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Screening Adolescents for Sexually Transmitted Infections

April 11, 2022

Half of new sexually transmitted infections (STIs) occur in adolescents and young adults (AYAs). As a result, national organizations like the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the United States Preventive Services Task Force all recommend screening for. All AYA females less than 25 years of age who are sexually active and males having sex with men (MSM) should be tested for STIs at least yearly. How is adherence to these recommendations? Liddon et al (10.1542/peds.2021-051893) share a national perspective on STI screening in sexually active youth in a study being early released this month in Pediatrics.

The authors took advantage of a new question added to the 2019 national Youth Risk Behavior Survey: “During the past 12 months have you been tested for an STD, other than HIV, such as chlamydia or gonorrhea?” Of the 2,501 high school students who reported being sexually active, only 20.4% percent reported being tested in the past year. Only 26.1% of sexually active females and 29.8% of MSM reported being tested. What makes this study even more interesting is that the authors looked at factors associated with being tested, including six sexual behavior indicators (e.g. condom use at last sexual intercourse), and demographic characteristics, including sexual identity. The analyses provided in this study are rich and yet sadly concerning given how infrequently AYAs who are at risk for STIs are getting tested.

So what can be done about this? We invited a commentary from Drs. Cynthia Holland-Hall and Andrea Bonny from Nationwide Children’s Hospital to share their input on the findings provided, the study’s limitations, and strategies for improving the poor testing results reported in this study (10.1542/peds.2021-055954). The commentary authors and study authors suggest an opt-out strategy may get more testing done in office visits. A previous study, by Sieving et al, published last year in Pediatrics (10.1542/peds.2020-049411), noted deficiencies in our discussing sexual and reproductive health with adolescents. Significant work is needed if opt-out screening is going to become the standard approach to testing AYAs. There is a lot of information shared in this study and commentary that can be applied to your practice if you link to both and learn more.

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