Subsequent Sexually Transmitted Infections Research Articles

Syphilis Diagnosis After a Chlamydia, Gonorrhea, or HIV Diagnosis Among Reproductive-Aged Women in Baltimore, MD.

Syphilis incidence is increasing among reproductive-aged women, and previous sexually transmitted infections (STIs) are a risk factor for subsequent STIs. This study aimed to determine syphilis incidence after a chlamydia, gonorrhea, or HIV diagnosis, and identify characteristics associated with higher syphilis incidence rates among reproductive-aged women in 1 mid-Atlantic city. A retrospective cohort of 85,113 chlamydia, gonorrhea, and HIV diagnoses occurring between 2009 and 2021 and among women aged 13 to 50 years was constructed using public health surveillance data. Cumulative incidence curves were estimated to examine time to early syphilis (i.e., primary, secondary, or early latent) diagnosis, and multivariable analyses determined incidence rate ratios by age (<25 vs. ≥25 years) and number of prior STI diagnoses (0 vs. ≥1) during the study period, stratified by STI. There were 85,113 reportable STI diagnoses and 646 syphilis diagnoses in the cohort. Approximately 1 of 150 chlamydia, 1 of 100 gonorrhea, and 1 of 50 HIV diagnoses were followed by a syphilis diagnosis within 5 years. Cumulative incidence of syphilis differed significantly by STI diagnosis ( P < 0.001). In multivariable analysis, syphilis incidence rates were higher among women diagnosed with ≥1 (vs. 0) prior STI regardless of STI type ( P < 0.05) and among women ≥25 (vs. <25) years old diagnosed with gonorrhea ( P < 0.05). There were significant differences in syphilis incidence by prior STI type, number of STIs, and age. Our data support targeted screening for syphilis among women with a history of STIs, parwomen with ≥1 prior STI diagnosis, and older women diagnosed with gonorrhea.

Posttraumatic Stress Disorder Symptoms and Incarceration: The Impact on Sexual Risk-Taking, Sexually Transmitted Infections, and Depression Among Black Sexual Minority Men in HIV Prevention Trials Network (HPTN) 061.

Black men and people belonging to sexual minority groups are disproportionately impacted by criminal legal involvement and sexually transmitted infections (STIs). Traumatic experiences are often associated with later criminal legal involvement, depression symptoms, sexual risk behavior, and STIs. Research on the joint influence of trauma and incarceration on STI risk among racial and/or sexual minority people is limited. This study tested the association between post-traumatic stress disorder (PTSD) symptoms and incarceration on sexual risk behavior and STI among Black sexual minority men, a population that may be at higher risk for contracting STIs. Using data from the HIV Prevention Trials Network 061 Study, a longitudinal study of adult Black sexual minority men in six U.S. cities (N = 855), we tested associations between past six-month incarceration and subsequent sexual risk behavior, STI, and depression symptoms, for those with and without pre-incarceration PTSD symptoms. PTSD symptoms were elevated among participants who reported Hispanic ethnicity, having sex with both men and women, and previous incarceration. Although there were not significant differences between recent incarceration and sexual risk for those with and without PTSD, incarceration was linked to some sexual risk behaviors regardless of PTSD symptoms. Among people with PTSD symptoms, there was a higher prevalence of sexual risk and depression symptoms, regardless of incarceration. These findings suggest a potentially compounding influence of PTSD symptoms and incarceration on sexual risk and infection among Black sexual minority men.

Sexually Transmitted Infections among Adolescent and Young Adult Patients with Obsessive–Compulsive Disorder

Objectives: The association between obsessive–compulsive disorder (OCD) and sexually transmitted infections (STIs) and the effects of OCD medication on STI risk remain unknown. In the present study, we intended to study the risks of subsequent STIs after an OCD diagnosis and the effects of related OCD medications on STI risk. Methods: With the Taiwan National Health Insurance Research Database, we enrolled 15,908 adolescent and young adult patients with OCD and 159,080 age- and sex-matched individuals without OCD between 2001 and 2009, and followed them up until the end of 2011 for subsequent STI diagnoses. Results: The total patients with OCD were significantly more to acquire an STI, with a hazard ratio (95% confidence interval) being 3.25 (2.61–4.03), than their counterparts without OCD (p &lt; 0.05). The associations between OCD medications, including antidepressants, mood stabilizers, and second-generation (atypical) antipsychotic drugs, and subsequent STI risk did not reach any significant differences. Conclusion: In this study, we found that OCD is an independent risk factor of acquiring any STI in the adolescent and young adult population. We recommend that clinicians should be more alert in identifying risky sexual behaviors and STI risks in such patients with OCD.

Sexually Transmitted Infection Among Adolescents and Young Adults with Autism Spectrum Disorder: A Nationwide Longitudinal Study.

The association between autism spectrum disorder (ASD) and subsequent sexually transmitted infections (STIs) and the potential effects of medications on STI risk remain unknown. In all, 5076 adolescents and young adults with ASD and 57,060 age-/sex-matched individuals without ASD were enrolled between 2001 and 2009 and followed-up to the end of 2011 for identification of subsequent STIs. The results revealed that patients with ASD were prone to acquiring an STI [hazard ratio (HR) 3.36] compared with the comparison group. Long-term use of atypical antipsychotics was associated with a lower risk of acquiring an STI later in life compared with nonuse (HR 0.34). We recommend that clinicians closely monitor risky sexual behaviors and STI risk in patients with ASD.

Transmission Risk Among Youth Living With HIV in the U.S.

PurposeHIV treatment as prevention is effective for reducing the risk of HIV transmission and the messaging campaign, undetectable = untransmittable, is gaining recognition. As youth living with HIV (YLWH) who have condomless sex may acquire and potentially transmit other sexually transmitted infections (STIs), the purpose of this study was to assess potential differences in transmission risk of HIV and other STIs among YLWH to inform subsequent HIV and STI prevention efforts. MethodsA cohort of 600 HIV behaviorally infected youth aged 13–24 years who were engaged in medical care completed an audio computer-assisted self-interview including questions about demographics, HIV disclosure, mental health, substance use, and sexual behaviors and beliefs. HIV viral loads and the presence of other STIs were abstracted from medical records. A viral load <200 copies/mL was considered undetectable. Univariate and bivariate analyses were conducted to examine differences by viral load and STIs. ResultsParticipants were categorized into four groups: (1) undetectable without STIs (55.2%); (2) undetectable with STIs (14.2%); (3) detectable without STIs (22.8%); and (4) detectable with STIs (7.8%). In comparison to the other three groups, youth in the undetectable group with STIs reported more favorable sexual risk reduction attitudes and beliefs, internet use for finding sex partners, anal sex with male partners, and condomless anal sex with male partners. ConclusionsYLWH with undetectable viral loads and other STIs engaged in higher risk behaviors. To realize the promise of the messaging campaign, undetectable = untransmittable, efforts must focus on sustained viral suppression and prevention of STIs among YLWH.

Borderline personality disorder is associated with an increased risk of sexually transmitted infections: A nationwide population-based cohort study in Taiwan

BackgroundSeveral features of borderline personality disorder (BPD) are likely to be associated with sexual health problems, such as unstable attachment, unstable sexual identity and sexual impulsivity. Since the issue of...

Sexually Transmitted Infection Among Adolescents and Young Adults With Bipolar Disorder: A Nationwide Longitudinal Study.

Evidence has shown a significant association between bipolar disorder and prevalence of risky sexual behaviors. However, the relationship between bipolar disorder and risk for sexually transmitted infections (STIs) requires further investigation, as do the effects of bipolar disorder medications on STI risk. In the present study, data from 26,028 adolescents and young adults with bipolar disorder (ICD-9-CM code 296 except 296.2x, 296.3x, 296.9x, and 296.82) and 104,112 age- and sex-matched non-bipolar-disorder controls from 2001 to 2009 were selected from the Taiwan National Health Insurance Research Database. Patients who contracted any type of STI-including human immunodeficiency virus, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis-during the follow-up period (from enrollment to the end of 2011) were identified. Cox regression analysis with full adjustment for demographic data, psychiatric comorbidities, and bipolar disorder medications showed that bipolar disorder was an independent risk factor (hazard ratio [HR] = 4.11; 95% confidence interval [CI], 3.62-4.66) for contracting an STI. Patients with bipolar disorder and substance and/or alcohol use disorders were at highest risk of STI occurrence. Long-term use of mood stabilizers (HR = 0.54; 95% CI, 0.34-0.86) and atypical antipsychotics (HR = 0.82; 95% CI, 0.71-0.95) was associated with reduced risk for contracting STIs. Adolescents and young adults with bipolar disorder exhibited an increased risk of subsequent STI during the follow-up period compared with those without bipolar disorder. Comorbidity of substance and alcohol use disorders further increased this risk. Long-term use of bipolar disorder medications (mood stabilizers and atypical antipsychotics) may reduce this risk.

High subsequent and recurrent sexually transmitted infection prevalence among newly diagnosed HIV-positive Thai men who have sex with men and transgender women in the Test and Treat cohort.

We determined subsequent and recurrent sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender women (TGW) in the Test and Treat cohort. Thai MSM and TGW adults with previously unknown HIV status were enrolled and tested for HIV. Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and syphilis were tested at baseline, month 12, and month 24 to identify subsequent STIs (any STIs diagnosed after baseline) and recurrent STIs (any subsequent STIs diagnosed among those with positive baseline STIs). Among 448 participants, 17.8% were HIV-positive, the prevalence of subsequent STIs and recurrent STIs was 42% (HIV-positive versus HIV-negative: 66.3% versus 36.7%, p < 0.001) and 62.3% (81% versus 52.5%, p < 0.001), respectively. Common subsequent STIs by anatomical site were rectal CT infection (21.7%), rectal NG infection (13.8%), pharyngeal NG infection (13.1%), and syphilis (11.9%). HIV-positive status was associated with both subsequent STIs (adjusted hazard ratio [aHR] 2.38; 95%CI 1.64-3.45, p < 0.001) and recurrent STIs (aHR 1.83; 95%CI 1.16-2.87, p = 0.01). The results show that newly diagnosed HIV-positive MSM and TGW were at increased risk of STIs despite being in the healthcare system. STI educational counseling is necessary to improve STI outcomes among MSM and TGW in both HIV prevention and treatment programs.

Risk of sexually transmitted infections following depressive disorder: A nationwide population-based cohort study.

Depressive disorder is a severe mental disorder associated with functional and cognitive impairment. Numerous papers in the literature investigated associations between sexually transmitted infections (STIs) and psychiatric illnesses. However, the results of these studies are controversial.We explored the relationship between depressive disorder and the subsequent development of STIs including human immunodeficiency virus (HIV) infection, primary, secondary, and latent syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis.We identified patients who were diagnosed with the depressive disorder in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without the depressive disorder who were matched according to age and sex. The occurrence of subsequent new-onset STIs was evaluated in both cohorts.The depression cohort consisted of 5959 patients, and the comparison cohort consisted of 23,836 matched control patients without depressive disorder. The incidence of subsequent STIs (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.34–1.76) was higher among the depressed patients than among the patients in the comparison cohort. Furthermore, female gender compared to male (HR 1.58, 95% CI 1.24–2.01) and young age <40-year-old (HR 1.79, 95% CI 1.38–2.32) are both risk factors for acquisition of STIs in depression patient. For individual STI, the results indicated that the patients with depressive disorder exhibited a markedly higher risk for subsequent STIs including HIV infection, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis.Depressive disorder might increase the risk of subsequent newly diagnosed STIs including HIV infection, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis in Taiwan population. Clinicians should pay particular attention to STIs in depression patients. Depression patients, especially those with the history of high-risk sexual behaviors, should be routinely screened for STIs.

The role of sexual networks in studies of how BV and STIs increase the risk of subsequent reinfection.

Prior studies have demonstrated that both bacterial vaginosis (BV) and sexually transmitted infections (STIs) are strong independent risk factors for subsequent STI. In observational studies of this biological enhancement (BE) hypothesis, it is important to adjust for the risk of STI exposure so that the independent effect of BE can be assessed. We sought to model if two markers of local sexual network (partner concurrency and cumulative number of STIs) represented residual confounding in the models of risk for subsequent infection in a study that screened 3620 women for STIs every 3 months for a year. Mixed-effects logistic regression was used to calculate the odds ratios for an incident diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and BV following a diagnosis of any of these four at the prior visit, controlling for the cumulative number of STIs and partner concurrency variables. We found that partner concurrency and cumulative number of STIs were each associated with incident infection, and in general, controlling for these variables reduced the strength of the association between prior and incident infections. We conclude that the frequently found association between prior and incident STIs is associated with both BE and sexual network structure.

Schizophrenia is associated with an increased risk of sexually transmitted infections: A nationwide population-based cohort study in Taiwan

ObjectivesIn Taiwan, there has been a growing emphasis on physical health screening, health education and improving access to treatment in patients with schizophrenia (SCZ). However, sexual health needs, including screening and prevention of sexually transmitted infections (STI), are neglected in this population. The study aimed to investigate the association between SCZ and the subsequent incident STI and to examine potential risk factors. MethodsUsing the National Health Insurance Research Database of Taiwan, 58,948 SCZ patients and 235,784 controls matched by gender and age were enrolled between 2000 and 2010 and followed until the end of 2011. Participants who developed any STI (HIV, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis) during the follow-up period were identified. Cox regression analysis was performed to examine the risk of STI between SCZ patients and controls. ResultsSCZ patients were predisposed to developing STI (hazard ratio (HR): 1.11, 95% confidence interval (95% CI): 1.01–1.21) that could be caused by syphilis (HR: 2.58, 95% CI: 2.14–3.10) or possibly HIV (Crude HR: 1.39, 95% CI: 1.04–1.86; adjusted HR: 1.11, 95% CI: 0.81–1.52). Additionally, this study found that female, young adults, low-income, living in less urbanized areas, and comorbid substance abuse were potential risk factors for developing STI. ConclusionThis study shows that SCZ is associated with an increased risk of developing STI, which has direct implications for the development of targeted prevention interventions or regular sexual health screening in mental health clinics to reduce the disproportionate burden of HIV and other STI in SCZ patients.

Risk of sexual transmitted infection following bipolar disorder: a nationwide population-based cohort study.

BackgroundBipolar disorder is a severe mental disorder associated with functional and cognitive impairment. Numerous studies have investigated associations between sexually transmitted infections (STIs) and psychiatric illnesses. However, the results of these studies are controversial.ObjectiveWe explored the association between bipolar disorder and the subsequent development of STIs, including human immunodeficiency virus infection; primary, secondary, and latent syphilis; genital warts; gonorrhea; chlamydial infection; and trichomoniasis.ResultsThe bipolar cohort consisted of 1293 patients, and the comparison cohort consisted of 5172 matched control subjects without bipolar disorder. The incidence of subsequent STIs (hazard ratio (HR) = 2.23, 95% confidence interval (CI) 1.68–2.96) was higher among the patients with bipolar disorder than in the comparison cohort. Furthermore, female gender is a risk factor for acquisition of STIs (HR = 2.36, 95% CI 1.73–4.89) among patients with bipolar disorder. For individual STIs, the results indicated that the patients with bipolar disorder exhibited a markedly higher risk for subsequently contracting syphilis, genital warts, and trichomoniasis.ConclusionsBipolar disorder might increase the risk of subsequent newly diagnosed STIs, including syphilis, genital warts, and trichomoniasis. Clinicians should pay particular attention to STIs in patients with bipolar disorder. Patients with bipolar disorder, especially those with a history of high-risk sexual behaviors, should be routinely screened for STIs.MethodsWe identified patients who were diagnosed with bipolar disorder in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without bipolar disorder who were matched with the bipolar cohort according to age and gender. The occurrence of subsequent new-onset STIs was evaluated in both cohorts.

Youth Violence and Connectedness in Adolescence: What Are the Implications for Later Sexually Transmitted Infections?

To examine associations between (1) youth violence victimization and perpetration and later sexually transmitted infections (STI) and (2) parent-family and school connectedness and later STI, and to explore the moderating role of connectedness on the associations between youth violence victimization and perpetration and later STI. We used data from Waves I and IV of the National Longitudinal Study of Adolescent Health, which provided a baseline weighted sample of 14,800 respondents. We used logistic regression to examine associations between youth violence and connectedness with self-reported ever STI diagnosis, including gonorrhea, chlamydia, syphilis, genital herpes, genital warts or human papillomavirus, or human immunodeficiency virus. If participants reported having an STI at Wave I they were excluded from the analysis. Controlling for biological sex, race/ethnicity, age, parent's highest education level, and parent's marital status, both youth violence victimization and perpetration were associated with an increased risk of later STI (adjusted odds ratio [AOR], 1.27, 95% confidence interval [CI], 1.07-1.52; and AOR, 1.21, 95% CI, 1.04-1.41, respectively). Parent-family and school connectedness in adolescence were associated with a decreased risk for later STI (AOR, .96, 95% CI, .95-.98; and AOR, .97, 95% CI, .95-.99, respectively); however, connectedness did not moderate the associations between nonsexual violence involvement and later STI. These results indicate that youth violence victimization and perpetration may be risk factors for STI later in life. Conversely, parent-family and school connectedness in adolescence appear to protect against subsequent STI. The findings suggest that provider efforts to address youth violence and connectedness in adolescence can promote positive sexual health outcomes in adulthood.

Status of adolescent pelvic inflammatory disease management in the United States

Pelvic inflammatory disease (PID) is a common and serious reproductive health disorder and disease rates remain unacceptably high among adolescent girls and young adult women in the United States. Despite data demonstrating that women experience major adverse health outcomes after PID, national recommendations for management of adolescents have become increasingly less cautious in an era of cost-containment. In this review, we take an alternative look at published data on adolescents with PID to frame the next steps for optimizing management for this vulnerable population. Several findings emerge from review of the literature. First, there is limited evidence to guide the best practice strategies for adolescents with PID due to low enrolment of early and middle adolescents in national trials. Second, adolescents and adult women in the United States receive suboptimal treatment regimens per Centers for Disease Control and Prevention (CDC) standards. Third, available evidence suggests that adolescents are at an increased risk for poor adherence to CDC recommendations for self-care, reacquisition of sexually transmitted infections (STIs) and PID, and subsequent adverse reproductive health outcomes. Efforts to develop and integrate adolescent-focused, evidence-based strategies for PID management and prevention of subsequent STIs and recurrent PID are warranted.

Longitudinal Associations Among Relationship Factors, Partner Change, and Sexually Transmitted Infection Acquisition in Adolescent Women

New sex partners put adolescents at increased risk for sexually transmitted infections (STIs), even when these sex partners are nonoverlapping. Although the risk of partner change is well described, little is known about its antecedents. We prospectively examined associations between relationship characteristics, partner change, and subsequent STI during intervals of "serial monogamy." As part of a longitudinal study, 332 adolescent women were interviewed and tested for gonorrhea, chlamydia, and trichomonas every 3 months for up to just over 6 years. Interviews covered partner-specific relationship characteristics and sexual behaviors. The quarterly interval, a 3-month period bracketed by interviews and STI testing, was the unit of analysis. We examined associations among relationship factors, partner change, and subsequent STI using a series of mixed regression models, controlling for age, STI at Time 1, and condom nonuse. Age, lower relationship quality, and lower levels of partner closeness to friends and family predicted partner change from Time 1 to Time 2. In turn, partner change was associated with acquisition of a new STI at Time 2. Although relationship factors did not exert a direct effect on STI at Time 2, they improved partner change-STI model fit. Similar patterns were seen with each organism. Relationship factors drive partner change, which in turn contributes to STI acquisition. STI prevention research may need to focus on the relationship antecedents to partner change, in addition to the partner change itself.

Subsequent Sexually Transmitted Infection After Outpatient Treatment of Pelvic Inflammatory Disease

To determine the frequency of recurrent sexually transmitted infections (STIs) and/or pelvic inflammatory disease (PID), the average time until subsequent infection following a baseline PID diagnosis, and age- and insurance-related associations with subsequent diagnoses. This study used prospective longitudinal follow-up of STI and/or PID outcome data from electronic medical records. An urban academic hospital system. A total of 110 adolescent girls treated for PID as outpatients in pediatric ambulatory sites. Main Exposure Electronic medical records used to assess subsequent PID diagnoses and/or infections with Neisseria gonorrhoeae or Chlamydia trachomatis during the study window. Demographic, health care use, and STI and/or PID outcome data were examined. Incidence of an STI and/or PID was calculated as incident cases per person-months of exposure. Cox proportional hazard modeling was performed to evaluate the incidence of STI by age or insurance status. The mean (SD) age was 16.8 (1.9) years, 89% of patients were black, and 39% had laboratory results that were positive for N gonorrhoeae or C trachomatis at baseline. Thirty-four percent of patients had an additional diagnosis of an STI during the 48-month follow-up window (incidence, 3.1 per 100 person-months) and the mean (SD) time to a subsequent STI and/or PID was 377 (297) days. Of those patients, 67% (n = 18) had chlamydia, 11% had gonorrhoeae, and 44% had PID. There were no differences based on age or insurance status. Adolescents treated for PID are at risk for subsequent STI and/or PID for a 48-month period. Given the need to prevent future infections in these vulnerable youths, efforts to explore the value of ongoing strategies for risk reduction after diagnosis are warranted.

Sexual Behaviors After Universal Screening of Sexually Transmitted Infections in Healthy Young Women

To prospectively study the relationship between diagnosis of sexually transmitted infections (STIs) at entry to U.S. Marines recruit training and subsequent sexual behaviors during vacation. Of all women entering recruit training (June 1999-June 2000), 2,157 (94%) voluntarily enrolled. At baseline, women received universal screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis and treatment and counseling for positive STIs. Recruit training (13 weeks) precluded any social activities. Unrestricted vacation followed (median 10 days). After training resumed (3 weeks), questionnaires and repeat STI screening were administered. Multivariable logistic regression examined STI diagnosis at baseline as a predictor for risky sexual behaviors at vacation and STI-positive diagnosis after vacation. The study was completed by 1,712 (79%) women (median age 18 years); 1,038 reported sexual activity during vacation; 71% used condoms inconsistently; 19% had casual partners. At baseline, 152 (15%) tested STI-positive. Baseline STI diagnosis was unrelated to inconsistent condom use, nonmonogamous partnerships, or multiple partnerships. However, women testing STI-positive at baseline were more likely to test STI-positive after vacation (adjusted odds ratio 3.74, 95% confidence interval 2.10-6.65). Baseline STI diagnosis predicted casual partnerships among women aged 19-21 years (adjusted odds ratio 2.48, 95% confidence interval 1.12-5.50). Substantial numbers of women engaged in risky sexual behaviors after universal STI screening and counseling. Compared with STI-negative women, STI-positive women were at increased risk for subsequent STI acquisition regardless of their similar behaviors. As universal STI screening is increasingly implemented, follow-up care will likely be required to further reduce risky behaviors and address network-level factors. II.

Adolescent Girls with Negative Pregnancy Tests

Study Objectives and Design This descriptive study assessed background characteristics and attitudes about pregnancy held by adolescent girls presenting for pregnancy tests and receiving negative results. An additional aim was to determine types of health care services that would be of perceived benefit to them to reduce their risk of subsequent pregnancy. Setting Two health care sites in an urban community included a hospital-based adolescent clinic and a hospital-based women's health care clinic. Participants Sixty-five adolescent, low-income, single women with negative pregnancy test results in a consecutive sample were included in the study. Participants had a mean age of 16.9 (±1.3) years and described themselves as 64.1% African American, 26.6% Latina and 9.4% white, with 81.5% enrolled or recently graduated from high school. Main Outcome Measures The following variables were included: demographic characteristics, reproductive health history, personal and perceived partner attitude about the negative pregnancy test result, perceived parental influences, and teens' suggestions for health care services to prevent unintended pregnancy. Results Health history data revealed high risk status for unintended pregnancy and sexually transmitted infections (STI); 28.5% of participants were ambivalent or disappointed with their negative result, 71.4% were pleased and the majority felt that their partners would be more disappointed with the negative result than they were. Health care services that teens felt would be most helpful were one-on-one contraceptive education and discussion sessions with their own health care provider. Conclusions Sexually active teen women with negative pregnancy test results are at high risk of subsequent pregnancy and STIs, and present important opportunities for preventive reproductive health care during visits with health care providers.