Screening for Nonviral Sexually Transmitted Infections in Adolescents and Young Adults

Abstract

Prevalence rates of many sexually transmitted infections (STIs) are highest among adolescents. If nonviral STIs are detected early, they can be treated, transmission to others can be eliminated, and sequelae can be averted. The US Preventive Services Task Force and the Centers for Disease Control and Prevention have published chlamydia, gonorrhea, and syphilis screening guidelines that recommend screening those at risk on the basis of epidemiologic and clinical outcomes data. This policy statement specifically focuses on these curable, nonviral STIs and reviews the evidence for nonviral STI screening in adolescents, communicates the value of screening, and outlines recommendations for routine nonviral STI screening of adolescents. Pediatrics 2014;134:e302-e311 EVIDENCE TO SUPPORT NONVIRAL STI SCREENINGThe goal of sexually transmitted infection (STI) screening is to identify and treat individuals with treatable infections, reduce transmission to others, avoid or minimize long-term consequences, identify other exposed and potentially infected individuals, and decrease the prevalence of infection in a community. Healthy People 2020 objectives for sexually transmitted diseases 1 include items that address screening for chlamydia in sexually active females younger than 25 years and set targets for decreased rates of chlamydia, gonorrhea, and syphilis in specific populations. The US Preventive Services Task Force (USPSTF), an independent panel of prevention and evidence-based medicine experts, has published chlamydia, 2 gonorrhea, 3 and syphilis 4,5 screening guidelines that recommend screening those at risk on the basis of epidemiologic and clinical outcomes data. The Centers for Disease Control and Prevention (CDC) publishes evidence-based STI screening recommendations for specific at-risk populations that are not addressed by the USPSTF but that pose public health challenges for disease prevention and control. 6-8 Major professional medical organizations, including the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians, have also published STI screening guidelines for specific populations. 7-10 The American Academy of Pediatrics' (AAP) Bright Futures guidelines for health supervision recommend chlamydia and gonorrhea screening as appropriate for the patient population and the clinical setting. 11 Recent AAP clinical reports addressing gynecologic examinations and male reproductive and sexual health care discuss clinic issues and provider COMMITTEE ON ADOLESCENCE and SOCIETY FOR ADOLESCENT HEALTH AND MEDICINE

Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection

“…This is concerning because current recommendations for STI screening by the CDC, USPSTF, and AAP recommend annual screening. (4–6) If these patients were screened only annually, the patients found to be positive in our study may have gone undetected for several months, increasing the risk of both infection-related morbidity and further spread of infection to others. Additionally, almost one-third of those infected had never previously undergone STI screening, further supporting ED-based STI screening programs.…”

“…(2) For these reasons, the Healthy People 2020 objectives identify as a national priority addressing the STI epidemic with a specific focus on STI reduction in adolescents. (3) The American Academy of Pediatrics(4) (AAP), Centers for Disease Control and Prevention(2) (CDC), and the US Preventative Services Task Force(5) (USPTF) all recommend at least annual STI screening among sexually active females. The AAP(4) and CDC(2) also recommend at least annual STI screening for sexually active males in settings with high prevalence rates.…”

“…(3) The American Academy of Pediatrics(4) (AAP), Centers for Disease Control and Prevention(2) (CDC), and the US Preventative Services Task Force(5) (USPTF) all recommend at least annual STI screening among sexually active females. The AAP(4) and CDC(2) also recommend at least annual STI screening for sexually active males in settings with high prevalence rates. Despite these recommendations, the majority of adolescents have never been screened for STIs.…”

Perceived Patient Preference and Clinical Testing for Chlamydia and Gonorrhea in Females: How Closely Are These Aligned?

“…While all are acceptable, the Centers for Disease Control and Prevention (CDC) states vaginal swabs are the optimal standard and urine samples may have slightly reduced performance. 3 , 4 Cervical examinations are no longer routinely recommended for adolescents. 5 Studies have demonstrated adolescent females prefer less invasive methods (urine and self-collected vaginal swabs) compared to invasive cervical swabs that require a speculum exam.…”

Behavioral Decision Research Intervention Reduces Risky Sexual Behavior

“…These goals require particular focus on adolescents [6]. In the US, adolescents and young adults (15–24 years) account for nearly two-thirds of new chlamydia infections and 70% of new gonorrhea infections [7,8].…”