Mexican adolescents and sexually transmitted diseases

Abstract

To the Editor: Of almost 100 millions of habitants in Mexico, approximately 20% are adolescents, one-half aged between 10 to 14 years and the other half between 15 to 19 years with a male:female ratio of 1:1 in both groups [1Instituto Nacional de Estadı́stica, Geografı́a e Informática.Principales resultados del XII Censo General de Población y Vivienda, 2000. Available at: http://www.inegi.gob.mx/difusion/espanol/poblacion. INEGI, México2002Google Scholar]. Sexually transmitted diseases (STDs) represent a major public health problem in Mexican adolescents. For example, the rate of trichomoniasis increases from 11.9 × 100,000 in children aged 5 to 14 years to 178.3 × 100,000 in youth 15 to 24 years old [2Instituto Nacional de Estadı́stica, Geografı́a e Informática.Estados Unidos Mexicanos. INEGI, México1998Google Scholar]. The Adolescence Service of the Hospital Infantil de Mexico (HIM) provides medical attention mainly to patients derived from other services of the hospital. Traditionally, patients are consulted in the presence of parents, and privacy during clinical history is usually rejected by parents’ pressure. We recently reviewed the databases of the above-mentioned Adolescence Service in order to analyze demographic aspects and clinical characteristics of adolescent female patients aged 10 to 18 years, seen between January 1995 and December 1999 and suffering vulvovaginitis. Information was retrieved from the medical records of 265 patients. Patients were classified according to the identified cervicovaginal microorganism either as an unspecific vulvovaginitis or a vulvovaginitis secondary to a STD. In 53 (20.0%) patients, a sexually transmitted microorganism was identified. In contrast to the honesty among middle and late school-aged adolescents in the United States previously identified [3Siegel D.M. Aten M.J. Roghmann K.J. Self-reported honesty among middle and high school students responding to a sexual behavior questionnaire.J Adolesc Health. 1998; 23: 20-28Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar], 98.1% of Mexican adolescents with a vulvovaginitis secondary to a STD denied sexual activity. Privacy has been the focus of an extensive debate in the United States [4Gotlieb E.M. Privacy rights, HIPAA, and the AAP About right; about time.Pediatrics. 2002; 109: 146-149Crossref PubMed Scopus (3) Google Scholar]. The Final Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 specifically protected privacy rights of adolescents. In Mexico, the unregulated rights for privacy of adolescents results in the presence of family members during examinations, which in turn inhibits disclosure of a highly sensitive issue as sexual activity. Therefore, Mexican adolescent females denying sexual activity are naturally responding to unprotected privacy, resulting in extensive and expensive evaluations in order to establish a STD diagnosis. We may consider results of the present study as proof of the negative consequences of inadequate privacy protection. Respectfully submitted