Sexually Transmitted Infections in the Adolescent Population. Abraham Lichtmacher MD FACOG Chief of Women s Services Lovelace Health System

Transcription

1 Sexually Transmitted Infections in the Adolescent Population Abraham Lichtmacher MD FACOG Chief of Women s Services Lovelace Health System

2 STI in the Adolescent High school students nationwide, 34.2% were currently sexually active, 38.9% of currently sexually active students had not used a condom during their last sexual intercourse Many adolescents are engaging in sexual behaviors other than vaginal intercourse. Nearly half have had oral sex and just over one in 10 have had anal sex. Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States: Data From the National Survey of Family Growth National Health Statistics Report-Number 36 n March 3, 2011

3 Sexual Activity in Adolescent US Department of Health and Human Services; Updated 12/21/2016

4 Pregnancy in the Adolescent US Department of Health and Human Services; Updated 12/21/2016

5 Sexually Transmitted Infections Adolescents ages account for nearly half of the 20 million new cases of STIs each year. Two in five sexually active teen girls have had an STI that can cause infertility and even death. Males make up more than 80 percent of HIV diagnoses among 13- to 19-year-olds.

6 STIs in the United States, 2015 Chlamydia Cases reported in 2015: 1,526,658 Rate per 100,000: 479; increase of 6% since 2014 Gonorrhea Cases reported in 2015: 395,216 Rate per 100,000: 124; increase of 13% since 2014

7 Most Reported Chlamydia and Gonorrhea Infections Occur among Year-Olds

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9 Why is the School RN Important? Clinician Educator Confidant

10 Education

11 Types of STIs Presentation, diagnosis, consequence Inflammatory (PID)- Ulcerative Proliferative- Systemic- Discharge- Chlamydia, Gonorrhea (GC) Herpes (HSV), Syphilis Genital Warts (HPV), HIV, hepatitis Trichomonas monillia (yeast) bacterial vaginosis (BV)

12 Types of Inflammatory STIs-Chlamydia C. trachomatis is a Gram-negative bacterium Symptoms-asymptomatic, pain, discharge, PID, infertility, ectopic pregnancy Male genital discharge, pruritus, and dysuria Diagnosis-swab testing or urine testing Treatment-Azithromycin 1 g orally in a single dose Prevention-condoms use, screening

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14 Types of Inflammatory STIs-GC The Clap" Neisseria gonorrhoeae- Gram-negative coffee bean shaped diplococcus bacteria (Gonococcus-GC) Symptoms-asymptomatic, pain, discharge, PID, infertility, ectopic pregnancy Male genital discharge, pruritus, and dysuria Diagnosis-swab, urine, culture Treatment- Ceftriaxone 250 mg IM in a single dose plus Azithromycin 1 g orally in a single dose Prevention condom use, routine screening

15 Neisseria Gonorrhea

16 Types of Ulcerative STIs-Syphilis Treponema pallidum- Symptoms primary-chancre at point of contact (3-90d) secondary 4-10 weeks later, palmar and plantar rash, flat warts latent-asymptomatic, serology positive tertiary- gummas, neurologic, cardiovascular Diagnosis direct microscopy, blood serology Treatment-single dose of intramuscular benzathine penicillin G, prolonged treatment for late disease Prevention-Latex condom use, abstinence, maternal screening

17 Palmar Rash

18 Person with tertiary (gummatous) syphilis. Bust in Musée de l'homme, Paris Wikipedia

19 Types of Ulcerative STIs-Herpes (HSV) Herpes Simplex Virus HSV 1-cold sores HSV 2-genital Symptoms- painful, watery blisters or sores, recurrent, asymptomatic Diagnosis- direct observation, viral culture, serology Treatment- antiviral meds, acyclovir, valacyclovir Preventionindividual abstain from contact with infected

20 HSV-1

21 Types of Proliferative STIs-HPV Huma Papilloma Virus Symptoms asymptomatic, genital warts, precancerous Diagnosis-direct observation, cytology (PAP)DNA testing Treatment-local excision/destruction, immunotherapy Prevention- vaccination

22 HPV

23 Types of STI s with Discharge- Trichomonas Trichomonas vaginalis -protozoan parasite Symptoms malodorous, or yellow-green with or without vulvar irritation, asymptomatic Diagnosis-Wet Mount, laboratory testing Treatment- Metronidazole 2 g orally in a single dose Prevention-Condoms use

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25 Types of STI s with Discharge- Yeast, BV Yeast- fungus (candida albicans) Symptoms- cheesy discharge, irritation, burning, dysuria Diagnosis- cultures KOH microscopy, lab testing Treatment- antifungal meds, OTC, prescriptions Prevention BV bacterial vaginosis Symptoms- watery discharge, odor Diagnosis- lab testing Treatment- antimicrobial meds Prevention

26 Types of Systemic STIs- Hepatitis, HIV Hepatitis-B HIV Symptoms-liver inflammation, jaundice Diagnosis-laboratory tests Treatment-Immune globulin Prevention-vaccination Symptoms- viral syndrome Diagnosis- laboratory tests Treatment- antiretroviral meds Prevention- screening

27 Recommendations

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29 Chlamydia Gonorrhea Syphillis Trichomonas Herpes Women Sexually active women under 25 years of age Sexually active women under 25 years of age All pregnant women at the first prenatal visit women at high risk for infection women presenting for an STD evaluation-(serology type) HIV All women aged years (opt-out) Men in populations with high burden of infection At least annually for sexually active MSM At least annually for sexually active MSM none men presenting for an STD evaluation (serology type) All men aged (optout) Cervical Cancer (HPV) Women years of age every 3 years with cytology

30 NOTIFIABLE DISEASES OR CONDITIONS IN NEW MEXICO NEW MEXICO ADMINISTRATIVE CODE Chlamydia trachomatis infections Chancroid Gonorrhea Syphilis HIV (Human Immunodeficiency Virus) and AIDS For details online of NMAC see:

31 Assessment

32 Common Complaints My boy/girlfriend told me they had an infection. I have a discharge.. It hurts when I pee. I ve got these bumps.. Can you check me for everything?

33 What do we want to know? Are there visible lesions? Are there any symptoms? Is there a discharge: color, odor, quality? Are there other symptoms?

34 Wrap Up Education Prevention Screening

35 ?