 20 to 24 years.

Based on the prevalence of these non-viral STIs, the AAP recommends physicians:

  • Routinely screen all sexually active females aged 25 years and younger for C. trachomatis and Neisseria gonorrheae annually;
  • Routinely screen sexually active adolescent and young MSM for rectal and urethral chlamydia and pharyngeal, rectal and urethral gonorrhea if they engage in receptive oral, anal or insertive intercourse. Screen every 3 to 6 months if they have risk factors such as multiple or anonymous sex partners, illicit drug use or have had sex partners who engaged in those activities;
  • Screen adolescents and young adults exposed to chlamydia or gonorrhea in the past 60 days;
  • Consider screening other sexually active males in settings with high prevalence rates, such as jails or juvenile corrections facilities, national job training programs, STD clinics, high school clinics and adolescent clinics;
  • Routine T. vaginalis screening of asymptomatic adolescent is not recommended; however, certain risky behaviors, such as new or multiple partners, history of STIs, exchanging sex for payment, or injecting drugs, may warrant screening;
  • Regarding syphilis, routine screening of non-pregnant, heterosexual adolescents is not recommended. However, screening is recommended for all sexually active adolescent and young adult MSM annually or every 3 to 6 months if considered at high risk;
  • Adolescents with chlamydia or gonorrhea should be rescreened 3 months after treatment;
  • Rescreening 3 months after treatment should be considered for females with trichomoniasis; and
  • Develop clinical procedures using prepared resources to incorporate STI risk assessments, screening and treatment, and prevention counseling into routine health care for sexually active adolescents.

“Pediatricians can take an active role in reducing disease prevalence and adverse sequelae by identifying and treating undiagnosed infections in addition to prevention counseling, promotion of condom use and safe sex practices, rescreening infected patients after treatment, and offering expedited partner therapy, where legally permissible and recommended, to prevent new and recurrent infections,” the researchers concluded.

Disclosure: The researchers report no relevant financial disclosures.