Diagnosis and management of sexually transmitted disease pathogens among adolescents.

Abstract

1. Gale R. Burstein, MD, MPH* 2. Pamela J. Murray, MD, MPH† 1. *Centers for Disease Control and Prevention, Atlanta, GA 2. †Children’s Hospital, Pittsburgh, PA After completing this article, readers should be able to: 1. List the possible clinical presentations and sequelae of Neisseria gonorrhoeae and Chlamydia trachomatis genital infections in males and females. 2. Describe the various types of licensed N gonorrhoeae and C trachomatis laboratory tests as well as their advantages and disadvantages. 3. List the Amsel criteria and available laboratory tests for diagnosis of bacterial vaginosis. 4. Describe the various treatments for vulvovaginal candidiasis. 5. Describe patient, partner, and practitioner barriers to implementing effective partner notification. Sexually transmitted diseases (STDs) have been labeled a “hidden epidemic” among adolescents, with adolescent females experiencing some of the highest rates of most STDs. Most adolescent STDs, regardless of pathogen, are asymptomatic. A primary care visit presents the perfect window of opportunity to screen for STDs. Clinical preventive care guidelines, such as the Guidelines for Adolescent Preventive Services (GAPS), Bright Futures, and the American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care, recommend screening adolescents for sexual risk behaviors and offering STD diagnostic tests to all sexually active adolescents. The National Committee for Quality Assurance adopted chlamydia screening of sexually active females ages 15 to 25 years as a new Health Plan Employer Data and Information Set (HEDIS) performance measure for managed care organizations in 2000. New nucleic acid amplification diagnostic technology allows for a widening scope of STD screening without performing an invasive genital examination. This article reviews the epidemiology and clinical presentation of common curable STDs acquired by adolescents and provides information on new diagnostic technologies and treatments for these STDs. Screening and treating STDs can be offered readily as part of routine adolescent health services. ### Epidemiology Chlamydia trachomatis and Neisseria gonorrhoeae are the sexually transmitted genital pathogens reported most commonly among adolescents. Both infections frequently are asymptomatic in males and females. A large multisite, randomized, controlled trial found …