Lawrence S. Neinstein, M.D., F.A.C.P.
Professor of Pediatrics and Medicine
USC Keck School of Medicine
Executive Director
University Park Health Center
Associate Dean of Student Affairs



Sexuality - Sexually Transmitted Infections - Overview (B3)

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One of the visible and sometimes not so visible consequences of adolescent sexuality is the presence of sexually transmitted infections. These diseases are among the many challenges and landmines along the way of the development of normal healthy adolescent sexuality. It is important for health care providers to be aware of the adolescents developing sexuality, as well as helping the teen to reduce their risks associated with that sexuality including STIs and pregnancy. Screening for sexually transmitted infections can be a critical part of an annual examination in this age group.

There is a significant disease burden of STIs among adolescents. For example, in 1998, in the United States , adolescents 15-19 had the highest gonorrhea and chlamydia rates among any age group - this is particularly true if you include only sexually active individuals. Chlamydia rates can vary from 3% up to 18% among adolescent women. T. vaginalis rates can be as high as 14% in adolescent women and 3% to 5% in asymptomatic males. Serologic studies show positivity rates for Herpes Simplex up to 30% in some adolescent groups, although most do not have symptomatic infections. The disease with the highest prevalence is most likely human papilloma virus infections. However, there is some good news in that that gonorrhea rates are falling globally (see graph below - although rates in the United States are well above those of Europe and Canada ).

Gonorrhea Trends: International Comparisons
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Incident rates are not equal in all groups as the graph below demonstrates the significantly higher rate of gonorrhea among African-American youth.

Gonorrhea - Reported rates for 15-19 year old females by race and ethnicity: United States, 1981-2000
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It is often asked why should adolescents have higher rate of STIs. While all of the reasons are not known, one suggestion has to do with the anatomy of the adolescent cervix. As can be seen in the next slide, the adolescent cervix usually has a lot of ectropion. There is much columnar epithelium (dark red) in the ectocervix of teens. The columnar squamous junction tends to occur in the ectocervix area. With age and after pregnancies, there is much squamous metaplasia converting columnar epithelium to squamous epithelium. The junction moves more to the endocervix. Gonorrhea and chlamydia have a predilection for columnar cells so with more columnar epithelium in the vaginal vault, teens may be at higher risk for a infection.

Adolescent cervix
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Other explanations include the substantial rates of sex partner infections, and inconsistent or incorrect condom use.

A major revolution in STI management has been the development of nucleic acid amplification tests (NAAT). These tests have superior sensitivity and specificity compared to culture or other diagnostic tests such as direct fluorescent antibody (DFA) or DNA probe tests. They also allow for testing of urine and vaginal specimens in addition to cervical or urethral specimens.

It is important to have an approach to sexually transmitted infections. Perhaps a more useful approach then going disease by disease is to look at the symptom complexes that can occur. These include:

  • Cervicitis/urethritis
  • Vaginitis
  • Abdominal pain
  • Genital ulcers
  • Genital growths
  • Hepatitis
  • Arthritis
  • Epididymitis
  • Perinatal/fetal infections

The discussion presented will focus on the first five.

Go to sexuality - stis - urethritis/cervicitis
Go to sexuality - stis - vaginitis
Go to sexuality - stis - pelvic pain
Go to sexuality - stis - genital ulcers
Go to sexuality - stis - genital growths

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Neinstein LS: Adolescent Health Care: A Practical Guide, 4 th edition, 2002, Philadelphia , Lippincott Williams and Wilkins


26: Genitourinary Tract infections:
LJD Angelo and LS Neinstein

55: Vaginitis and Cervicitis:
M Haward and MA Shafer

60: Overview of Sexually Transmitted Diseases,
JD Fortenberry and LS Neinstein

61: Gonorrhea:
PK Braverman and LS Neinstein

62: Chlamydia trachomatis:
MA Shafer and A Countouriotis

63: Pelvic Inflammatory Disease:
JR Pletcher and GB Slap

64: Syphilis:
JD Fortenberry and LS Neinstein

65: Herpes Genitalis:
LE Schack and LS Neinstein

66: Human Papillomavirus and Molluscum Contagiosum:
A Joffe and LS Neinstein

68: Minor Sexually Transmitted diseases:
MS Jay and LS Neinstein

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Copyright (©) 2004-2013 Lawrence S. Neinstein, University of Southern California . All rights reserved. Republication or redistribution of the text, table, graphs and photos is expressly prohibited. The University of Southern California shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.