VAIL, COLO. – National data indicate general pediatricians now provide care for more adolescents than ever before – and that means they need to keep current with new trends in STD management, according to Dr. Ann-Christine Nyquist.
The authoritative source on STD diagnosis, treatment, and prevention is the Centers for Disease Control and Prevention’s "Sexually Transmitted Diseases Treatment Guidelines, 2010." But the "2010" is misleading; the guidelines are actually a living document that is constantly being updated. Thus, it’s best to consult the online version (www.cdc.gov/std/treatment) rather than a hard copy, noted Dr. Nyquist, professor of pediatrics at the University of Colorado at Denver.
As evidence that pediatricians need to be adept at STD management, she cited a major study funded by the American Board of Pediatrics showing that during the years 2000-2006, the proportion of office visits to general pediatricians made by the nation’s 11- to 17-year-olds climbed from 38% to 53%.
Meanwhile, the proportion of office visits to family physicians and other nonpediatric generalists declined from 38% to 30%, while the proportion of visits to nonpediatric specialists dropped from 28% to 22% and visits to pediatric specialists inched up from 2% to 5% (J. Pediatr. 2010;157:148-52e1), DrNyquist noted at a conference on pediatric infectious diseases, sponsored by Children’s Hospital Colorado.
The data came from the CDC’s National Ambulatory Medical Care Survey, with the analysis conducted by pediatricians at the University of Michigan, Ann Arbor. The study was a follow-up to an earlier report on national trends showing who is providing medical care for America’s children, conducted by the same research group (Arch. Pediatr. Adolesc. Med. 2004;158:22-6). The latest study confirms an accelerating trend seen during 1980-2000 for a greater proportion of health care visits for children and adolescents in the United States being provided by general pediatricians.
Nearly 50% of all STDs occur in 15- to 24-year-olds. The CDC guidelines recommend annual screening for chlamydia and gonorrhea in all sexually active females under age 25; the available data aren’t strong enough at present to support routine annual screening of all similarly aged males.
The preferred screening assay is a DNA-based nucleic acid amplification test because of its superior sensitivity and specificity. The assay can be done using a urine sample or a vaginal, rectal, or pharyngeal swab specimen. That’s a boon for pediatricians who are uncomfortable doing a pelvic exam to collect a cervical specimen.
It’s vital to talk with the sexually active adolescent about his or her specific sexual behaviors in order to know what sites to test. The considerable diversity in patterns of adolescent sexual initiation was underscored in a recent study of nearly 14,000 18-year-old participants in the National Longitudinal Study of Adolescent Health. Four in five had engaged in vaginal intercourse, oral-genital sexual activity, and/or anal intercourse by age 18. One in 10 reported anal intercourse. One-third of the youths initiated two or more of the sexual behaviors within a 1-year period (Am. J. Public Health 2012;102:1221-8).
Dr. Nyquist reported having no relevant financial conflicts.