Adolescents

Adolescents and STDs including HIV infection

Children transition from childhood into adulthood and face a challenging task. The task for children to conquer is the one requiring them to become a healthy sexual adult. Success can be defined when the transition occurs and intimate relationships develop while avoiding what they should be aware of or sexually transmitted diseases and infections; however, unfortunate as it is and for a variety of reasons, this transition has lead adolescents to the highest rates of STDs/STIs with the inclusion of HIV in some localities. A researcher stated “the challenge lies in getting teenagers to view their relationships in a more realistic light without destroying the positive ways in which these (relationships) may also add to their lives.”

 

Epidemiology of STDs and HIV among adolescents

 

Population conducted risk assessment studies have and continue to underestimate the risks for sexually active adolescents due to the rate being confounded as cases of disease divided by the total number of individuals in the group; however, those at risk are those who have had intercourse and not merely a measure of actual reported cases of infections/diseases. For rates to be adequately expressed among the sexually experienced, calculation should include the number of individuals, in the denominator, of those who have had sexual intercourse. For example, in 2002, 87% of those 20-24 year old women had sexual intercourse but this was true of only 53% of women aged 15-19. Since the least amount of women in the youngest adolescent group have had intercourse, estimated of their risk has been miscalculated. Risk, once corrected is greatest for the youngest adolescents or those women aged 15-19.

 

 Chlamydia

 

Chlamydia trachomatis is the most associated STD/STI with adolescents. Family planning clinics showed that the prevalence of cervical chlamydia is great among sexually active persons under 20 years of age. This is twice the rate found among older individuals. These findings are on the same level with more recent data from population-based assessments. Male chlamydia rates are also significant but are less than the prevalence amongst women.

Population-based prevalence data are available from several sources. As part of the 1999-2001 National Health and Nutrition Examination survey (NHANES), urine specimens among women 15-39 years of age were tested for chlamydia and almost 5% of those 14-19 years of age were infected; prevalence was under 2% for older women. African American women (with prevalence exceeding 10% among those 14-19 years of age) and women with 12 years of education or less were also at greater risk of infection. Similar results were found in a follow-up of the National Longitudinal Study of Adolescent Health (AddHealth) cohort at 18-26 years of age; prevalence among females was 4.7% and rates were substantially higher among blacks than whites, but in this survey prevalence varied less by age.

As would be expected, prevalence from multiple settings shows that prevalence among young males is lower in suburban clinical settings (0.9%) , and higher in general clinical settings (4%), and among detainees (3.2%-8.0%). Data from the 1999-2002 NHANES indicates that just over 2% of males 14-19 years of age and over 3% of those 20-29 years had chlamydia; prevalence was approximately three times greater among African American males than among whites and low among males 30-39 years of age (prevalence under 0.7%) Data from AddHealth cohort and the National Survey of Adolescent Males were consistent, finding a somewhat lower prevalence among adolescent males than that among young adult males and documenting substantial racial disparity. However, these data were not adjusted for sexual activity.

Continuing risk of chlamydial infection is significant among adolescents. Among females adolescents tested at least twice in family planning clinics in Washington, Oregon, Idaho and Alaska from 1988 through 1991, 22% were found to be infected on at least one visit. Similar findings were produced by a population-basedstudy in Umea, Sweden, which evaluated cumulative risk of chlamydia by serologic tests. The prevalence of C. trachomatis , identified by culture, among 19-year-old women was 5.5% (3/55). However, 29.1% of these women and 18.0% of 21-year-old women (n=139) showed serologic evidence of previous chlamydial infection.

Recurrent infections may be particularly worrisome, since such infections may be more likely to be associated with significant damage to the fallopian tubes than is primary infection. The risk of recurrent infection is higher among adolescents compared with older women, with several studies finding  that women treated for chlamydia, at least 10% had infection identified again within 4-6 months after treatment. Recurrent or persistent infections have been associated with the continuing presence of an untreated partner and with treatment failure. This highlights the importance have having both in a couple treated. However, more information is needed concerning factors responsible for chlamydial persistence after treatment among young adults.

 

Gonorrhea

 

Gonorrhea reates in the US have fell by almost 75%, from a peak of 467 cases per 100,000 in 1975 to 120 cases per 100,000 in 1997; subsequently, decreases have been smaller and less consistent. Rates among adolescent have also fallen, although not entirely in sync with overall rates. For example, from 1981 to 1991, although the overall gonorrhea rate among males declined 46%, the rate among 15-19-year-old males did not decline at all. From 1985 to 1995, while the overall rate among females decreased by 53%, rates among 15-19-year-old females decreased by 39%. In contrast, from 1995 to 2005, overall rates of gonorrhea decreased less than 23%, while rates among 15-19-year-olds declined by over 34%. Rates among females 15-19 years of age have been highest of any age group since 1984.

In the US, as of 2006, rates of reported gonorrhea among African American adolescents are over 17-fold higher than that among their white counterparts. Over the past 10 years, the disparity has decreased somewhat; in 1995 there was a 25-fold difference. These differences are comparable to results of a population-based survey among the cohort enrolled in the AddHealth, which was age 18-26 years at evaluation. Prevalence of gonorrhea among black males and females (approximately 2% for both men and women) was 36 and 14 times greater than that among white men and women, respectively. Reasons for such racial inequalities are beginning to be understood, and involve structural causes as well as sexual mixing patterns.

Gonorrhea screening among sexually active women is a major component of the national prevention program, and recent recommendations acknowledge that women under 25 years of age are at increased risk. However, it is not clear that young age is sufficient criterion for screening (as it is for chlamydia), since prevalence is so variable across some populations, and closely related factors such as race and geography; indeed, the mediation state-specific prevalence of gonorrhea among 15-24-year females attending selected family planning clinics was 0.9%, while that among females admitted to juvenile detention centers was almost 6%, highlighting the importance of screening in such venues.

Recently, gonorrhea rates have been increasing in several locales and countries (France, Denmark, England, Denver) typically related to increases among MSM, but have not appeared to involve adolescents to any extent. However, increases in Sweden and Canada have involved young women, although the reasons for such increases are unclear.

 

Human immunodeficiency virus

 

HIV is a big problem for a lot of the world’s adolescents. It has become elucidated in several sub-Saharan countries with the highest rates of HIV, the risk of HIV acquisition among women increases dramatically in the adolescent and early adult years. In a recent population-based survey among young people in South Africa, HIV prevalence among 15-19-year-old females was 7.3%, but 2.5% for males of the same age; among those 20-24 years, 24.5% of women were infected, compared with 7.6% of males. Similar results have been noted elsewhere. Overall, 26% of individuals in Kisumu and 28% in Ndola were HIV-positive. In both sites, HIV prevalence in women was six times that in men among sexually active 15-19 year olds (with rates as high as 23% in Kisumu) and three times that in men among 20-24-year-olds but equal to that in men among 25-29-year-olds; young women were at similarly increased risk compared to males in Zimbabwe (age-adjusted odds ratio 4.6). Although several factors, such as cervical immaturity, and increased prevalence of STDs contribute, the major factor associated with the increased risk for young women appears to be having older male partners. While young men typically have sexual relations with partners who are of the same age or younger, it is common for young women to have male partners 5-10 years older, as was found in Zimbabwe and elsewhere. Young women prefer older males in large part for economic reasons; unfortunately, they are less likely to use condoms with such partners, who frequently have had relations with commercial sex workers and who view the young women as “safe” and unlikely HIV-infected.

In the US, there have been few recent HIV-prevalence studies among adolescents. Older US studies have demonstrated that prevalence of HIV infection was appreciable in several populations and adolescents. Prevalence exceeding 1% was documented among adolescents seen at STD clinics, among those at shelters for homeless and runaway youth, and among those in correctional facilities. Many of these young people have had sex in exchange for drugs, shelter, or food (“survival sex”).  African American youth are disproportionately affected, accounting for 56% of HIV infections reported among those aged 13-24 years. National HIV surveillance data, using named-based reporting, revealed that, from 1994 to 2003, cases among females 13-24 years of age decreased slightly. A different pattern was seen among males; from 1994 to 1999 male cases decreased substantially, but increased from 1999 to 2004. This increased occurred primarily among 20-24-year-old MSM, and involved all races, with increases greatest among blacks. Such findings are consistent with other reports of high rates of HIV prevalence among young MSM (14% of those 18-24 years). Among those MSM with HIV, young MSM were most likely to have unrecognized infection (79%).

 

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Posted by admin - August 12, 2012 at 8:29 pm

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Determinants of STD/HIV risk among adolescents

Adolescence is a unique time of life, when societal, biologic, behavioral, and developmental factors all act in together to increase the rate of STD/HIV contraction.

 

Biological factors

 

Several aspects of physical development may be relevant to the high risk of STDs among sexually active adolescents. The histology of the cervix and vagina undergo dramatic changes from childhood through puberty and into adulthood. Newborns show effects of exposure to maternal estrogen, which produces the squamous epithelium lining of the vagina as seen in adults. Soon after birth, these squamous cells are replaced with columnar epithelium. Such epithelial changes may be particularly important at the cervix, since persistence of cervical epithelium in young women appears to significantly increase their their vulnerability to STDs. Although cervical columnar epithelium eventually recedes completely, to be replaced with squamous epithelium, the replacement is a gradual process, continuing well into adulthood. Typically the cervix in the adolescent still displays areas of exposed columnar epithelium, a condition often referred to as ectopy. This is significant because C. trachomatis infects columnar, not squamous, epithelium and thus ectopy may increase exposure of susceptible mucosa to infection.

The presence of ectopy has repeatedly been associated with chlamydial infection, even after adjusting for sexual behavior and other confounders. Although it may be that chlamydial infection causes the appearance of columnar epithelium on the cervix, longitudinal studies have demonstrated that ectopy is associated with increased risk of subsequent infection. However, whether ectopy facilitates the detection of chlamydia is still the question.

The presence of ectopy also appears to increase the risk to other STDs and their adverse outcomes. Neisseria gonorrhoeae attaches preferentially to columnar epithelium rather than squamous tissue. In addition, there is some evidence that ectopy may contribute to HIV acquisition and HIV shedding. The vasculature found with the column epithelium associated with ectopy is more superficial and more easily traumatized than that of squamous epithelium, theoretically permitting HIV-infected cellular elements from the circulation to gain access to mucosal surface, infected monocytes and lymphocytes to reach the circulation. Ectopy may partially account for the high incidence of HIV among adolescent women by increasing susceptibility; the implications of possibly increased infectivity, associated with HIV shedding, are unknown. However, some studies have not found an association between HIV and ectopy. The vaginal flora also changes during puberty. The appearance of Lactobacillus spp results in the reduction of the high vaginal pH levels of childhood to the more acidic pH associated with adulthood. The higher vaginal pH of early adolescence may be associated with a lower prevalence of hydrogen peroxide-producing organisms. However, the casual links between these anatomic or physiologic changes and STD contraction have not yet been demonstrated.

Changes in mucosal anatomy produce changes in mucus production, which is minimal in childhood. Mucus production is greatly increased in early puberty, but the mucus is thinner than that found in older adolescents or adult women. Thinner mucus may permit organisms to penetrate more easily and to attach to mucosal sites or gain access to the upper tract.

Research has suggested  that adolescent females experience a greater decline in IgG levels in cervical secretions during menstrual cycles than adult women, but the implications of such a finding for disease contraction are unknown. There are many aspects of immune protection of the female reproductive tract, such as expression of chemokines and cytokines, or expressions of CCR5 and CXCR4 receptors, that my function differently among young women, but such differences have not yet been documented and need to be elucidated. Unfortunately, there is very little information about how male development affects their risk of STD contraction and transmission.

 

Psychological and cognitive development

 

The stages of adolescence have been arbitrarily categorized as “early,” “middle,” and “late,” and have been considered in terms of psychologic, physiologic, and social development. Development in each of these areas is not necessarily parallel. Individuals are often advanced in some categories, but slower than their age-matched peers in others. Futhermore, growth in some of the cognitive areas is strongly influenced by the quality of teaching or role-modeling individuals’ experience. This is particularly relevant for STD prevention, where adults may use indirect methods of educating or rely on “scare tactics” rather than using skills training. Several characteristics of adolescents, particularly in early or middle stages of development, may have important implications for STD risk and prevention. Younger adolescent frequently use a concrete style of reasoning, focusing on the present time, and until they reach middle or late adolescence are unable to conceptualize the long-term impact that current actions may have. Some some STDs (e.g. HIV or chlamydia) may have adverse effects that are not experienced for a decade or more, it should not be surprising that younger adolescents may not take actions needed to avoid such consequences. Furthermore, adolescents may have difficulty correctly implementing complex tasks (such as condom use) involving a series of steps that must be accomplished in a certain sequence to be effective.

These findings are consistent with ongoing research concerning cognitive development. Significant structural changes in the brain continue into the later teenage years, and the development of an “executive suite” f upper level decision-making functions is a lengthy process, requiring time and experience. Pubertal development and its attendant hormonal milieu appear to fire romantic motivations and an appetite for risk taking, independent of chronological age. However, self-regulation and competent decision making while under emotional stress (i.e., in the throes of adolescent passion) develop slowly and continue well after puberty. The occurence of puberty at younger ages is, as described by one researcher, like starting a car engine with an inexperienced driver at the well. The fact that adolescents are not fully prepared to handle the situations they find themselves in is a reason why it is important to provide appropriate “social scaffolding,” and may explain why parental monitoring appears to be an effective prevention strategy.

Finally many parents, educators, and health-care workers do not teach about STD risk or even details of pubertal development until long after many adolescents are at risk for STDs. Therefore, these youths do not have even the basic information to make informed choices.

 

Sexual behavior

 

Over the last century, sociocultural and behavior changes have combined with changes in aspects of the developmental physiology of adolescents to increase the risk of STDs among these young people. Biologically, the average age at menarche has decreased (although it has been stable over the last generation). At the same time, societal changes have resulted in increases in the average age at which young men and women marry. As a result, while 100 years ago young men in the US spent approximately 7 years between maturation and marriage, more recently the interval was 13 years, and increasing; for young women, the interval between menarche and marriage has increased from 8 to 14. For this reason alone, it should be expected that premarital sex in the US has increased.

Changes in sexual behavior have placed adolescents at increased risk of STDs, with the longstanding trend to earlier age at first intercourse occurring worldwide. However, in the US, several ongoing, population-based surveys that provide information about the sexual behavior of adolescents show that during the past decade, the proportion of teenagers that have experienced premartial sexual intercourse has declinded. This change in behavior reveres the trend seen over the previous several decades in the United States, in which, the age of first intercourse had steadily decreased. in 1970, only 5% of women in the US had premarital intercourse by age 15, whereas in 1988, 26% had engaged in intercourse by this age. However, in 1988 37% of never married 15-17-year-olds had egaged in intercourse but in 2002, only 30% had. Comparable data from males demonstrated even greater declines-50% of never married 15-17-year-olds reported having had intercourse in 1988, compared with only 31% in 2002. Consistent with these U.S. data, between 1991 and 2000, the pregnancy rate among US females (16-17 years) declined by 33%. Similarly, the percentage of 9-12th graders who reported having had four or more sexual partners also declined from 19% in 1993 to 14% in 2003. This trend is not universal; no such decline was reported in Sweden.

Younger age of sexual “debut” is associated with a greater number of sexual partners–an important determinant of STD risk. In 1988, among American women 15-24 years of age who were sexually active for the same length of time (less than 24 months), over 40% of 15-19-year-olds had two or more partners, compared with only 26% of women 20 years of age or older. Younger age of sexual debut (below age 18) is also associated with ongoing sexual risk among unmarried women, with an increased likelihood of have two or more recent partners. Adolescent relationships are of shorter duration than those of older adults. Duration on average is 15 months, and many relationships are  less than 4 months. It is becoming clear that determinants of STD risk at both an individual and population level include other factors such as concurrency and sexual mixing patterns, which involve assessment of sexual network structure and should be considered regarding adolescent STD risk. Nevertheless, partner acquisition tends to follow a pattern of serial monogamy, with one study finding that fewer than 10% of sexually active adolescents having more than one partner within a 3-month period. In another study, among adolescents reporting activity in the previous 18 months, over 85% indicated that they had either a single or sequential relationships. However, among serially monogamous females of all ages, adolescents are quicker to acquire a new partner than older women; in a national survey, mean gap between partners was 8 months for serially monogamous 15-19-year-old women, compared with 11 months and 18 months for 20-29 and 30-44-year old women, respectively. (Some smaller studies among higher risk cohorts of adolescent have found mean interval between old and new partners to be as short as 21 days). It should be noted, however, that among those adolescents who had more than one partner, concurrency is rather frequent; among adolescents who reported more than one partner in the previous 18 months, over 40% had overlapping sexual relationships.

Although concurrency is expected to have population level effects, implications for individual risk are less clear, since concurrency may or may not be associated with increased individual STD risk. Furthermore, risk for the individual adolescent may be affected by the likelihood that one’s partner has concurrent partners, which appears related to whether one lives in a high-risk community or not.

Recent studies provide some insight into sexual (and romantic) network structures among adolescents. As part of the AddHealth, data were obtained from all students in a large high school and all the romantic and sexual relationships among those students identified. The relationship structure was described by the researchers as a “spanning tree,” similar to “rural phone lines running from a long trunk to individual house.” Such a structure does not reflect random partner selection, but rather a situation in which there are rules about who can be involved with whom. In addition, although there were few “short cycles” (i.e., cyclical pattern which promptly leads back to the same individual), there was a large network component that linked over half of the adolescents involved in romantic relationships. Such a structure would allow efficient spread of an STD across the network, and, as the authors point out, demonstrates that STD risk in not simply defined by the number of partners. Moreover, the structure has implications for STD prevention. Given the existence of a “spanning tree” network, effective prevention efforts need to target individuals in the “core.” A prevention approach that reaches all adolescents-and thus breaks the “spanning tree” into smaller, unconnected clusters-might be even more effective. Of course, this is a single study, performed in a middle-sized town, in the Midwest among working-class population, with limited diversity; and the network analysis did not include individuals who were not high-school attendees; therefore the extent to which its results are generalizable is unknown.

Population-based data demonstrate that condom use has increased substantially in the United States, but that use is not consistent. Surveys indicate that adolescents are more likely to use condoms than older individuals. In 2002, 66% of male teens reported using condoms at last intercourse compared with 53%, 45%, and 29% of males 20-24 years, 25-29 years, and 30-44 years, respectively. In addition, 67% of US women reported condom use at first intercourse if it occurred during 1990-2002, while only 36% of women 15-44 years of age reported condom use at first intercourse that occurred before 1990. Condom use among adolescents in general has increased. In 2002, among never married sexually active 15-19-year-old females, 54% used condoms at last intercourse, compared to 38% and 31% in 1995 and 1998, respectively. Similar increases are reported by adolescent males; in 2002, 71% of sexually active, never married 15-19-year-old males reported use of condoms at last intercourse, compared with 64% and 53% in 1995 and 1988, respectively.

However, follow-up data indicate that as males get older and as the duration of the existing relationship increases, condoms are likely to be replaced by forms of contraception that offer less protection against STDs, particularly oral contraceptives. This pattern has also been reported from other countries, such as Australia, Canda, and New Zealand, It is noteworthy that the combined effect of serial monogamy and diminishing use of condoms over the duration of a relationship may be particularly important in exposure to and ongoing transmission of organisms such as HSV-2, chlamydia, HPV, and HIV, which are associated with chronic and often asymptomatic infection.

Although more people are using condoms, few people, including adolescents, use them consistently. Among unmarried US women, 28% of 15-19-year-olds report using condoms consistently (i.e., all the time) over the past 12 months; 48% of 15-19-year-old males report doing so. Not surprisingly, both teenagers and older individuals use condoms less frequently with partners in an ongoing relationship, than in sexual encounters outside that relationship. Furthermore, the young people most at risk for STDs appear to use condoms least. A survey among adolescent males indicated that those who were substance abusers or had paid for sex were among the least likely to have used condoms at last intercourse. Young males were less likely than older males to use condoms at first intercourse with partners they perceived to be at higher STD risk.  Among young people with two or more partners, individuals with a greater number of partners were less likely to use condoms consistently with either primary or secondary partners. A similar pattern has been observed in other countries.

Use of condoms is complex behavior, but we can make some generalizations about determinants of condom use upon which to base prevention strategies; most parallel determinants noted among adults. Many studies, but not all, indicate that use is associated with perceived risk of HIV infection. Youths who think their peers use condoms are more likely to use them, and adolescent males who are more able to communicate with their parents and with peers. Adolescents are often mistaken about what their partners believe, however, with females overestimating the resistance and negative attitudes that males have about condom use. In addition, when condoms are used, adolescents frequently experience errors in their use. In one study, among adolescent females who used condoms in the prior 3 months, at least one condom error was reported by 71%. National survey data indicates that misconceptions about condom use (i.e., need for space at tip; use of vaseline; protection with lambskin vs. latex condoms) are quite prevalent, with up to 50% of adolescents being mistaken about some of these issues.

Studies have noted that self-efficacy, perceived risk, and partner support are important factors in increased condom use. However, many young females who feel confident that they could get their partner to use condoms, are not motivated to use them. An important factor appears to be the extent to which young people underestimate their partners’ risk of infection. Young homosexual males believe that they are safe if they have sex with younger partners. Heterosexual females often feel that they have little or no risk of acquiring HIV from their male partners and believe their boyfriends’ statements of fidelity, often despite have a history of STD themselves. Another major concern is the belief that their partners, particularly their steady partners, would view the request to use a condom as indicating a lack of trust. Conversely, if the request for use is made by the male, the female may assume he is dating outside the relationship.  Approaches to reconciling these issues are complex and require skillful and practiced communication, as well as interventions suitable for sexually active adolescents who are in the formative phases of social skill development. Other barriers to condom use that are unique to adolescents include lack of ready availability. Embarrassment about purchasing condoms may be a particular obstacle for girls.

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Posted by admin - August 11, 2012 at 11:45 pm

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Adolescents, Legal and Ethical Issues

Adolescents have unique legal status with regard to the provision of health care. Legally they are accorded more rights than children, but in some matters they may have rights that differ from those of adults. These issues are addressed by state minor consent laws that may allow minors to give their own consent for health care. These laws differ by state. However, in all states, adolescents who are at least 14-years-old can be diagnosed and tested for STDs without parental consent or knowledge, and some states have specific provisions regarding testing for and treating HIV infection. Beyond STD diagnosis and treatment, there are some basic issues providers confront in dealing with adolescents:

1. Is the adolescent who is under 14 years of age old enough to have the authority to consent to care without parental involvement? Must the provider request any specific evidence of age?

2. Does the adolescent have the authority to release or prevent release of confidential information (particularly to parents?)

3. Is the adolescent or another source responsible for payment for services rendered. Can adolescents insist that parents not be contacted for health insurance coverage or payments?

In  the US, the answers vary by state; however, some geralizations are possible. First, it should be noted that in most states the age of majority is 18, but in three states (Alabama, Nebraska, and Wyoming) it is 19, and elsewhere 21 (Mississippi, and District of Columbia). However, as stated, all states either have specific statues or otherwise permit the diagnosis and treatment of “venereal disease” (the usual terminology) without parental consent.

 

Consent

 

Although all states and the District of Columbia permit a minor to consent to STD care without parental consent, some states identify an age criterion. In five states (Alabama, California, Delaware, Illinois, and Vermot), minors must be at least 12 years old to consent to STD-related care, and in five states (Hawaii, Idaho, New Hampshire, North Dakota, and Washington) they must be 14-years-old. Laws may also address the extent to which providers can, in “good faith,” rely on information provided by the minor about his or her ability to consent. Over a dozen states have such a statement (Alabama, Alaska, Colorado, Delaware, District of Columbia, Indiana, Maine, Massachusetts, Minnesota, Missouri, Oklahoma, Pennsylvania and Texas).

 

Parental notification

 

In general, providers are obligated to maintain confidentiality, although communication with parents is sometimes addressed specifically. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) suggests statutory protection, by indicating that when minors consent to their own care without parental consent, parents do not necessarily have the right to information related to that care. However, it is state law that determines the specific protections that are applicable (i.e., medical, privacy laws, state minor consent laws, etc.) In several states, laws indicate that the information is confidental, and thus parents cannot be informed without the minor’s consent (e.g., California, Connecticut, Delaware, Florida, Hawaii, Iowa, Massachusetts,) although exceptions are made if life or limb are in danger (Massachusetts), or if the adolescent is found to have HIV (Delaware, Iowa). Other states either permit the provider to notify parents, indicate that providers are not obligated to notify parents, or do not address the issue.

 

Liability

 

Most states have not specifically addressed this issue. However, in several states (Connecticut, District of Columbia, Maine, Minnesota, and Oklahoma, and also in the Montana), depending upon ability to pay, the minor who seeks STD care is liable for costs. In many others it is stated that the parents are not liable, and therefore cost recovery would not be a reason to contact them.

The specific issue of a minor consenting for care relating to HIV/AIDS has been addressed by a majority of states. Many states have statues that permit emancipated minors in “special circumstances”- those who are married, are themselves parents of children, including diagnosis and treatment of HIV infection. In addition, many states have laws specifically authorizing minors to give consent for HIV testing. Furthermore, several other states indirectly authorize minors to consent to diagnosis and treatment of HIV infection by either (1) stating that HIV/AIDS is an STD and permitting minors to consent to diagnosis and treatments of such conditions. As a result, adolescents in well over half of the states can consent to diagnosis and treatment of HIV infection, although some laws may limit the care to testing.

Clinicians caring for adolescents should know the laws regarding medical treatment of minors in their locale. Some health-care workers may feel a conflict between the desire to honor a minor’s right to confidentiality and the desire to involve a parent or other adult. In addition to being aware of laws supporting an adolescent’s right to confidential care for STDs, providers should realize that by disclosing confidential information they may undermine the ability of any provider to care for adolescents in the future, particularly with regard to these sensitive issues.

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Posted by admin - June 12, 2012 at 10:19 pm

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FAQ – Teen Talk

Question 1: What is an STD?

 

STD means “sexually transmitted diseases.” The word STD is interchangeable with STI or “sexually transmitted infection.” These infections are passed along during vaginal, anal or oral sex. Some STDs/STIs are curable with others may not be. Just within the US there are an estimated 19 new million cases per year. Teenagers account for millions of these cases.

 

Question 2: Who can get an STD/STI?

 

Anyone can get an STD/STI.

 

Question 3: How do I know if I have an STD/STI?

 

Testing is the way to know if you have an STD/STI since many of these infections are without symptoms.

 

Question 4: Do condoms prevent me from getting an STD/STI? 

 

Condoms will definitely help lower your risk of getting infected when used properly; however, condoms only protect the area they cover. HPV or warts for example, (the most common STD) can infect areas that aren’t covered. While a condom is always a good idea and while it will lower your risk of getting an STD/STI it will not fully protect you against all sexually transmitted diseases and infections.

 

Question 5: What kind of condoms provide the best protection against STDs/STIs?

 

Latedx condoms provide the highest degree of protection. Plastic condoms made from polyurethane provide some protection and “skin” condoms from animal membranes don’t provide any protection. The best single way to protect yourself is abstinence or not having sex at all.

 

 Question 6: What are the symptoms of common STDS?

 

Chlamydia

  • Discharge from genitals
  • Burning with urination
  • In women, lower abdominal and/or back pain, and pain during sex.
  • 3 out of 4 infected females and 1 in 2 infected males have no symptoms
Gonorrhea
  • Discharge from the genitals
  • Burning or itching during urination
  • Pelvic pain
  • Sore throat
  • Anal discharge and itching
  • Females frequently have no symptoms
Syphilis
  • Painless sores on genitals (10 days to 3 months after infection)
  • Rash (3 to 6 weeks after sores appear)
HIV/AIDS
  • No symptoms may appear for years until symptoms of AIDS occur
HPV
  • Genital warts (sometimes warts are not visible)
  • Most people with HPV have symptoms. That includes people infected with the types of HPV linked to cervical cancer.
Genital Herpes (HSV type 2)
  • Itching, burning, or pain in the genital area
  • Blisters or sores (sores always heal but can reappear throughout your life).

 

Question 7: Who can I talk to?

 

  • Your parents or trusted adults: Whether or not you are sexually active, you may want to talk to your aprents or other trusted adults who can help you find medically accurate information about STDs, contraception, and condoms. Parents are a great source of information, and they can help you work through the many issues you are faced with when thinking about having sex.
  • Your doctor or health care provider: If you are sexually active, or are thinking about having sex, you may want to talk to your doctor or other health care provider about getting effective contraception, using a condom correctly every time you have sex, and being tested for STDs/STIs.
  • Your partner (boyfriend or girlfriend): You may want to talk to your partner preferably before you have sex- about your relationship, whether to have sex or to wait, your sexual and disease histories, and protecting yourselves by using a condom correctly every time you have sex. Even if you and your partner already had sex, these issues are important

 Question 8:  What can happen if I contract an STD/STI?

 

  • With gonorrhea and chlamydia: In women, these two STDs can cause serious health problems if not diagnosed and treated early. One possible result is pelvic inflammatory disease (PID) which can damage fallopian tubes and make you infertile which means you won’t be able to have a baby. Gonorrhea and chlamydia can also cause constant pain in the lower abdomen and a tubal pregnancy. A tubal pregnancy is also known as an ectopic pregnancy and is a condition in which the developing baby grows in the fallopian tube instead of the uterus. This problem is potentially dangerous and requires urgent care.
  • HPV can cause genital warts and other types can cause cervical cancer.
  • Syphilis can get really nasty and can cause blindness, heart disease, mental illness, joint damage and death if not diagnosed and treated early. This is the disease that gangster Al Capone contracted.
  • HIV contraction risk can be increased by certain STDs/STIs such as syphilis and herpes. In addition, active HIV increases its spreading rate.

 Question 9: How can I prevent getting an STD? 

 

Not having vaginal, oral and anal sex or abstinence is the best prevention method. It is the only way that is 100 percent effective. Even if sexually active, returning to abstinence is the best protection. For those choosing a sexually active lifestyle, the best prevention method is a good habit of always using latex condoms properly. Condoms will protect you against the worst infection or HIV but will not provide protection against all STDs/STIs.

 

Question 10: If I am taking birth control pills, can I still get an STD?

 

Birth control pills only prevent pregnancy and will not help one bit against STDs/STIs. Those taking pills or hormonal injections, patches, implants, or rings to prevent pregnancy should make a good habit of regular latex or plastic condom use.

 

Question 11: What should I do if I think I might have an STD? 

 

If you think you’ve been exposed the first step is to talk with a doctor and to get tested as soon as possible. STD Test Express is located in many cities and can help you. In addition, other health departments which diagnose and treat STDs are located in almost all cities and counties. Information provide is confidential and they will answer your questions. I’d with STD Test Express today.

 

Question 12: Should I have a checkup?

 

Routine checkups are a good idea. The more partners you have the more important it is to have a checkup or test to prevent STD/STI transmission and exposure.

 

Question 13: What is contraception?

 

Contraception (also known as birth control) refers to the many different methods of preventing pregnancy. Abstinence from sexual activity until marriage is the only 100% sure contraception. Also, abstinent teens are not at risk for pregnancy or STDs/STIs, including HIV/AIDs. Teens who choose to be sexually active should remain faithful (not have sex with anyone else) to reduce the possibility of getting or giving someone an STD or HIV/AIDS. The latex condom is the only contraceptive method that may provide protection against some STDs, including HIV/AIDS. Research shows that latex condoms may not be effective against some STDs such as Human papilloma Virus (HPV – the virus that causes genital warts).

 

Question 14: Who needs contraceptive?

 

Anyone who has sex and doesn’t want to get pregnant or get someone pregnant needs contraception. Any time you have sex, there is a risk of pregnancy. Not having sex-abstinence-is the only 100% sure way to avoid pregnancy.

 

Question 15: Are some methods of contraceptive better than others at preventing pregnancy? 

 

 

Yes. Abstinence is the only 100% sure way to not get pregnant. If you choose to have sex, know that some contraception methods are more effective than others, but no other method offers you total assurance. To be effective, whatever method you choose must be used correctly and consistently. Always read and follow the package instructions. It is a good idea to discuss this with your health provider.

 

Question 16: Is the condom the only kind of contraception for males?

 

No. Vasectomy is a permanent method of contraception. But the condom is the most common method used by young males. Remember, the condom not only protects you from getting (or getting someone) pregnant, it may also provide protection against HIV/AIDS and some other STDs/STIs.

 

Question 17: How do I decide which method of contraception to use? 

 

Your health care provider can help you decide which method is best for you. Remember, even if you are using a method like the pill, the latex condom is the only method that may provide some protection against HIV/AIDS and some STDs/STIs.

 

Question 18: Do I need a prescription to get contraception?

 

Latex condoms can be purchased without a prescription, but other methods require one. Even if you use a nonprescription method, it is a good idea to see a health care provider on a regular basis.

 

Hormonal methods: 

 

Hormonal methods prevent pregnancy by interrupting the normal process for becoming pregnant. Hormonal methods do not protect against STDs/STIs. 

Emergency contraception: Hormonal pills that are taken within 72 hours of unprotected sex or method failure (e.g., the condom broke or you forgot to take your pill). Emergency contraception is the only method that can be used after having sex to prevent pregnancy.

Hormonal implant: Small capsules inserted under the skin of a woman’s upper arm that release small amounts of hormone.

Hormonal injection: A hormone injection (“shot”) that is injected into a woman’s arm or buttock on a regular basis (every 1 to 3 months, depending on the hormones).

Hormonal patch: A thin beige patch containing hormones that a woman applies to her skin once a week for three weeks. Hormones that prevent pregnancy are released during the time the patch is on. The women remove it for one week, during which time she has her period.

The pill: A pill for women that must be taken at the same time every day.

Vaginal ring: A ring containing hormones that a woman puts into her vagina and leaves there for three weeks. Hormones that prevent pregnancy are released for that time. The woman removes it for one week, during which time she has her period.

 

Barrier methods

 

Barrier methods prevent sperm from reaching the egg. 

Condom/Rubber:  A cover for the penis or vagina. Latex condoms may provide protection against some STDs/STIs, including HIV/AIDs.

Diaphragm/Cervical Cap: A shallow latex cup which the woman puts into her vagina, covering the cervix, before having sex. The diaphragm is generally used with a spermicidal jelly or cream that stops or kills sperm.

 

Other methods

 

Abstinence: Not having vaginal, oral, or anal intercourse. Abstinence is the only 100% effective way to prevent pregnancy and STDs/STIs, including HIV/AIDS.

Intra-Uterine Device (IUD): An IUD is a small plastic device that is inserted into a woman’s uterus by a trained clinician. Those used in the U.S. contain copper or hormones. This method is not generally recommended for teens, but is excellent for faithful married couples.

Natural Family Planning: Not having sex during the 5 or 6 days of the month when it is possible for the woman to get pregnant. Specialized training is essential for using this method.

Spermicide: A cream, foam, jelly or insert which kills sperm. Spermicides do not protect against STDs or HIV/AIDS. Nonoxynol-9, the most common spermicide, may increase the risk of HIV/AIDS in individual who are at risk for STD/STI or HIV/AIDS.

Sterilization: A permanent, surgical form of contraception that blocks the fallopian tubes in women (tubal ligation) and the vas deferens in men (vasectomy).

Withdrawal: Removing the penis from the vagina before ejaculation. It may not prevent pregnancy, because some semen may leak before ejaculation.

(Back to adolescents from teen talk)

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Posted by admin - August 14, 2011 at 3:06 pm

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