While self-reported behavior is the mainstay of evaluating intervention strategies, this study suggests the numbers of affected adolescents may be underestimated. The study has several limitations. The participants’ baseline STD status was unknown, responses were based on recall, and it only dealt with one type of sexual contact – just to mention a few of the limitations. This is also not the ideal way to evaluate behavioral intervention programs, and such was never the intent of the study.
Other sections of the CDC guidelines address vaccination and counseling, again based on previous published guidelines from federal agencies and medical professional organizations. These include providing the HPV vaccine to 11- to 12-year old females, hepatitis B vaccine to all adolescents unless already vaccinated, and the hepatitis A vaccine in areas with existing vaccination programs.
Importantly, health care providers who care for children and adolescents should integrate sexuality education into clinical practice. This includes a discussion of both abstinence and consistent, correct condom use. Information regarding HIV infection, testing, transmission, and implications of infection also should be regarded as an essential component of the anticipatory guidance provided to all adolescents as part of health care.
The CDC guidelines include a box with suggested language for initiating a sexual history by asking about the "Five P’s": Partners, Prevention of pregnancy, and Protection from STDs, Practices, and Past history of STDs.
Obtaining a sexual history, educating patients, and/or treating STDs should not have to be referred to other specialists. As primary care physicians, you have a unique opportunity to educate and counsel young patients with whom you already have a well-established relationship. It’s not the easiest topic to tackle, but doing so is vital to the health of your patients on their journey to adulthood. The updated treatment guidelines are an excellent resource for every practitioner.
Dr. Word is an infectious disease specialist in Houston. She said she has no relevant financial disclosures.