Boost teens' knowledge when it comes to STDs
You deliver some bad news to your next patient, a 16-year-old student: She has a chlamydia infection. She then asks, "What is chlamydia?"
If this scenario replays in your exam room on a regular basis, you are not alone. Findings from a new study indicate that most sexually active teenage girls know relatively little about sexually transmitted diseases (STDs) until they are diagnosed with one.1
Teens may learn about HIV in school-based health education, but they are not getting companion information on other STDs, says Julie Downs, PhD, lead author of the new research and director of the Center for Risk Perception in Communication at Carnegie Mellon University in Pittsburgh. Without knowledge of such diseases as chlamydia and genital herpes, teens may operate under a false sense of confidence, Downs explains.
"When we interview teens in research, they may say, 'I was really concerned about HIV and I was concerned about getting pregnant,' but some of them will say 'but anything else, you just take a pill,'" Downs comments. "That is not really true."
Downs and fellow researchers surveyed 300 adolescent girls in the Pittsburgh area and administered a test to gauge teens' knowledge of eight STDs: HIV/AIDS, chlamydia, gonorrhea, genital herpes, genital warts, hepatitis B, trichomoniasis, and syphilis. Girls who reported having been diagnosed with an STD knew more about that particular disease than other girls, but they did not know more about the other diseases, researchers found.1 With the exception of HIV/AIDS, the teens did not know many basic facts about STDs, researchers report.1
Teens with little knowledge about STDs are more likely to engage in risky sexual behavior and to delay infection treatment.2,3 Such treatment delay is particularly important when it comes to chlamydia, the most prevalent STD in the United States.4 Untreated chlamydial infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID), which can lead to permanent damage to the fallopian tubes, uterus, and surrounding tissues.5
Boost teens' STD IQ
Providers miss opportunities to provide STD, HIV, and pregnancy prevention counseling to high-risk youth during preventive health care visits, according to an analysis of a national adolescent survey.6
How can you help to boost teens' STD IQ?
Assessing a teen's knowledge of STDs comes into play during questioning about reproductive health issues, says Karen Hacker, MD, MPH, executive director for the Institute for Community Health and assistant professor in the department of medicine at the Harvard Medical School, both in Cambridge, MA. Hacker presented on the topic of talking to teens about drugs, alcohol, and sex at the 2005 Contraceptive Technology conference in Boston.
Use the mnemonic device HEADS (Home, Education, Activities, Drugs, Sexuality) to cover important points in a teen's medical history, she suggests. Many adolescent providers also look to the American Medical Association's (AMA) Guidelines for Adolescent Preventive Services (GAPS), a comprehensive set of recommendations for teen care, says Hacker. By getting to know about different aspects of a teen's life, the provider is then able to move into more sensitive subjects, she notes.
When the topic of sex is broached, Hacker says she varies her approach based on age. If it is a young teen, she may ask, "Have you learned anything about sex education in school? Have you thought about that?" before she asks, "Have you engaged in any sexual activity?" If the response is no, Hacker says, "If you want any information, I'd be happy to respond. If not, come back when you do." Handouts also can provide take-home information. Also direct teens to teen-friendly information on the web.
If a teen has come in specifically for birth control, Hacker says she tends to take a more direct route in her queries, asking questions such as, "If you are sexually active, how many partners have you had in your lifetime?" to understand their level of risk-taking. She spends time explaining the difference between pregnancy prevention and STD prevention, and she notes that while many methods are effective contraceptives, they do not provide STD protection.
The advent of urine-based STD testing has made it easier to screen teens, says Hacker. If teens have come in for emergency contraception, she takes that opportunity to say, "While we are checking your urine for a pregnancy test, in the meantime it would be good to check you for STDs, too." This comment also provides a segue into an explanation that emergency contraceptive pills, such as oral contraceptives, do not prevent STDs.
According to Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta, the single most important time to bring up the prevention of STDs is when clinicians and counselors are stressing the dual use of condoms and a woman's chosen contraceptive, such as pills, the contraceptive ring, or the contraceptive patch.
Visit the American Medical Association web site, www.ama-assn.org, to review materials affiliated with its Guidelines for Adolescent Preventive Services (GAPS). Under "AMA Agenda," click on "Advocacy Efforts." Next, click on "Improving the Health of the Public," "Promoting Healthy Life-styles," "Adolescent Health," and "Downloads and Resources." Documents of GAPS patient questionnaires in English and Spanish for younger adolescents, middle/older adolescents, and parents/ guardians are available, as well as a monograph of the GAPS program. Click on "Patient Handouts" for a link to the association's "Parent Package," a set of documents designed to help providers share important information about adolescence with parents and adolescent patients. Each of the 15 topics addressed in these handouts contains up-to-date facts, parenting tips, and other resources.
1. Downs JS, Bruine de Bruin W, Murray PJ, et al. Specific STI knowledge may be acquired too late. J Adolesc Health 2006; 38:65-67.
2. Yacobi E, Tennant C, Ferrante J, et al. University students' knowledge and awareness of HPV. Prev Med 1999; 28:535-541.
3. Fortenberry JD. Health care seeking behaviors related to sexually transmitted diseases among adolescents. Am J Public Health 1997; 87:417-420.
4. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2004. Atlanta: U.S. Department of Health and Human Services, September 2005.
5. Centers for Disease Control and Prevention. Chlamydia: CDC Fact Sheet, 2004.
6. Burstein GR, Lowry R, Klein JD, et al. Missed opportunities for sexually transmitted diseases, human immunodeficiency virus, and pregnancy prevention services during adolescent health supervision visits. Pediatrics 2003; 111(5 Pt 1): 996-1,001.