Managing sexually transmitted diseases in adolescents

Control of sexually transmitted diseases (STDs) in adolescents is a primary responsibility of health care providers. Using the tools of history and physical examination, and drawing on the awareness of different stages of adolescent development, health care providers can define at-risk for STDs. This article discusses screening practices, disease control through reporting and preventive counseling, and treatment guidelines for common STD syndromes.     

The pediatrician and the sexually active adolescent. A primer for sexually transmitted diseases

Sexual activity is a common practice among young adolescents, placing them at high risk for STDs, many of which have long-term consequences. Early diagnosis and treatment are essential to limit both the consequences and the spread of these infections. The clinician has a responsibility to the adolescent patient to recognize and treat these diseases. Using history and physical examination, the clinician should be able to determine an adolescent's risk for an STD, and, based on this risk, undertake the appropriate evaluations. Patient treatment, follow-up, and management of sex partners are then guided by the results of either presumptive or definitive diagnostic tests.     

Contraception and the prevention of sexually transmitted diseases

Sexually transmitted diseases (STDs) are a major cause of ill health in women and their sexual partners and children. Contraceptive methods alter in various ways the risk of acquiring STD but assessment of the odds ratio is difficult due to the many confounding factors. Spermicides have been reported to kill a wide range of bacteria and viruses including HIV in vitro and to protect in vivo from infection by gonorrhoea, chlamydia and pelvic inflammatory disease (organisms unspecified). Spermicides will not cure pre-existing infections. Condoms and diaphragms will give some protection from bacterial and viral infections in all parts of the genital tract. Hormonal contraception and tubal ligation give protection to the upper genital tract but not the cervix. Carcinoma of the cervix follows the same pattern as STDs. The risk of pelvic infection in intrauterine device users is discussed in the chapter by Bromham (pp 100-123, this issue).     

What do Norwegians know about sexually transmitted diseases? Results from a survey on Norwegians' knowledge about sexually transmitted diseases

This paper reports on knowledge about sexually transmitted diseases in Norwegian adults. The sample (572 males and 601 females) was representative of Norwegians aged 15 and above. Data were collected by means of personal interviews and self-completed questionnaires. Out of ten respondents, seven did not know that sexually diseases are not transmitted via toilet seats; six that syphilis is not the most prevalent of the sexually transmitted diseases in Norway; five that both males and females can be infected by chlamydia; four that contraceptive pills do not protect against chlamydia infection; three that condoms protect against all sexually transmitted diseases; and two that condoms protect against gonorrhoea and that females infected by sexually transmitted diseases run higher risk of infertility. Knowledge about sexually transmitted diseases was lowest in the youngest and oldest age groups, and increased monotonously with increased education.     

Education at school about sexually transmitted diseases

A case of renal cell carcinoma with successive multiple bone metastases which survived over a 36-month period is presented. A clinical and radiological regression of bone lesions was obtained by means of combined therapy (hormone therapy, radiotherapy, and immunotherapy), after the original tumor had been removed.     

Violence and associated high-risk health behavior in adolescents. Substance abuse, sexually transmitted diseases, and pregnancy of adolescents

The intricate relationship between the social and health behaviors of persons of all ages has long been described. In adolescent health care, the risk-taking behaviors that are recognized in the areas of sexuality, drug and alcohol abuse, and violence need to be addressed. This article discusses adolescent risk behaviors and their relationships to violence. Health care providers need to consider these risk behaviors as they care for adolescents.     

Relation of tubal infertility to history of sexually transmitted diseases

We studied the history of sexually transmitted diseases in 283 nulliparous women diagnosed with infertility due to tubal adhesions or occlusion and 3,833 women admitted for delivery at seven collaborating hospitals. The adjusted risks of tubal infertility associated with the history of each sexually transmitted disease were estimated by the odds ratios obtained by multiple logistic regression. Women who reported prior infection with gonorrhea were at a significantly increased risk of tubal infertility (relative odds = 2.4, 95% confidence interval 1.3-4.4). In addition, the risk of tubal infertility was almost twice as high in women who recalled previous trichomoniasis compared with women with no such infection (relative odds = 1.9, 95% confidence interval 1.3-2.8). Furthermore, there was a trend of increasing risk with an increasing number of episodes of gonorrhea or trichomoniasis.     

Susceptibility to vaccine-preventable diseases in a sexually transmitted disease clinic population

OBJECTIVE: To determine whether general practitioners (GPs) had received Australian guidelines on early detection, screening and surveillance for colorectal cancer or rectal bleeding, and whether their reported practice conformed with these guidelines. DESIGN: Cross-sectional postal survey of self-reported practice. PARTICIPANTS AND SETTING: 213 GPs in practice in the southern metropolitan area of Perth, Western Australia, were randomly selected from the Fremantle Regional Division of General Practice database and surveyed in March 1997. RESULTS: Replies were received from 155 (73%) of the GPs, and 110 reported receiving guidelines (from the Australian Gastroenterology Institute [AGI], 44; Gut Foundation of Australia [GFA], 40; others, 6; and not specified, 20). GPs who reported receiving guidelines were significantly more likely to screen for colorectal cancer (99/110; 90%) than those who reported not receiving guidelines (33/45; 73%) (P = 0.008). The commonest method to investigate people with identifiable risk factors for colorectal cancer was colonoscopy. Reported screening frequencies in asymptomatic patients with above-average risk (family history of colorectal cancer or past history of adenomatous polyps or colorectal cancer) were significantly higher than recommended by AGI and GFA guidelines (P < 0.05). Up to 24% of GPs investigated altered bowel habit or bleeding per rectum with faecal occult blood testing. CONCLUSIONS: Most GPs report having received guidelines. Reported screening frequency was higher than recommended for most above-average-risk patients, which will result in excessive consumption of resources without benefits for cancer prevention.     

Establishing a link between cultural evolution and sexually transmitted diseases

Measurement results of click evoked otoacoustic emissions (EOAE) and distortion products otoacoustic emissions (DPOAE) in a case of sensorineural hearing loss in a case of sensorineural hearing loss in a patient with a history of oticus zoster with nerve VII palsy are presented. Feasibility of using otoacoustic emissions measurements for hearing loss type identification is discussed.     

A controlled trial of nonoxynol 9 film to reduce male-to-female transmission of sexually transmitted diseases

BACKGROUND: Nonoxynol 9 is a proved spermicide, but whether it is also a microbicide is uncertain. A truly effective vaginal microbicide would reduce the susceptibility of women to sexually transmitted diseases, including infection with the human immunodeficiency virus (HIV). METHODS: We enrolled 1292 HIV-negative female sex workers in Cameroon and enrolled them in a double-blind, placebo-controlled study in which the participants were randomly assigned to use either a film containing 70 mg of nonoxynol 9 or a placebo film, inserted into the vagina before intercourse. All of the women were provided with latex condoms and were instructed to have their male sexual partners use them. At monthly follow-up visits, we examined the women with a colposcope for genital lesions, tested endocervical specimens for gonorrhea and chlamydia infection with DNA probes, tested for HIV infection, and treated the women for curable sexually transmitted diseases. RESULTS: The rates of HIV infection (cases per 100 woman-years) were 6.7 in the nonoxynol 9 group and 6.6 in the placebo group (rate ratio, 1.0; 95 percent confidence interval, 0.7 to 1.5). The rates of genital lesions were 42.2 cases per 100 woman-years in the nonoxynol 9 group and 33.5 in the placebo group (rate ratio, 1.3; 95 percent confidence interval, 1.0 to 1.6). The rates of gonorrhea were 33.3 and 31.1 cases per 100 woman-years in the nonoxynol 9 and placebo groups, respectively (rate ratio, 1.1; 95 percent confidence interval, 0.8 to 1.4). The corresponding rates of chlamydia infection in the nonoxynol 9 group and the placebo group were 20.6 and 22.2 per 100 woman-years (rate ratio, 0.9; 95 percent confidence interval, 0.7 to 1.3). The women reported that condoms were used during 90 percent of sexual acts. CONCLUSIONS: The use of a nonoxynol 9 vaginal film did not reduce the rate of new HIV, gonorrhea, or chlamydia infection in this group of sex workers who used condoms and received treatment for sexually transmitted diseases.