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AAP: ‘Room for improvement’ in STD prevention

To address the varying sexual and reproductive health concerns among adolescents and young adults, the AAP recently issued a clinical report that it said would help pediatricians play a “significant role” in improving patients’ care in these areas.

Government agencies and medical groups have previously issued recommendations and guidelines on the provision of reproductive and sexual health information and services, according to Arik V. Marcell, MD, MPH, of the division of general practice and adolescent medicine, department of pediatrics at the School of Medicine at Johns Hopkins University.

“However, despite these recommendations, recent studies have revealed that there is substantial room for improvement in actually delivering the recommended services,” he wrote on behalf of AAP’s Committee on Adolescence.

Marcell wrote that to ensure adolescents receive ongoing health care, patients must have a chance to discuss their concerns with their pediatrician confidentially. In addition, pediatricians should offer convenient and extended office hours; employ an office staff that is welcoming and friendly to all patients regardless of sexual orientation; provide reading materials that address common health concerns; and involve the patient’s family as much as possible in the patient’s care.

The committee suggested interviewing techniques to obtain adolescent or young adult patients’ medical and psychosocial histories:

• offering a range of sexual-orientation questions;
• using gender-neutral language;
• offering reassuring statements and presenting supportive statements;
• utilizing questions that provide insight into the patient;
• restating the patient’s feelings, clarifying a statement and summarizing the interview;
• using open-ended questions to prevent “yes” or “no” responses; and
• offering reflection responses that align with the patient’s feelings.

Marcell also wrote that pediatricians can use these techniques to discuss a patient’s mental health; nicotine, alcohol and other drug use; sexual problems, sexual assault and abuse; reproductive life plans; sexual health assessments; sexuality and puberty concerns.

In addition, he stated that pediatricians should be prepared to counsel patients on topics such as their hygiene; pregnancy desires; birth control, including condoms; and STD risk reduction.

The clinical report also provides a number of AAP and CDC stances on preventing STDs, including:

• performing routine HPV immunization on all 11- and 12-year-olds and catch-up vaccinations on adolescents and young adults 13 through 26 years;
• performing routine immunizations against hepatitis A and B viruses in young adults;
• completion of the rubella, mumps and measles vaccine series, especially for reproductive-aged females;

• starting cytologic screening for cervical cancer at age 21 years and continuing every 3 years among 21- to 29-year-olds;
• testing youth at increased risk, such as teenagers having unprotected anal or vaginal intercourse or men who have sex with men, for HIV annually;
• routinely offering HIV screening to all adolescents at least once according to CDC guidelines;
• considering screening young men who have sex with men that report behaviors which can increase their risk of STDs or HIV (eg, unprotected oral or anal sex, frequent partner changes, anonymous sex, or multiple sexual partners) more frequently, such as every 3 to 6 months;
• recommending routine screening for hepatitis B virus infection for adolescents and young adults at high risk, including those who have been previously vaccinated;
• forgoing routine trichomonas screening in adolescents who are asymptomatic;
• forgoing routine screening heterosexual adolescents and nonpregnant young adults for other STDs such as syphilis — except in areas where there are high endemic rates — genital herpes and HPV;
• considering annual gonorrhea and chlamydia screening on the basis of population- and individual-based risk factors for heterosexual adolescent and young adult males consistent with CDC guidance; and
• screening all sexually active females annually for gonorrhea and chlamydia annually.

Physical exams should cover breast and genital examinations, Marcell wrote, and BMI and BP should be measured annually.

“Pediatricians should be prepared to educate adolescents and young adults on sexual development and promote healthy behaviors in relationships and prevention of [STDs] and unintended pregnancies,” Marcell, who is also a member of the department of population, family and reproductive health at the Bloomberg School of Public Health at Johns Hopkins University, wrote.

“Pediatricians should be prepared to address these issues with preventive counseling for adolescents and young adults and their parent(s) or guardian(s) and provide sexual and reproductive health services or a referral to a provider who can provide the services (eg, adolescent medicine specialists in-person or via telemedicine),” he continued.

Marcell added there are tools on AAP’s website to help pediatricians with these topics. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.