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About half of 9th to 12th graders have had sexual intercourse. In a study by the Centers for Disease Control and Prevention, one in four girls between 14 and 19 have at least one of four STDs: HPV, chlamydia, herpes simplex virus or trichomoniasis. Infection with HPV was most common, affecting 18 percent of teenage girls.
The HPV vaccine prevents two types of HPV that cause 70 percent of cervical cancers, and two types of HPV that cause 90 percent of genital warts. The recommended age for vaccination is 11 to 12 years, but the vaccine can be administered to girls as young as age 9.
Boys and girls need to know about STDs, but boys are studied less often and have lower rates of STDs than girls. This may be because most STDs transmit most readily by contact with mucus membranes. Girls have more surface area of mucus membranes lining their vagina than boys have lining their urethra.
Both boys and girls who are sexually active should be screened for STDs. All women under 26 should be screened for chlamydia at least annually (and more frequently if at high-risk). The recommendations for boys are less firm, but it makes sense to consider screening all sexually active boys annually as well. Screening for gonorrhea should be considered for higher-risk patients (those with frequent partner changes or multiple partners; or sex in exchange for something like drugs, food or shelter). For both boys and girls, non-invasive and self-collected (urine, vaginal) options exist for testing for both gonorrhea and chlamydia. There are no screening options for HPV or herpes.
When speaking to patients’ parents, we encourage them to look for “teachable moments” rather than have “The Talk.” Parents can help their children be aware that abstinence is the best prevention method for STDs and pregnancy. Adolescents who do engage in sexual activity should know how to use a condom correctly and consistently, choose their sexual partners wisely, limit the number of people they have sex with and only have sex with people who are at low risk for STDs.
As patients get older (by 11 or 12 for most children), let them and their parents know you will be having private time with the adolescent during their routine visits. Discuss the conditional confidentiality you will have in your relationship; you will respect their requests to keep information private unless you have concerns for their safety (for example, suicidal ideation, imminent risk of harm, or homicidal ideation). Recognize their need to separate from parents and give them space to develop a relationship with you so they will be receptive to confidential care.
—Lydia Shrier, MD, Adolescent Medicine
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