STI screening important for adolescent patients

NEW YORK — All sexually active females should be screened for gonorrhea and chlamydia annually, according to a presenter here at the 26th Annual Infectious Diseases in Children Symposium.

Cynthia Holland-Hall, MD, MPH, an associate professor of clinical pediatrics at The Ohio State University College of Medicine, said that high-risk patients may need to be tested more frequently.

Cynthia Holland-Hall

According to CDC data published in 2011, 47% of high school students have had sex, 15% have had four or more sexual partners, and 40% stated they did not use a condom the last time they had sex. Therefore, pediatricians should be having the appropriate discussions with adolescent patients, according to Holland-Hall.

“Sexually transmitted infections (STIs) are a disease of pediatrics if you take care of teenagers,” she said.

Currently, CDC screening guidelines recommend that all sexually active females younger than 25 years be screened for Chlamydia trachomatisinfection, and high-risk individuals should also be screened for gonorrhea. Available tests for STIs include nucleic acid amplification tests, first-catch urine tests, and vaginal swabs. Vaginal swabs with nucleic acid amplification tests are the preferred screening specimen, she said.

Holland-Hall said urine testing is an appropriate way to screen asymptomatic males and females for gonorrhea and chlamydia. Urine testing is also appropriate for testing symptomatic males, however symptomatic females should receive further evaluation.

Most studies have shown that vaginal swabs are equal in sensitivity to endocervical swabs and presumably include both urethral and cervical secretions. Vaginal swabs also have superior sensitivity to first-catch urine tests.

The CDC has stated that self-collected vaginal swabs are now the preferred specimen for screening among asymptomatic females, and studies have shown that efficacy is similar between patient and doctor collected specimens.

Doxycycline or azithromycin can be used to treat uncomplicated cervicitis or urethritis and both are equally efficacious when adherence is high. Ceftriaxone is the preferred treatment for gonococcal infections. Quinolones are no longer recommended and resistance is emerging against cephalosporin. Dual treatment of gonococcal infections is recommended with azithromycin or doxycycline.

For more information:

Holland-Hall C. Presented at: IDC NY 2013; Nov. 16-17, 2013; New York.

Disclosure: Holland-Hall reports no relevant financial disclosures.