INTRODUCTION
Among all age groups, adolescents and young adults are at the highest risk of being diagnosed with a sexually transmitted disease (STD) due to a combination of factors, including risk-taking behaviors, increased biologic susceptibility, and barriers to accessing appropriate reproductive health care services. Although young people between the ages of 15 and 24 years comprise a quarter of the sexually experienced population, they account for up to a half of newly acquired STDs. In 2009, women aged 15 to 19 years had the highest rates of Chlamydia, gonorrhea, and HPV infection compared to all other age groups.
While often asymptomatic, the clinical presentation of most STDs in adolescents can be highly variable. Females may present with vaginal discharge, abnormal vaginal bleeding, vaginal itching, dysuria, or pain (lower abdominal, right upper quadrant, or rectal). Males may present with urethral discharge, dysuria, testicular pain or swelling, or rectal pain. Presentation can also include rash, pharyngitis, arthralgia or arthritis, and inguinal adenopathy.
Clinicians should educate adolescents about the transmission of STDs and the importance of protecting oneself. Primary prevention includes helping guide the development of healthy sexual behaviors and providing accurate sexual and reproductive health information, as well as access to reproductive health resources. Providers should remember that adolescents with chronic conditions engage in intimate relationships like their healthy peers and are also at risk for acquiring STDs. Adolescents across the United States, with limited exceptions, can consent to the confidential diagnosis and treatment of STDs, and medical care for STDs can be provided to adolescents without parental consent or knowledge. Providers should inform adolescents of their right to confidentiality and should comply with state laws and policies to ensure the confidentiality of STD-related services for adolescents.
Appropriate treatment of both the patient and the partner is essential.
DIFFERENTIAL DIAGNOSIS LIST
HINT: FTA-ABS or TP-PA helps differentiate infections from diseases such as lupus that produce a false-positive VDRL. However, these tests are positive in Lyme disease, which does not have a positive VDRL.
