STDs & Adolescents

Health care providers should routinely acquire sexual histories from their patients to facilitate risk assessment and risk reduction counseling for preventative sexual health services.  A sexual history should be taken during any new or routine patient visit, and especially if the patient presents with signs or symptoms of STDs.  To obtain the most pertinent information effectively, the use of open-ended questions in a non-judgmental/normalizing way is recommended.   

The 5 “P”s of a Sexual History:

• Partners—Have they been and are they sexually active; any new partners lately; how many partners in past year; gender of partners; do their partners have other partners?
• Pregnancy Prevention—What do they do to prevent pregnancy or plan for a healthy pregnancy?
• Protection—What do they use or don’t use to protect themselves and how often do they use it?
• Practices—What types of sex (vaginal, oral, anal) do and did they have?
• Past history of STDs—What did they have, and when did they have it?

Routine laboratory screening for common STDs is recommended for sexually active adolescents as followed:

• Routine screening for C. trachomatis on an annual basis is recommended for all sexually active females aged <25 years.  Screening of sexually active young males should be considered in clinical settings serving populations of young males with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, and STD clinics) and multisite testing should be offered to young men who have sex with men (YMSN).
• Routine screening for N. gonorrhoeae on an annual basis is recommended for all sexually active females <25 years of age and other high risk populations.  Multisite testing should be offered to YMSM.
• HIV screening should be discussed and offered to all adolescents. Frequency of repeat screenings of those who are at risk for HIV infection should be based on level of risk.  Persons who test positive for HIV should receive prevention counseling and a referral to Spokane Regional Health District at (509) 324-1544 before leaving the testing site.
• Routine screening of adolescents who are asymptomatic for certain STDs (e.g., syphilis, trichomoniasis, BV, HSV, HPV, HAV, and HBV) is not generally recommended. However, YMSM and pregnant adolescent females should always be screened for syphilis.

The following recommendations are for primary prevention of STDs (i.e., vaccination and counseling) for sexually active adolescents and young adults:

• The HPV vaccine, bivalent, quadrivalent, or 9-valent, is recommended routinely for females aged 11 and 12 years and can be administered beginning at 9 years of age.  Vaccination is also recommended for females aged 13–26 years who have not yet received all doses or completed the vaccine series.
• The quadrivalent or 9-valent HPV vaccine is recommended routinely for males aged 11 and 12 years and can be administered beginning at 9 years of age.  Vaccination with quadrivalent or the 9-valent HPV vaccine is recommended for males aged 13–21 years who have not yet received all doses or completed the vaccine series, although males aged 22–26 years also can be vaccinated.
• Providers should counsel adolescents without judgement about the sexual behaviors that are associated with risk for acquiring STDs and educate patients regarding evidence-based prevention strategies. Interactive counseling approaches, such as high-intensity behavioral counseling (HIBC) and motivational interviewing, are effective STD/HIV prevention strategies.

Washington State explicitly allows minors (individuals aged 14 and older) to consent for their own health services for STD screenings and treatment. 

When a child tests positive for a STD, disease management requires close cooperation between clinicians, laboratorians, and child-protection authorities. Certain diseases (e.g., gonorrhea, syphilis, and chlamydia), if acquired after the neonatal period, strongly suggest sexual contact. For other diseases (e.g., HPV infections and vaginitis), the association with sexual contact is not as clear.

A Guide to Taking a Sexual History 

2015 Treatment Guidelines

Adolescent Health Care 101