9/17/2015 Sta tistic s Ado le sc e nts a g e s 15-24 a c c o unt fo - - PDF document

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Ado le sc e nt ST I Dia g no sis a nd T re a tme nt

K a rla Re inha rt DNP, F NP-C, ARNP Oc to b e r 2015

Co nflic t o f I nte re st

No ne

Ob je c tive s

 Disc uss the la te st dia g no stic pro c e dure s fo r ST I s  L ist the c urre nt re c o mme nde d tre a tme nts fo r pre va le nt ST I s  Summa rize the e pide mio lo g y o f the mo st c o mmo n ST I s in the US  De sc rib e ho w to tre a t ST I s a ppro pria te ly using re g ime s c o nsiste nt with the re c o mme nda tio ns in the ne w CDC 2015 tre a tme nt g uide line s  Ho w to a ppro a c h the sub je c t o f ST I s with a do le sc e nts in a sc ho o l b a se d he a lth c e nte r

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Sta tistic s

 Ado le sc e nts a g e s 15-24 a c c o unt fo r ne a rly ha lf o f the 20 millio n ne w c a se s

• f ST

I s e a c h ye a r.  Amo ng a do le sc e nts in the US ST I b urde n is sub sta ntia l  HPV is the mo st pre va le nt ST I fo llo we d b y Chla mydia  ST I s a ppe a r to b e a c q uire d ra pidly a fte r se xua l initia tio n  Ado le sc e nt ra te s o f Chla mydia a re inc re a sing ye a rly

Ore g o n E pide mio lo g y

 Chla mydia  I

n 2012 13,499 c a se s re po rte d in Ore g o n  Oc c urre d in a ll b ut o ne c o unty  Je ffe rso n c o unty ha d the hig he st ra te s fo llo we d b y Multno ma h a nd Ma rio n c o untie s  Ove r the la st de c a de a ste a dy inc re a se in numb e r o f c a se s ha s b e e n se e n, ho we ve r the ra te sta ys b e lo w the na tio na l a ve ra g e

 GC  Ba c te ria l Va g ino sis (BV)

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Risk F a c to rs

 Ra c e (no n-Hispa nic b la c k)  Ge nde r  Initia tio n o f se xua l a c tivity unde r a g e 17  Unpro te c te d se xua l a c tivity  Multiple pa rtne rs  Pre vio us ST I  F

• rc e d se xua l a c tivity (ra pe , a ssa ult)

 Drug a nd Alc o ho l usa g e  Re side nt in a juve nile fa c ility  Ho me le ss  L GT B

ST I De finitio n

 An infe c tio n tha t c a n b e tra nsfe rre d fro m o ne pe rso n to a no the r thro ug h se xua l c o nta c t. I n this c o nte xt, se xua l c o nta c t is mo re tha n just se xua l inte rc o urse (va g ina l a nd a na l) a nd a lso inc lude s kissing , o ra l-g e nita l c o nta c t, a nd the use o f se xua l "to ys," suc h a s vib ra to rs.

Chla mydia

 Ca se s in the US 2013: 1,401,906  Mo st c o mmo n re po rta b le illne ss in Ore g o n. Mo re tha n 13,000 c a se s

• c c urre d in 2012.

 Prima rily a se xua lly tra nsmitte d b a c te ria l infe c tio n.  Ma jo rity la c k visib le sympto ms  Must b e re po rte d to lo c a l he a lth de pa rtme nt.

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Go no rrhe a

 Ca se in the US in 2013: 333,004  A to ta l o f 1,469 c a se s o f g o no rrhe a we re re po rte d in Ore g o n in 2012  Ore g o n ra te s fro m 2002-2012 we re we ll b e lo w the o ve ra ll US ra te s  Ra te s a re hig he r in me n tha n in wo me n  Hig he st ra te s o c c ur a mo ng me n a nd wo me n in the ir 20s.  Ce pha lo spo rin is the pre fe rre d a ntib io tic tre a tme nt fo r g o no rrhe a , a ltho ug h the e ffe c tive ne ss a ppe a rs to b e de c lining . No c le a r a lte rna tive s e xist fo r the tre a tme nt o f g o no rrhe a .

HPV

 I t is e stima te d tha t a b o ut 11,967 ne w c a se s o f HPV-a sso c ia te d c e rvic a l c a nc e r a re dia g no se d in the Unite d Sta te s e a c h ye a r.  Ore g o nia ns va c c ina te d 66 pe rc e nt o f the ir da ug hte rs - a hig he r ra te tha n the na tio na l a ve ra g e . But the ir so ns we re va c c ina te d a t a b o ut the sa me a s the na tio na l a ve ra g e , 36 pe rc e nt.  Mo st HPV infe c tio ns re so lve witho ut tre a tme nt usua lly within o ne ye a r, so me g o o n to c a use g e nita l wa rts, pre c a nc e ro us c e rvic a l c ha ng e s tha t c a use a b no rma l Pa p sme a rs, a nd c e rvic a l c a nc e r  T ype s 16 a nd 18 a re re spo nsib le fo r 70% o f c e rvic a l c a nc e rs a nd mo st a b no rma l Pa p sme a rs wo rldwide , while stra ins 6 a nd 11 a re re spo nsib le fo r 90% o f g e nita l wa rts a s we ll a s 9% to 12% o f lo w-g ra de a b no rma l Pa p sme a rs.

Ba c te ria l Va g ino sis

 T he pre va le nc e in the Unite d Sta te s is e stima te d to b e 21.2 millio n (29.2%) a mo ng wo me n a g e s 14–49.  Mo st wo me n fo und to ha ve BV (84%) re po rte d no sympto ms.  Wo me n who ha ve no t ha d va g ina l, o ra l, o r a na l se x c a n still b e a ffe c te d b y BV (18.8%), a s c a n pre g na nt wo me n (25%), a nd wo me n who ha ve e ve r b e e n pre g na nt (31.7%).  Pre va le nc e o f BV inc re a se s b a se d o n life time numb e r o f se xua l pa rtne rs.  No n white wo me n ha ve hig he r ra te s (Afric a n-Ame ric a n 51%, Me xic a n Ame ric a ns 32%) tha n white wo me n (23%).  BV is a po lymic ro b ia l c linic a l syndro me re sulting fro m re pla c e me nt o f the no rma l hydro g e n pe ro xide pro duc ing L a c to b a c illus sp. in the va g ina with hig h c o nc e ntra tio ns o f a na e ro b ic b a c te ria  Metr

• nidazole 500 mg o ra lly twic e a da y fo r 7 da ys- o the r tre a tme nt

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Sc re e ning Re c o mme nda tio ns

 Ag e 15-65 HI V e ve ryo ne  Chla mydia - se xua lly a c tive unde r a g e 25 (re te st 3 mo nths a fte r tre a tme nt)  Go no rrhe a - se xua lly a c tive unde r a g e 25 (re te st 3 mo nths a fte r tre a tme nt)  Pre g na nt wo me n- HI V, He pa titis B, Chla mydia , GC, He pa titis C, Syphilis  Me n se x with Me n  HI V po sitive  Ne w pa rtne r  www.c dc .g o v/ std/ tg 2015/ sc re e ning -re c o mme nd a tio ns.htm

Dia g no stic Pro c e dure s

 Po int o f c a re te sting (te a c ha b le mo me nt)  We t Mo unt  Ra pid a ntig e n T V te st  Se lf T a ke n Va g ina l Swa b (SVS)  E ndo c e rvic a l swa b  Ure thra l swa b  Re c ta l swa b  Dirty Urine  Blo o d  Visua liza tio n

Pre ve ntio n

 E a rly a nd c o mpre he nsive se x e duc a tio n  De la y se xua l initia tio n  Minimize numb e r o f pa rtne rs  Avo id c o nc urre nt se xua l pa rtne rships  Use o f c o ndo ms  HPV va c c ina tio n

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T re a tme nt CDC Re c o mme nda tio ns

2015 CDC Re c o mme nda tio ns Wa ll Cha rt Bo o kle t

Alte rna tive T re a tme nts

 De c re a se pro c e sse d fa st fo o ds  De c re a se sug a r, c o ffe e , a lc o ho l a nd drug c o nsumptio n  Bo ric Ac id (a lg o rithm)  Ho me o pa thy  Ac upunc ture  Anti-vira l he rb s

BV Alg o rithm

Se e Ha ndo ut

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Ado le sc e nts in a Sc ho o l Ba se d He a lth Ce nte r (SBHC)

Ac c e ss Co nfide ntia lity Priva te insura nc e Co ntra c e ptive a va ila b ility Appro a c h

Re fe re nc e s

Ado le sc e nts a nd Se xua lly T ra nsmitte d Infe c tio ns re trie ve d fro m www.a do vc a te sfo ryo uth.o rg Cro sb y, R., Dic le me nte , R., Wing o o d, G., Sa la za r, L ., Ro se , E ., L e vine , D., …& Silve r, B. (2004). Asso c ia tio ns b e twe e n se xua lly tra nsmitte d dise a se dia g no sis a nd sub se q ue nt se xua l risk a nd se xua lly tra nsmitte d dise a se inc ide nc e a mo ng a do le sc e nts. Se xually T ransmitte d Dise ase s 31(4), 205-2008. F

• rha n, S., Go ttlie b , S., Ste rnb e rg , M., Xu, F

., Da tta , D., Mc Quillia n, G., Be rma n, S., & Ma rko witz, L . (2009). Pre va le nc e o f se xua lly tra nsmitte d infe c tio ns a mo ng fe ma le a do le sc e nts a g e d 14 to 19 in the Unite d Sta te s. Pe diatric s 124(6), 1505-1513. Ho e b e , C., Ra de ma ke r, C., Bro uwe rs, E ., Wa a rb e e k, H., & Va nBe rg e n, J. (2006). Ac c e pta b ility o f se lf-ta ke n va g ina l swa b s a nd first-c a tc h urine sa mple s fo r the dia g no sis o f uro g e nita l c hla mydia tra c ho ma tis a nd Ne isse ria g o no rrhe a with a n a mplifie d DNA a ssa y in yo ung wo me n a tte nding a pub lic he a lth se xua lly tra nsmitte d dise a se c linic . Se xually T ransmitte d Dise ase s 33(8), 491-495.

Re fe re nc e s

Me e ting the Se xua l a nd Re pro duc tive He a lth Ne e ds o f Ado le sc e nts in Sc ho o l- Ba se d He a lth Ce nte rs re trie ve d fro m www.g uttma c he r.o rg Re e d, J., Sime nding e r, L ., Griffe th, S., K im, H., & Huppe rt, J. (2010). Po int o f c a re te sting fo r se xua lly tra nsmitte d infe c tio ns inc re a se s a wa re ne ss a nd sho rt-te rm a b stine nc e in a do le sc e nt wo me n. Jo urnal Ado le sc e nt He alth, 46(3), 270-277.

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Que stio ns