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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Policy Statement. Pediatrics 2024; 153:e2024066326. [PMID: 38646690 DOI: 10.1542/peds.2024-066326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is an essential component of high-quality health care for adolescents and young adults and can have an impact on the health care experiences and health outcomes of youth. Federal and state laws, professional guidelines, and ethical standards provide a core framework for guidance in the implementation of confidentiality protections in clinical practice. This policy statement provides recommendations for pediatricians and other pediatric health care professionals, clinics, health systems, payers, and electronic health record developers to optimize confidentiality practices and protections for adolescents and young adults across the spectrum of care.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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Mukherjee G, Zhang C, Kandaswamy S, Gooding H, Orenstein E. Current Inpatient Screening Practices for Sexual History and STIs: An Opportunity to Seize. Clin Pediatr (Phila) 2024; 63:350-356. [PMID: 37424327 DOI: 10.1177/00099228231183501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
The American Academy of Pediatrics recommends utilizing hospitalizations as an opportunity to provide sexual health screenings for adolescents. This study aimed to describe the current practice of sexual history documentation (SHxD) and sexually transmitted infection (STI) testing among adolescents admitted to a pediatric hospital medicine service. Retrospective cross-sectional study of adolescents (14-19 years old) admitted to the PHM service from 2017-2019 was performed at an academic children's health system. Patient (demographics, history of complex chronic condition, and insurance), hospitalization (length of stay, diagnosis, STI tests ordered/results), and physician (level of training and gender) characteristics were extracted for each encounter. A natural language processing algorithm identified the presence of SHxD. Univariate analysis and multivariable analysis were performed to detect factors associated with SHxD and STI screening. The prevalence of STIs was calculated for those who were tested. Out of 2242 encounters, SHxD and STI testing rates were 40.9% and 17.2%, respectively. Patient gender, race, lack of complex chronic condition, and resident involvement were predictive of SHxD and STI testing. SHxD increased the odds of STI testing significantly (OR 5.06, CI 3.90-6.58). Among those who were tested, the prevalence of STIs was highest for chlamydia (37/329, 11.2%). Overall, sexual health screening rates remain low in the hospital setting and future improvement initiatives are needed.
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Affiliation(s)
- Gargi Mukherjee
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
| | - Chao Zhang
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
| | - Swaminathan Kandaswamy
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
| | - Holly Gooding
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
- Department of Pediatrics, Emory University/Grady Memorial Hospital, Atlanta, GA, USA
| | - Evan Orenstein
- Department of Pediatrics, Emory University/Children's Healthcare of Atlanta-Egleston Hospital, Atlanta, GA, USA
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Saragih ID, Imanuel Tonapa S, Porta CM, Lee BO. Effects of telehealth interventions for adolescent sexual health: A systematic review and meta-analysis of randomized controlled studies. J Telemed Telecare 2024; 30:201-214. [PMID: 34903065 DOI: 10.1177/1357633x211047762] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Telehealth interventions to advance adolescent sexual health have evolved and are being used to promote adolescent sexual health knowledge and healthy sexual behaviors. However, as this area of intervention modality expands, there is a need to pause and examine the effects of telehealth interventions on adolescent sexual health outcomes. Addressing this knowledge gap will inform researchers and practitioners on the current state of evidence of telehealth interventions and inform further intervention development and testing. This study aimed to explore the meta-effects of telehealth interventions on self-efficacy of using condoms, condom use practices, and sexually transmitted infection testing behaviors among adolescents. METHODS A systematic review and meta-analysis of randomized controlled trials were conducted. Seven databases (Academic Search Complete, CINAHL, EMBASE, MEDLINE, PubMed, OVID (UpToDate), and Web of Science) were searched for relevant full-text articles from the inception to May 2021. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random effects model to calculate the pooled effects of telehealth interventions for adolescents. Stata 16.0 was used for statistical analysis. RESULTS A total of 15 studies (N = 5499) that used telehealth interventions with adolescents were included in the analysis. Telehealth interventions were found to increase self-efficacy for condom use (standardized mean difference: 0.22; 95% confidence interval: 0.08-0.36), practice for condom use (standardized mean difference: 0.35; 95% confidence interval: 0.23-0.47), and being screened/tested for sexual transmitted infections (standardized mean difference: 0.61; 95% confidence interval: 0.31-0.92). DISCUSSION Telehealth interventions show promise as effective intervention delivery solutions for improving self-efficacy and certain sexual health behaviors among adolescents. These telehealth strategies could be important alternatives to in-person visits to accessing sexual health information or services near where they live. Future research should consider testing telehealth strategies where there is evidence of impact to move the field forward.
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Affiliation(s)
| | - Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung
- School of Nursing, Sam Ratulangi University, Manado, Indonesia
| | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung
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Sharma D, Muralidhar S, Lachyan AS, Khunger N. Risk factors associated with increasing prevalence of gonorrhea and the antimicrobial susceptibility profiles of Neisseria gonorrhoeae among adolescents: A decade-long, hospital-based study from India. Indian J Sex Transm Dis AIDS 2024; 45:15-18. [PMID: 38989070 PMCID: PMC11233057 DOI: 10.4103/ijstd.ijstd_74_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/09/2023] [Accepted: 09/29/2023] [Indexed: 07/12/2024] Open
Abstract
Background Gonorrhea is a significant cause of morbidity among sexually active population. Young adults and adolescents have a high risk of contracting sexually transmitted infections (STIs) due to behavioral, biological, and cultural factors fuelling the epidemic among them. The Centers for Disease Control recommends annual STI screening for sexually active individuals under twenty-five and those at higher risk. The present study aims at determining the risk factors linked to the rising prevalence of gonorrhea among Indian adolescents and antimicrobial susceptibility profiles of Neisseria gonorrhoeae. Materials and Methods Clinical samples from adolescents attending the STI clinics were collected over 10 years. The isolates were confirmed as N. gonorrhoeae and antimicrobial susceptibility tests were performed to various drugs using the minimum inhibitory concentration strip method. Results A total of 7308 genital discharge specimens were collected from STI clinic attendees, of which 417 samples were positive for gonorrhea (25 among male adolescents). Seventy six percent of positive adolescents had multiple sex partners, with only 4% using condoms. Nearly 20% practiced exchange of drugs for sex. Antimicrobial susceptibility rates were 96% sensitive for azithromycin, cefixime, and ceftriaxone. Gentamicin and spectinomycin reported 100% sensitivity rates. High resistance rates were reported to penicillin, ciprofloxacin, and tetracycline at 80%, 88%, and 68%, respectively. Conclusion Regular screening for STIs helps understand the trends and transmission of gonorrhea, which helps initiate appropriate control measures. The resistance to recommended treatment regimens such as azithromycin and cefixime seems to be escalating gradually, probably due to irrational use of antibiotics for non-STI cases and empirical treatment, which needs close monitoring.
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Affiliation(s)
- Devanshi Sharma
- Apex Regional STD Centre and State Reference Laboratory for HIV, New Delhi, India
| | - Sumathi Muralidhar
- Apex Regional STD Centre and State Reference Laboratory for HIV, New Delhi, India
| | | | - Niti Khunger
- Department of Dermatology and STD, Apex Regional STD Centre, Safdarjung Hospital, New Delhi, India
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Shields-Haas V, Bray C. Improving Effective Chlamydia Screening for Women at Risk at a Rural Family Planning Clinic. J Dr Nurs Pract 2023; 16:205-212. [PMID: 38049181 DOI: 10.1891/jdnp-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Background: Chlamydia is the most common bacterial sexually transmitted infection (STI) in the United States, with an incidence of 1.7 million infections annually. It results in an estimated $691 million in lifetime medical costs. Objective: The objective of the project was to improve effective care for women at risk of chlamydia infection in a rural family planning clinic to 80% in 90 days. Methods: The Plan-Do-Study-Act process of quality improvement (QI) was implemented over four 2-week cycles. Qualitative and quantitative data were collected and analyzed iteratively and informed tests of change for each cycle. Results: Results indicated an improvement in effective care from a baseline of 42%-81%. Patient visit time decreased from 38 minutes at baseline to 23 minutes. Compared with pre-implementation, the number of positive chlamydia test results went from three to six, doubling the positivity rate, while the number of chlamydia tests billed increased by 32%. Conclusions: This project was successful in improving effective care. Implementing a standardized risk assessment decreased patient visit time. Implications for nursing: QI projects directed at meeting national standards for STI screening can be implemented in rural health clinics at low cost and with high impact.
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Affiliation(s)
| | - Carla Bray
- Frontier Nursing University, Versailles, KY, USA
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Strobel TM, Desai NA, Arrington-Sanders R. Acute Infectious Proctitis in Adolescents. Pediatr Rev 2023; 44:491-497. [PMID: 37653133 DOI: 10.1542/pir.2022-005862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The diagnosis of acute proctitis requires understanding who is at risk, being aware of symptoms, and leveraging a thorough sexual history with appropriate risk stratification to make the diagnosis. Cases have been concentrated in adolescents (ages 15-19 years), young adults (ages 20-24 years), men and transgender women who have sex with men, and those with a history of human immunodeficiency virus infection. Black adolescents experience a disproportionately high number of cases of proctitis due to an intersection of concentrated cases in sexual networks and delayed screening/diagnosis due to health care access barriers. Signs and symptoms include purulent discharge, bleeding, pain, tenesmus, pruritus, diarrhea or constipation, weight loss, or fever. Multisite sexually transmitted infection testing should be offered based on risk stratification (eg, history of condomless anal sex, oral intercourse, number of sex partners). Further management includes promotion of barrier protection and preexposure prophylaxis, routine surveillance, partner notification, and routine access to preventive immunizations.
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Affiliation(s)
| | - Neerav A Desai
- Division of Adolescent and Young Adult Health, Vanderbilt University Medical Center, Nashville, TN
| | - Renata Arrington-Sanders
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, Baltimore, MD
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Wood SM, Fiks AG. Growing Evidence Supports an Implementation Shift Toward Vaginal Sampling for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis Screening. Ann Fam Med 2023; 21:100-102. [PMID: 36973048 PMCID: PMC10042558 DOI: 10.1370/afm.2959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Sarah M Wood
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bedgood M, Rabbani N, Brown C, Goldstein R, Carlson JL, Steinberg E, Powell A, Pageler NM, Morse K. The Prevalence of Confidential Content in Adolescent Progress Notes Prior to the 21st Century Cures Act Information Blocking Mandate. Appl Clin Inform 2023; 14:337-344. [PMID: 37137339 PMCID: PMC10156443 DOI: 10.1055/s-0043-1767682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/16/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND The 21st Century Cures Act information blocking final rule mandated the immediate and electronic release of health care data in 2020. There is anecdotal concern that a significant amount of information is documented in notes that would breach adolescent confidentiality if released electronically to a guardian. OBJECTIVES The purpose of this study was to quantify the prevalence of confidential information, based on California laws, within progress notes for adolescent patients that would be released electronically and assess differences in prevalence across patient demographics. METHODS This is a single-center retrospective chart review of outpatient progress notes written between January 1, 2016, and December 31, 2019, at a large suburban academic pediatric network. Notes were labeled into one of three confidential domains by five expert reviewers trained on a rubric defining confidential information for adolescents derived from California state law. Participants included a random sampling of eligible patients aged 12 to 17 years old at the time of note creation. Secondary analysis included prevalence of confidentiality across age, gender, language spoken, and patient race. RESULTS Of 1,200 manually reviewed notes, 255 notes (21.3%) (95% confidence interval: 19-24%) contained confidential information. There was a similar distribution among gender and age and a majority of English speaking (83.9%) and white or Caucasian patients (41.2%) in the cohort. Confidential information was more likely to be found in notes for females (p < 0.05) as well as for English-speaking patients (p < 0.05). Older patients had a higher probability of notes containing confidential information (p < 0.05). CONCLUSION This study demonstrates that there is a significant risk to breach adolescent confidentiality if historical progress notes are released electronically to proxies without further review or redaction. With increased sharing of health care data, there is a need to protect the privacy of the adolescents and prevent potential breaches of confidentiality.
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Affiliation(s)
- Michael Bedgood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
- California Department of Public Health, Coronavirus Science Branch, Richmond, California, United States
| | - Naveed Rabbani
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Conner Brown
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Rachel Goldstein
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Jennifer L. Carlson
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Ethan Steinberg
- Stanford Center for Biomedical Informatics Research, Stanford University, Palo Alto, California, United States
| | - Austin Powell
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Natalie M. Pageler
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
| | - Keith Morse
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
- Information Services, Stanford Children's Health, Palo Alto, California, United States
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Bonett S, Teixeira da Silva D, Lazar N, Makeneni S, Wood S. Trends in sexually transmitted infection screening during COVID-19 and missed cases among adolescents. Public Health 2022; 213:171-176. [PMID: 36423495 PMCID: PMC9576220 DOI: 10.1016/j.puhe.2022.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The COVID-19 pandemic disrupted sexual health services for young people, with potential consequences of decreasing preventive screening and increasing undiagnosed sexually transmitted infections (STIs). This study aimed to assess trends in asymptomatic screening among patients receiving STI testing and to estimate the number of STI cases that were missed during the early months of the pandemic. STUDY DESIGN A cross-sectional study of electronic health records for chlamydia, gonorrhea, and trichomonas testing encounters from six pediatric primary care clinics in Philadelphia, July 2014 to November 2020. METHODS A total of 35,548 testing encounters were analyzed, including 2958 during the pandemic. We assessed whether testing at each encounter was performed as asymptomatic screening, risk-based testing, or symptomatic testing. We evaluated screening trends over time and estimated the number of missed STI cases during the pandemic. RESULTS The mean monthly testing encounters decreased from 479 per month prepandemic to 329 per month during the pandemic. The percent of tests performed as asymptomatic screening dropped from 72.5% prepandemic to a nadir of 54.5% in April 2020. We estimate that this decrease in asymptomatic screening would represent 159 missed cases (23.8% of expected cases) based on patient volume from the previous year. CONCLUSIONS During the pandemic, the total volume of STI testing encounters and the proportion of tests performed as asymptomatic screening decreased, potentially resulting in missed diagnoses. Undiagnosed STIs can result in severe sequelae and contribute to community transmission of STIs. Efforts are needed to re-establish and sustain access to STI services for adolescents in response to disruptions caused by the pandemic.
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Affiliation(s)
- S. Bonett
- School of Nursing, University of Pennsylvania, USA,Corresponding author. School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA. Tel.: +215-573-4299
| | | | - N. Lazar
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA
| | - S. Makeneni
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - S.M. Wood
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA,PolicyLab, Children's Hospital of Philadelphia, USA
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Teixeira da Silva D, Petsis D, Santos T, Mahajan A, Bonett S, Wood S. Chlamydia Trachomatis/Neisseria Gonorrhea Retesting Among Adolescents and Young Adults in a Primary Care Network. J Adolesc Health 2022; 71:545-551. [PMID: 35963759 PMCID: PMC9588690 DOI: 10.1016/j.jadohealth.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) retesting three months after diagnosis is a guideline-recommended strategy to detect re-infections. Adolescents and young adults are priority populations in the U.S. Sexually Transmitted Infections National Strategic Plan, but there is a lack of research examining CT/NG retesting among these populations. This study describes retesting following CT/NG diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting. METHODS We evaluated electronic medical records from 2014 to 2020 from an academic urban-suburban primary care network. The primary outcome was retesting, defined as a diagnostic test for CT or NG ordered 8-16 weeks after index diagnosis. Mixed effects logistic regression modeling stratified by Title X funding was conducted to evaluate the association of patient-level factors with CT/NT retesting. RESULTS Overall, 23.5% (n = 731) of patients were retested within 8-16 weeks following index CT/NG diagnosis. A significantly greater proportion of Title X patients were retested compared to non-Title X patients. Males were significantly less likely to be retested compared to females, and the proportion of patients retested decreased significantly over the study period. DISCUSSION Guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients. Decreases in CT/NG retesting over the study period may be contributing to worsening of the STI epidemic. Our results provide insights into CT/NG retesting that can inform efforts to end the STI epidemic.
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Affiliation(s)
- Daniel Teixeira da Silva
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Danielle Petsis
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tatiane Santos
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anjali Mahajan
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephen Bonett
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Wood
- Department of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Robertson C, Mukherjee G, Gooding H, Kandaswamy S, Orenstein E. A method to advance adolescent sexual health research: Automated algorithm finds sexual history documentation. Front Digit Health 2022; 4:836733. [PMID: 35937421 PMCID: PMC9354080 DOI: 10.3389/fdgth.2022.836733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background:We aimed to develop and validate a rule-based Natural Language Processing (NLP) algorithm to detect sexual history documentation and its five key components [partners, practices, past history of sexually transmitted infections (STIs), protection from STIs, and prevention of pregnancy] among adolescent encounters in the pediatric emergency and inpatient settings.MethodsWe iteratively designed a NLP algorithm using pediatric emergency department (ED) provider notes from adolescent ED visits with specific abdominal or genitourinary (GU) chief complaints. The algorithm is composed of regular expressions identifying commonly used phrases in sexual history documentation. We validated this algorithm with inpatient admission notes for adolescents. We calculated the sensitivity, specificity, negative predictive value, positive predictive value, and F1 score of the tool in each environment using manual chart review as the gold standard.ResultsIn the ED test cohort with abdominal or GU complaints, 97/179 (54%) provider notes had a sexual history documented, and the NLP algorithm correctly classified each note. In the inpatient validation cohort, 97/321 (30%) admission notes included a sexual history, and the NLP algorithm had 100% sensitivity and 98.2% specificity. The algorithm demonstrated >97% sensitivity and specificity in both settings for detection of elements of a high quality sexual history including protection used and contraception. Type of sexual practice and STI testing offered were also detected with >97% sensitivity and specificity in the ED test cohort with slightly lower performance in the inpatient validation cohort.ConclusionThis NLP algorithm automatically detects the presence of sexual history documentation and its key components in ED and inpatient settings.
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Affiliation(s)
- Caryn Robertson
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Gargi Mukherjee
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- *Correspondence: Gargi Mukherjee
| | - Holly Gooding
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Grady Memorial Hospital, Atlanta, GA, United States
| | - Swaminathan Kandaswamy
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Evan Orenstein
- Department of Pediatrics, Emory University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
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Ahmad FA, Fischer K, Gu H, Bailey TC, Jeffe DB, Carpenter CR, Payne PRO. Impact of risk-based sexually transmitted infection screening in the emergency department. Acad Emerg Med 2022; 29:879-889. [PMID: 35184344 PMCID: PMC10648282 DOI: 10.1111/acem.14465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Sexually transmitted infections (STIs), including chlamydia, gonorrhea, and human immunodeficiency virus (HIV) pose a significant health burden in adolescents. Many adolescents receiving care in the emergency department (ED) are in need of testing, regardless of their chief complaint. Our objective was to determine whether an electronic, risk-based STI screening program in our ED was associated with an increase in STI testing among at-risk adolescents. METHODS We conducted a retrospective cohort analysis of patient outcomes in our pediatric ED after integrating an Audio-enhanced Computer-Assisted Self-Interview (ACASI) as standard of care. It obtained a focused sexual history and generated STI testing recommendations. Patient answers and testing recommendations were integrated in real-time into the electronic health record. Patients who tested positive received treatment according to our standard-of-care practices. All patients 15-21 years of age were asked to complete this on an opt-out basis, regardless of the reason for their ED visit. Exclusions included those unable to independently use a tablet, severe illness, sexual assault, or non-English speaking. Our primary outcome was to describe STI-testing recommendations and test results among ACASI participants. We also compared STI testing between ACASI participants and those who were eligible but did not use it. RESULTS In the first 13 months, 28.9% (1788/6194) of eligible adolescents completed the ACASI and 44.2% (321/790) accepted recommended STI testing. The mean age of participants was 16.6 ± 1.3 years, with 65.4% (1169) being female. Gonorrhea/chlamydia testing was significantly higher among participants vs. non-participants (20.1% [359/1788] vs 4.8% [212/4406]; p < 0.0001). The proportion of positive STI tests was similar between the two groups: 24.8% (89/359) vs. 24.5% (52/212; p = 0.94) were positive for chlamydia and/or gonorrhea, while 0.6% (2/354) participants vs. 0% non-participants (p > 0.99) were positive for HIV. Among participants whose chief complaints were unlikely to be related to STIs but accepted recommended testing, 20.9% (37/177) were positive for gonorrhea or chlamydia. CONCLUSIONS Our program facilitated STI testing in the ED and identified many adolescents with STIs, even when their ED complaint was for unrelated reasons. More rigorous implementation is needed to determine the impact of deployment of ACASI to all eligible adolescents and addressing barriers to accepting STI testing recommendations.
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Affiliation(s)
- Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kayleigh Fischer
- Department of Emergency Medicine, Children's Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas, USA
| | - Hongjie Gu
- Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Thomas C Bailey
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Donna B Jeffe
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Polhemus S, Pickett ML, Liu XJ, Fraser R, Ferguson CC, Drendel AL. Racial Disparities in the Emergency Department Evaluation of Adolescent Girls. Pediatr Emerg Care 2022; 38:307-311. [PMID: 35353799 DOI: 10.1097/pec.0000000000002675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Racial disparities and differences exist in emergency care. Obtaining a sexual history is standard of care for adolescents with abdominal pain. Testing for sexually transmitted infections (STIs) and pregnancy should be based on historical findings. The objective of this study was to determine whether differential care was provided to adolescent female patients with abdominal pain based on patient race or healthcare provider characteristics by evaluating the documentation of sexual history, STI testing, and pregnancy testing. METHODS This was a retrospective chart review of female patients between the ages of 14 and 18 years with abdominal pain presenting to a pediatric emergency department. Patient and provider characteristics, sexual history documentation, STI, and pregnancy testing were abstracted. Data were analyzed using χ 2 test and logistic regression model. RESULTS Eight hundred eighty-six encounters were included in the analysis. Median patient age was 16 years (range, 14-18 years); 359 (40.5%) were non-White. Differential care was provided. Non-White patients compared with White patients were more likely to have a documented sexual history (59.9% vs 44.0%, P < 0.001), STI testing (24.8% vs 7.8%, P < 0.001), and pregnancy testing (76.6% vs 66.2%, P < 0.001). Among sexually active female patients, the racial disparity for STI testing persisted ( P = 0.010). Provider type and sex did not result in differences in sexual history documentation, STI, or pregnancy testing for non-White compared with White patients ( P > 0.05). CONCLUSIONS Differential care was provided to non-White adolescents with abdominal pain compared with White adolescents. They were more likely to have a documented sexual history, STI testing, and pregnancy testing. Healthcare provider characteristics did not impact patient care. This racial disparity resulted in better medical care for non-White adolescents, but this may be the consequence of underlying implicit bias.
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Affiliation(s)
| | - Michelle L Pickett
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Xuerong Joy Liu
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Raphael Fraser
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Amy L Drendel
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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14
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Sharko M, Jameson R, Ancker JS, Krams L, Webber EC, Rosenbloom ST. State-by-State Variability in Adolescent Privacy Laws. Pediatrics 2022; 149:187003. [PMID: 35531640 DOI: 10.1542/peds.2021-053458] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Health care providers managing the complex health needs of adolescents must comply with state laws governing adolescent consent and right to privacy. However, these laws vary. Our objectives were to summarize consent and privacy laws state-by-state and assess the implications of variation for compliance with the 21st Century Cures Act and with evidence-based guidance on adolescent care. METHODS We summarized state laws and regulations on minor consent for the following: health services, substance abuse treatment, prenatal care, mental health care, contraceptive management, immunizations, sexually transmitted infection management, human immunodeficiency viruses testing and treatment, dental care, and sexual assault evaluation. We compared state laws and regulations with American Academy of Pediatrics' evidence-based guidelines to assess consistencies in guidance. RESULTS We observed notable state-by-state variability in laws governing consent for adolescent patients. No states had identical policies for all services studied. For example, although all states had provisions for consent to management of sexually transmitted infections, there were variable specifications in the age and type of minor, whether this includes human immunodeficiency viruses, and whether confidentiality is protected. Providing confidential care to the adolescent patient has been set as a priority by medical societies; however, guidelines are limited by the need to comply with state laws and regulations. CONCLUSIONS State laws on consent and privacy for adolescents are highly variable, and many do not reflect pediatric professional standards of care. This inconsistency is a barrier to operationalizing a consistent and equitable experience providing evidence-based medical care and ensuring adolescent privacy protection.
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Affiliation(s)
- Marianne Sharko
- Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Rachael Jameson
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lisa Krams
- American Academy of Pediatrics, Itasca, Illinois
| | - Emily C Webber
- Riley Hospital for Children, Indianapolis, Indiana.,Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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The Use of the Consolidated Framework for Implementation Research (CFIR) to Understand Facilitators and Barriers to STI Screening in Primary Care. Sex Transm Dis 2022; 49:610-615. [PMID: 35649512 DOI: 10.1097/olq.0000000000001656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Adolescents bear a disproportionate burden of sexually transmitted infections (STI) and the sequelae of delayed treatment, yet STI screening is infrequently performed in pediatric primary care clinics with many of those at-risk not administered testing. This study aims to understand contextual factors influencing STI screening and testing among adolescents in pediatric primary care. METHODS Using the Consolidated Framework for Implementation Research (CFIR) as part of a stepwise approach to facilitate a deep understanding the pediatric primary care environment. We conducted semi-structured interviews of physicians, nurses, and patient-parent dyads from four pediatric primary care practices in the St. Louis Metropolitan area about STI screening practices and common concerns regarding STI screening. Qualitative analysis was conducted using a categorical coding technique informed by CFIR followed by a thematic coding technique. RESULTS We interviewed 23 physicians/nurses and 12 patient-parent dyads. Individual level barriers to STI screening and testing included wide variability in clinicians' practice patterns and their perception of STI risk in the patient population. Structural barriers included a lack of capacity to perform testing in clinic and time constraints during patient visits. Confidentiality issues also created significant barriers to screening and testing on both individual and structural levels. Adopting confidential methods for testing and educating providers on patients' recommendations for STI testing were discussed as ways to potentially improve STI care in pediatric patients. CONCLUSION Our use of CFIR facilitated a systematic approach to identify gaps in STI care for adolescents and identified opportunities to close those gaps. An integrated, systematic approach that enhances patient confidentiality and improves clinicians' knowledge could address gaps in STI care in pediatric primary care settings.
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16
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Liddon N, Pampati S, Dunville R, Kilmer G, Steiner RJ. Annual STI Testing Among Sexually Active Adolescents. Pediatrics 2022; 149:186749. [PMID: 35403192 PMCID: PMC9126309 DOI: 10.1542/peds.2021-051893] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES National guidelines call for annual testing for certain sexually transmitted infections (STIs) among specific adolescent populations, yet we have limited population-based data on STI testing prevalence among adolescents. With inclusion of a new item in the 2019 national Youth Risk Behavior Survey, we provide generalizable estimates of annual STI testing among sexually active high school students. METHODS We report weighted prevalence estimates of STI testing (other than HIV) in the past 12 months among sexually active students (n = 2501) and bivariate associations between testing and demographic characteristics (sex, age, race and ethnicity, sexual identity, and sex of sexual contact). Multivariable models stratified by sex and adjusted for demographics examine the relationships between testing and sexual behaviors (age of initiation, number of sex partners, condom nonuse at last sexual intercourse, and substance use at last sexual intercourse). RESULTS One-fifth (20.4%) of sexually active high school students reported testing for an STI in the previous year. A significantly higher proportion of female (26.1%) than male (13.7%) students reported testing. Among female students, prevalence differed by age (≤15 years = 12.6%, age 16 = 22.8%, age 17 = 28.5%, or ≥18 years = 36.9%). For male students, there were no differences by demographic characteristics, including sexual identity, but most sexual risk behaviors were associated with increased likelihood of STI testing (adjusted prevalence ratios ranging from 1.48 to 2.47). CONCLUSIONS Low prevalence of STI testing suggests suboptimal adherence to national guidelines, particularly for sexually active adolescent females and young men who have sex with men who should be tested for Chlamydia and gonorrhea annually.
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Affiliation(s)
| | - Sanjana Pampati
- Divisions of Adolescent and School Health,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | | | - Riley J Steiner
- Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Hood MK, Michalopulos M, McCoy E, Winer JC, Bowden M. Improving Sexually Transmitted Infection Screening in Inpatient Pediatric Patients. Hosp Pediatr 2022; 12:507-515. [PMID: 35380002 DOI: 10.1542/hpeds.2021-005939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a group of infectious diseases that cause acute illness and lifelong health effects. Half of the diagnosed cases occur in adolescents and young adults, ages 15 to 24. The American Academy of Pediatrics and the Centers for Disease Control and Prevention provide guidelines for STI screening for sexually active adolescents. Despite this, screening rates in adolescents admitted to our hospital are low. The purpose of this study is to use quality improvement methodology to improve the percent of adolescent patients who had documentation of sexual histories from 49% to 69% and STI testing from 29% to 49%. METHODS Eligible patients included adolescents ages 14 to 18 admitted to our hospital's academic general pediatric service. After baseline data collection, we introduced a series of 6 interventions; percentages of sexual history documentation and STI screening were recorded monthly. Interventions included resident education on STI screening, history, and physical form prompts for sexual history documentation, "badge buddy" sexual history templates, faculty development, and an electronic medical record template. Data were interpreted by using statistical process control to show process change. RESULTS Before the interventions, 48.7% of patients ages 14 to 18 had sexual histories documented; 29.1% of patients were tested for STIs. After interventions, there was a special cause variation resulting in new center lines of 67.1% and 49.1%, respectively. CONCLUSIONS Simple interventions to normalize and standardize adolescent sexual history discussions cumulatively led to a significant increase in sexual history documentation and STI screening in an inpatient adolescent population.
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18
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Watson DL, Shaw PA, Petsis DT, Pickel J, Bauermeister JA, Frank I, Wood SM, Gross R. A retrospective study of HIV pre-exposure prophylaxis counselling among non-Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014-2019. J Int AIDS Soc 2022; 25:e25867. [PMID: 35192740 PMCID: PMC8863354 DOI: 10.1002/jia2.25867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Youth account for a disproportionate number of new HIV infections; however, pre-exposure prophylaxis (PrEP) use is limited. We evaluated PrEP counselling rates among non-Hispanic Black youth in the United States after a bacterial sexually transmitted infection (STI) diagnosis. METHODS We conducted a retrospective cohort study of Black youth receiving care at two academically affiliated clinics in Philadelphia between June 2014 and June 2019. We compared PrEP counselling for youth who received primary care services versus those who did not receive primary care services, all of whom met PrEP eligibility criteria due to STI diagnosis per U.S. Centers for Disease Control and Prevention clinical practice guidelines. Two logistic regression models for receipt of PrEP counselling were fit: Model 1 focused on sexual and gender minority (SGM) status and Model 2 on rectal STIs with both models adjusted for patient- and healthcare-level factors. RESULTS Four hundred and sixteen patients met PrEP eligibility criteria due to STI based on sex assigned at birth and sexual partners. Thirty patients (7%) had documentation of PrEP counselling. Receipt of primary care services was not significantly associated with receipt of PrEP counselling in either Model 1 (adjusted OR (aOR) 0.10 [95% CI 0.01, 0.99]) or Model 2 (aOR 0.52 [95% CI 0.10, 2.77]). Receipt of PrEP counselling was significantly associated with later calendar years of STI diagnosis (aOR 6.80 [95% CI 1.64, 29.3]), assigned male sex at birth (aOR 26.2 [95% CI 3.46, 198]) and SGM identity (aOR 317 [95% CI 39.9, 2521]) in Model 1 and later calendar years of diagnosis (aOR 3.46 [95% CI 1.25, 9.58]), assigned male sex at birth (aOR 18.6 [95% CI 3.88, 89.3]) and rectal STI diagnosis (aOR 28.0 [95% CI 8.07, 97.5]) in Model 2. Fourteen patients (3%) started PrEP during the observation period; 12/14 (86%) were SGM primary care patients assigned male sex at birth. CONCLUSIONS PrEP counselling and uptake among U.S. non-Hispanic Black youth remain disproportionately low despite recent STI diagnosis. These findings support the need for robust investment in PrEP-inclusive sexual health services that are widely implemented and culturally tailored to Black youth, particularly cisgender heterosexual females.
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Affiliation(s)
- Dovie L. Watson
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of BiostatisticsEpidemiology and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Pamela A. Shaw
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Danielle T. Petsis
- Craig Dalsimer Division of Adolescent MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Julia Pickel
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - José A. Bauermeister
- Department of Family & Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ian Frank
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Sarah M. Wood
- Craig Dalsimer Division of Adolescent MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Robert Gross
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of BiostatisticsEpidemiology and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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19
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Allison BA, Park RV, Walters EM, Perry MF. Increased Detection of Gonorrhea and Chlamydia After Implementation of a Universal Screening Protocol in a Pediatric Primary Care Clinic. Sex Transm Dis 2022; 49:117-122. [PMID: 34407011 PMCID: PMC8881983 DOI: 10.1097/olq.0000000000001534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Literature suggests that adolescents may not accurately report sexual activity to their providers, impeding risk-based screening efforts for gonorrhea and chlamydia (GC/CT). We assessed the effect of a clinic-based universal GC/CT screening initiative on GC/CT screening frequency and detection of GC/CT infections among adolescents (boys and girls ≥13 years) and the association between positive GC/CT and documented sexual activity. METHODS We conducted a pre-post analysis of a primary care clinic affiliated with an academic institution. The electronic medical record was queried to extract all adolescent well and acute encounters for the 12 months preimplementation and postimplementation of universal GC/CT screening in January 2015. RESULTS Eight hundred fifty-six encounters from 752 unique adolescents were included. Screening increased postimplementation (23.3% vs 61.4%, P < 0.001) of universal screening. Although there were similar rates of documented sexual activity preimplementation and postimplementation (14.6% vs 16.0%), a larger proportion of unknown sexual activity was documented (10.5% vs 23.7%, P < 0.001). Provider-level factors were the most frequent reasons for not screening. The absolute number of GC/CT cases increased, although the proportion of cases out of all eligible adolescents remained similar as more testing was completed (chlamydia, 5 of 752 vs 12 of 752; P = 0.09; gonorrhea, 0 of 752 vs 1 of 752; P = 0.32). Nearly half of positive chlamydia infections postimplementation appeared in adolescents who reported no sexual activity. CONCLUSIONS Universal screening in a primary care clinic increased screening and detection of cases of gonorrhea and chlamydia, including in adolescents who did not report sexual activity.
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Affiliation(s)
| | | | - Elizabeth M Walters
- University of North Carolina School of Nursing, Carrington Hall, Chapel Hill, NC
| | - Martha F Perry
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
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20
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Krist AH, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Stevermer J, Tseng CW, Wong JB. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326:949-956. [PMID: 34519796 DOI: 10.1001/jama.2021.14081] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Chlamydia and gonorrhea are among the most common sexually transmitted infections in the US. Infection rates are highest among adolescents and young adults of both sexes. Chlamydial and gonococcal infections in women are usually asymptomatic and may lead to pelvic inflammatory disease and its associated complications. Newborns of pregnant persons with untreated infection may develop neonatal chlamydial pneumonia or gonococcal or chlamydial ophthalmia. Infection in men may lead to urethritis and epididymitis. Both types of infection can increase risk of acquiring or transmitting HIV. OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for chlamydia and gonorrhea in sexually active adolescents and adults, including pregnant persons. POPULATION Asymptomatic, sexually active adolescents and adults, including pregnant persons. EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes with moderate certainty that screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection has moderate net benefit. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. RECOMMENDATION The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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21
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Fonseca S, Lacerda L, Teixeira C, Reis-Melo A, Tavares M. Sexually transmitted infections in Portuguese adolescents. An Pediatr (Barc) 2021; 96:454-455. [PMID: 34526245 DOI: 10.1016/j.anpede.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sara Fonseca
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal.
| | - Luísa Lacerda
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Cláudia Teixeira
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal; Facultad de Medicina, Universidad de do Porto, Oporto, Portugal; UCIBIO-REQUIMTE, Universidad de do Porto, Oporto, Portugal
| | - Ana Reis-Melo
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Margarida Tavares
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
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22
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Calihan JB, Recto M, Wheeler N, Tomaszewski K, Trent M. Using Reproductive Health as a Strategy to Engage Youth in Preventive Care. J Adolesc Health 2021; 69:523-526. [PMID: 33824072 PMCID: PMC8403621 DOI: 10.1016/j.jadohealth.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This research examined differences in receipt of recommended preventive services by contraceptive use in adolescent and young adult (AYA) women. METHODS Data are from a retrospective chart review of 408 AYA women who received sexual health risk reduction counseling in an urban academic AYA clinic. Descriptive, bivariate, and logistic regression analyses were used to examine relationships between contraception use and receipt of care. RESULTS AYA women aged 12-24 years using hormonal contraception were more likely to receive recommended preventive care, including an annual preventive visit and sexually transmitted infection screening, compared with those using condoms or no contraception. Women using medium-acting reversible contraception were more likely to have an annual visit compared with those not using hormonal contraception. CONCLUSIONS AYA women using contraception are more likely to receive recommended preventive health services, suggesting reproductive health visits may be used to promote engagement around preventive care.
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Affiliation(s)
- Jessica B Calihan
- Departments of Internal Medicine and Pediatrics, Johns Hopkins School of Medicine, Bloomberg Center, Baltimore, Maryland.
| | - Michelle Recto
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Noah Wheeler
- Analytics, Reporting, and Insights, APSI, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathy Tomaszewski
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria Trent
- Division of Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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23
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Rastogi R, Rome ES. Adolescent Gynecology in the Office Setting. Pediatr Rev 2021; 42:427-438. [PMID: 34341084 DOI: 10.1542/pir.2019-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ensuring open communication, partnership with patient and parent, and clarification of confidentiality during an adolescent gynecologic visit helps establish an environment in which a history and physical examination can be performed safely and with a focus on prevention, recognition of disease, and treatment as necessary. The history should include the menstrual status and gynecologic review of systems. The examination should document Tanner staging (sexual maturity rating) and be otherwise symptom guided. Similarly, testing in the office is largely risk and symptom related. Contraceptive counseling is an important component of the office visit, as well. Long and short curricula for teaching pediatric and adolescent gynecology have been developed by the North American Society for Pediatric and Adolescent Gynecology and are readily available for use. (1)(2) Although state-based variation in consent and confidentiality exists, pediatric practices should aim to protect patient confidentiality and transition to more independent health-care decision making.
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Affiliation(s)
- Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Ellen S Rome
- Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, Department of Pediatric Endocrinology, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH
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24
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Mohamad Shakir SM, Wong LP, Lim Abdullah K, Adam P. Online STI information seeking behaviour and condom use intentions among young Facebook users in Malaysia. Health Promot Int 2021; 35:1116-1124. [PMID: 31665378 DOI: 10.1093/heapro/daz108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Internet has opened pathways for youth to find sexual health information which was not easily available to them in the past. Studies have shown that seeking sexual health information online may potentially influence an individuals' decision-making to change their sexual health behaviours. However, there is a gap in research on the associations of seeking online sexually transmitted infection (STI) information with STI prevention among young people, particularly in Malaysia. This study investigated the associations of seeking STI information online with the intentions of condom use among young adult online users in Malaysia. A cross-sectional online survey was conducted among Malaysian youth aged 18-25 years old who were recruited through Facebook. In total, 1530 respondents completed the survey, identifying 874 respondents who had sought STI information online. The majority of respondents had intentions to use condoms as protection against STI. Respondents who sought online STI information were significantly more likely to have the intention to use condoms compared to respondents who did not seek online STI information (OR = 1.33, 95% CI = 1.01-1.76, p = 0.040). Online STI information has the potential to increase access to STI information among young online users in Malaysia amid the stigma surrounding sex-related issues. Providing accurate STI information online from reliable sources may equip young people who have Internet access with awareness of sexual health protective behaviours such as condom use. It is recommended to facilitate Internet access to reach sectors of the population that currently do not have access, as the Internet is useful in STI prevention.
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Affiliation(s)
- Sharina Mahavera Mohamad Shakir
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Phillipe Adam
- Centre for Social Research in Health, UNSW Sydney, NSW 2052, Australia
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25
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Fonseca S, Lacerda L, Teixeira C, Reis E Melo A, Tavares M. [Sexually transmitted infections in Portuguese adolescents]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00224-1. [PMID: 34304983 DOI: 10.1016/j.anpedi.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sara Fonseca
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal.
| | - Luísa Lacerda
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Cláudia Teixeira
- Servicio de Patología Clínica, Centro Hospitalar Universitário de São João, Oporto, Portugal; Facultad de Medicina, Universidade do Porto, Oporto, Portugal; UCIBIO-REQUIMTE, Universidade do Porto, Oporto, Portugal
| | - Ana Reis E Melo
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Margarida Tavares
- Servicio de Pediatría, Hospital Pediátrico Integrado, Centro Hospitalar Universitário de São João, Oporto, Portugal; Unidad Pediátrica de Enfermedades Infecciosas e Inmunodeficiencias, Servicio de Pediatría, Centro Hospitalar Universitário de São João, Oporto, Portugal
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A Clinic-Based Quality Improvement Initiative to Increase Screening for Gonorrhea and Chlamydia in Adolescents. Jt Comm J Qual Patient Saf 2021; 47:510-518. [PMID: 34074609 DOI: 10.1016/j.jcjq.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Universal screening is a strategy for addressing the limitations of risk-based screening for gonorrhea and chlamydia (GC/CT). This quality improvement (QI) initiative aimed to improve GC/CT screening by implementing universal annual screening for all adolescents ≥ 13 years old. METHODS At an academic pediatric resident continuity clinic, an interdisciplinary team designed and conducted multiple Plan-Do-Study-Act (PDSA) cycles over one year. The primary aim, and process measure, was to increase the percentage of encounters with screening for GC/CT in the 12 months prior to the encounter to 80%. The secondary outcome measure was rate of detection of GC or CT infection. Further, pulse checks of provider/staff knowledge and adherence were conducted. The balancing measure was denied insurance claims. RESULTS The mean screening rate of 29.2% increased during the project implementation to 65.1% with several bundles of PDSA cycles. There were no cases of gonorrhea detected in the baseline period or implementation period. The case rate of chlamydia was similar during both periods (from 9.7 per 1,000 adolescent encounters to 10.8 per 1,000 adolescent encounters, p = 0.74). There was similarly high provider/staff knowledge about (p = 0.35) and adherence to (p = 0.06) the screening protocol at 6 and 12 months of implementation. There was no increase in percentage of denied insurance claims. CONCLUSION This QI initiative doubled rates of GC/CT screening with no statistically significant increase in number of cases.
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Ahmad FA, Payne PRO, Lackey I, Komeshak R, Kenney K, Magnusen B, Metts C, Bailey T. Using REDCap and Apple ResearchKit to integrate patient questionnaires and clinical decision support into the electronic health record to improve sexually transmitted infection testing in the emergency department. J Am Med Inform Assoc 2021; 27:265-273. [PMID: 31722414 DOI: 10.1093/jamia/ocz182] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/16/2019] [Accepted: 09/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Audio-enhanced computer-assisted self-interviews (ACASIs) are useful adjuncts for clinical care but are rarely integrated into the electronic health record (EHR). We created a flexible framework for integrating an ACASIs with clinical decision support (CDS) into the EHR. We used this program to identify adolescents at risk for sexually transmitted infections (STIs) in the emergency department (ED). We provide an overview of the software platform and qualitative user acceptance. MATERIALS AND METHODS We created an ACASI with a CDS algorithm to identify adolescents in need of STI testing. We offered it to 15- to 21-year-old patients in our ED, regardless of ED complaint. We collected user feedback via the ACASI. These were programmed into REDCap (Research Electronic Data Capture), and an iOS application utilizing Apple ResearchKit generated a tablet compatible representation of the ACASI for patients. A custom software program created an HL7 (Health Level Seven) message containing a summary of responses, CDS recommendations, and STI test orders, which were transmitted to the EHR. RESULTS In the first year, 1788 of 6227 (28.7%) eligible adolescents completed the survey. Technical issues led to decreased use for several months. Patients rated the system favorably, with 1583 of 1787 (88.9%) indicating that they were "somewhat" or "very comfortable" answering questions electronically and 1291 of 1787 (72.2%) preferring this format over face-to-face interviews or paper questionnaires. CONCLUSIONS We present a novel use for REDCap to combine patient-answered questionnaires and CDS to improve care for adolescents at risk for STIs. Our program was well received and the platform can be used across disparate patients, topics, and information technology infrastructures.
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Affiliation(s)
- Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.,Department of Medicine, Washington School of Medicine University in St. Louis, St. Louis, Missouri, USA
| | - Ian Lackey
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Rachel Komeshak
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kenneth Kenney
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Brianna Magnusen
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christopher Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas Bailey
- Department of Medicine, Washington School of Medicine University in St. Louis, St. Louis, Missouri, USA
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Ardura MI, Coscia LA, Meyers MR. Promoting safe sexual practices and sexual health maintenance in pediatric and young adult solid organ transplant recipients. Pediatr Transplant 2021; 25:e13949. [PMID: 33491268 DOI: 10.1111/petr.13949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
The majority of Americans make their sexual debut during their adolescent years. Preventing pregnancy and STI during this period is vital to ensuring health and safety. As survival has improved after pediatric SOT, chronically immunosuppressed adolescents seek guidance in their medical home on matters of sexual health. Transplant practitioners often do not feel equipped to fully address these needs. This review serves as an introductory sexual preventive care resource for adolescent and young adult (AYA) SOT recipients. First, we review data on safety, efficacy, and use of contraceptive options currently available for transplant recipients with child-bearing potential. Then, we suggest a personalized sexual health discussion focusing on the diagnosis and prevention of STIs in adolescent and young adult transplant recipients. Finally, we present recommendations for STI screening of asymptomatic patients, use of index of suspicion and diagnostic testing in symptomatic patients, and opportunities to optimize STI prevention strategies. Data compiled from studies of adult SOT recipients, general population studies, and published guidelines are often extrapolated for use, as limited data exist in AYA SOT recipients. This informational dearth underscores the need for future research to better characterize the unique needs of AYA SOT recipients.
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Affiliation(s)
- Monica I Ardura
- Pediatric Infectious Diseases & Host Defense, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Lisa A Coscia
- Transplant Pregnancy Registry International, Philadelphia, PA, USA
| | - Melissa R Meyers
- Pediatric Nephrology, Children's National Health System, Washington, DC, USA
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Schlegel EC, Smith LH. Improving Research, Policy, and Practice to Address Women's Sexual and Reproductive Health Care Needs During Emerging Adulthood. Nurs Womens Health 2021; 25:10-20. [PMID: 33453156 PMCID: PMC8549865 DOI: 10.1016/j.nwh.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/11/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
Women in the period of emerging adulthood (18-25 years of age) have the greatest rates of unintended pregnancy and sexually transmitted infections. Despite this disproportionate risk, women's sexual and reproductive health needs during emerging adulthood are poorly understood. As a result, few age-specific policies or person-centered practice guidelines are available to reduce sexual risk. In this commentary we explore the unique characteristics of emerging adulthood that contribute to greater sexual and reproductive health risks for women. Current evidence on sexual and reproductive health outcomes of women during emerging adulthood and limited practice guidelines are discussed. Recommendations for health care providers, especially nurses, for guiding personalized care for women in emerging adulthood are discussed.
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Thompson EL, Griner SB, Galvin AM, Lowery AD, Lewis MA. Correlates of STI Testing Among US Young Adults: Opportunities for Prevention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:216-226. [PMID: 33135130 PMCID: PMC7855090 DOI: 10.1007/s11121-020-01179-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to examine sex cognitions and behavioral strategy correlates for chlamydia, gonorrhea, and HIV testing among a national sample of young adults ages 18-20. Young adults (18-20 years) were recruited nationally (n = 1144). The sample was restricted (n = 817) based on inclusion/exclusion criteria for analysis. The outcome variables were gonorrhea, chlamydia, and HIV testing, respectively, in the last 12 months. Covariates included demographic variables, alcohol use, perceived vulnerability, protective behavioral strategies, and sexual behavior in the last 3 months. Adjusted logistic regression models were estimated in SAS 9.4. Approximately 24% of respondents were tested for chlamydia and gonorrhea, and 21% were tested for HIV in the past year. Women were more likely than men to be tested for chlamydia (OR = 1.67, 95% CI 1.13, 2.46) and gonorrhea (OR = 1.55, 95% CI 1.05, 2.28). Persons who were worried about an STI after a sexual encounter and who engaged in casual sex were more than two times as likely to be tested for all three STIs. Similarly, persons who used more non-condom-related protective behavioral strategies were more likely to be tested. Future studies may consider these correlates as potential intervention points for promoting STI testing among young adults.
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Affiliation(s)
- Erika L Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Stacey B Griner
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Annalynn M Galvin
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Ashley D Lowery
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Melissa A Lewis
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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Gearhart AS, Badolato GM, Goyal MK. Adolescent Attitudes Toward Sexually Transmitted Infection Screening in the Emergency Department. Pediatr Emerg Care 2020; 36:e573-e575. [PMID: 29298252 PMCID: PMC6028310 DOI: 10.1097/pec.0000000000001387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adolescents who seek care in emergency departments (EDs) are often at high risk for sexually transmitted infections (STIs). The objective of this study was to assess adolescent attitudes toward ED-based STI screening. METHODS We conducted a secondary analysis of a cross-sectional study that evaluated STI screening acceptability and prevalence when STI testing was universally offered to asymptomatic adolescents presenting to the ED for care. Adolescents 14 to 21 years old completed a computerized survey and answered questions regarding attitudes toward ED-based STI screening and sexual behavior. We performed multivariable logistic regression to compare differences in attitudes toward ED-based STI screening among patients who agreed versus declined STI testing. RESULTS Of 553 adolescents, 326 (59.0%) agreed to be tested for STIs. Most (72.1%) believed the ED was an appropriate place for STI screening. Patients who agreed to be tested for STIs were more likely to positively endorse ED-based STI screening than those who declined STI testing [77.0% vs 64.8%; adjusted odds ratios, 1.6; 95% confidence interval (CI), 1.1-2.4]. Most (82.6%) patients stated they would feel comfortable getting tested for STIs in the ED. There was no difference in the comfort level of ED-based STI testing between those who agreed and declined STI testing (83.5% vs 81.4%; adjusted odds ratios, 1.1; 95% CI, 0.7-1.8). CONCLUSION Our results suggest that adolescents view the ED as an acceptable location for STI screening. Therefore, the ED may serve a role in increasing the accessibility of STI detection and prevention resources for adolescents.
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Affiliation(s)
| | | | - Monika K. Goyal
- Children’s National Health System, Washington, DC
- Departments of Pediatrics and Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
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"I'll Just Pick It Up…": Women's Acceptability of Self-Sampling Methods for Sexually Transmitted Infection Screening. Sex Transm Dis 2020; 46:762-767. [PMID: 31688722 DOI: 10.1097/olq.0000000000001077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rates of sexually transmitted infection (STI) screening are suboptimal among college women. Self-sampling methods (SSMs) may improve STI screening rates, but critical gaps remain regarding the influential characteristics of SSM to prioritize in intervention development. The purpose of this study was to explore intervention characteristics influencing the decision to adopt SSM among college women. METHODS In-depth interviews (n = 24) were conducted with sexually active college women aged 18-24 years to explore preferred intervention characteristics of SSM. Interviews were stratified by screening status (screened or not screened). The instrument was guided by constructs from the Diffusion of Innovation theory and included characteristics of SSM, such as relative advantage, compatibility, complexity, adaptability, and risk and uncertainty. RESULTS Overall, women felt that the SSM was not complex and that the instructions were straightforward. Participants discussed their strong preference for receiving their results via text or e-mail rather than via telephone. In addition, women described their concerns about mailing their sample and described their concern about potential contamination and tampering. The most salient advantage to use of SSM was avoiding an interaction with a health care provider. CONCLUSIONS This study contributes to an understanding of the salient intervention characteristics influencing the use of SSM for STI screening, which can be leveraged to improve the health of students and improve rates of screening. Findings can be used to inform the development of a future innovative, theory-based intervention that promotes the use of SSM to improve STI screening rates, and ultimately decrease the burden of STI-related disease.
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Kessler R, Hinkle BT, Moyers A, Silverberg B. Adolescent Sexual Health: Identity, Risk, and Screening for Sexually Transmitted Infections. Prim Care 2020; 47:367-382. [PMID: 32423720 DOI: 10.1016/j.pop.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Development of SOGIE (sexual orientation and gender identity and expression) is not unique to minority populations, as all adolescents grapple with their sexuality and identity. Health care providers straddle the unique positions of authority figure and advocate and can help these young people establish behaviors that will allow them to flourish as adults. This article discusses the appropriate language to use while conducting a sexual history, summarizes the epidemiologic data on sexually transmitted infections, and reviews the screening and reporting guidelines set forth by the United States Preventive Services Task Force and the Centers for Disease Control and Prevention.
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Affiliation(s)
- Roanna Kessler
- Johns Hopkins University Student Health and Wellness Center, Homewood Student Affairs, 1 East 31st Street, N200, Baltimore, MD 21218, USA
| | - B Tate Hinkle
- Total Healthcare at Russell Medical Center, 3504 Highway 280, Alexander City, AL 35010, USA; Department of Family Medicine, UAB Huntsville Regional Medical Campus, 301 Governors Drive SW, Huntsville, AL 35801, USA
| | - Amy Moyers
- Department of Family Medicine, WVU Medicine, 6040 University Town Center Drive, Morgantown, WV 26501, USA
| | - Benjamin Silverberg
- Department of Family Medicine, WVU Medicine, 6040 University Town Center Drive, Morgantown, WV 26501, USA; Department of Emergency Medicine, WVU Medicine, 1 Medical Center Drive, Box 9149, Morgantown, WV 26506, USA; Division of Physician Assistant Studies, Department of Human Performance, West Virginia University School of Medicine, 64 Medical Center Drive, Box 9226, Morgantown, WV 26506, USA.
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Barrow RY, Ahmed F, Bolan GA, Workowski KA. Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020. MMWR Recomm Rep 2020; 68:1-20. [PMID: 31899459 PMCID: PMC6950496 DOI: 10.15585/mmwr.rr6805a1] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
This report (hereafter referred to as STD QCS) provides CDC recommendations to U.S. health care providers regarding quality clinical services for sexually transmitted diseases (STDs) for primary care and STD specialty care settings. These recommendations complement CDC's Sexually Transmitted Diseases Treatment Guidelines, 2015 (hereafter referred to as the STD Guidelines), a comprehensive, evidence-based reference for prevention, diagnosis, and treatment of STDs. STD QCS differs from the STD Guidelines by specifying operational determinants of quality services in different types of clinical settings, describing on-site treatment and partner services, and indicating when STD-related conditions should be managed through consultation with or referral to a specialist. These recommendations might also help in the development of clinic-level policies (e.g., standing orders, express visits, specimen panels, and reflex testing) that can facilitate implementation of the STD Guidelines. CDC organized the recommendations for STD QCS into eight sections: 1) sexual history and physical examination, 2) prevention, 3) screening, 4) partner services, 5) evaluation of STD-related conditions, 6) laboratory, 7) treatment, and 8) referral to a specialist for complex STD or STD-related conditions.CDC developed the recommendations by synthesizing relevant, evidence-based guidelines and recommendations issued by other experts; reviewing current practice in the United States; soliciting Delphi ratings by subject matter experts on STD care in primary care and STD specialty care settings; discussing the scientific evidence supporting the proposed recommendations at a consultation meeting of experts and institutional stakeholders held November 20, 2015, in Atlanta, Georgia; conducting peer reviews of draft recommendations and supporting evidence; and discussing draft recommendations and supporting evidence during meetings of the CDC/Health Resources and Services Administration Advisory Committee on HIV, Viral Hepatitis, and STD Prevention and Treatment STD Work Group. These recommendations are intended to help health care providers in primary care or STD specialty care settings offer STD services at their clinical settings and to help the persons seeking care live safer, healthier lives by preventing and treating STDs and related complications.
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Gannon-Loew KE, Holland-Hall C. A review of current guidelines and research on the management of sexually transmitted infections in adolescents and young adults. Ther Adv Infect Dis 2020; 7:2049936120960664. [PMID: 33598210 PMCID: PMC7863142 DOI: 10.1177/2049936120960664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/28/2020] [Indexed: 11/19/2022] Open
Abstract
Adolescents and young adults are at high risk for sexually transmitted infections (STIs). Providers have the responsibility to accurately manage these infections to prevent medical complications and the spread of STIs. This article will review the epidemiology, screening recommendations, diagnostic tests, and treatment guidelines for STIs most commonly encountered in this population: Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus, and Trichomonas vaginalis, as well as the sexually associated infection bacterial vaginosis. This review will discuss ongoing research that explores ways to improve the management of STIs in adolescents and young adults.
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Affiliation(s)
| | - Cynthia Holland-Hall
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
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Feldkamp ML, Arnold KE, Krikov S, Reefhuis J, Almli LM, Moore CA, Botto LD. Risk of gastroschisis with maternal genitourinary infections: the US National birth defects prevention study 1997-2011. BMJ Open 2019; 9:e026297. [PMID: 30928950 PMCID: PMC6475179 DOI: 10.1136/bmjopen-2018-026297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the association between occurrence and timing of maternal self-reported genitourinary tract infection (urinary tract infections [UTIs] and/or sexually transmitted infection [STI]) and risk for gastroschisis in the offspring. DESIGN Population-based case-control study. SETTING National Birth Defects Prevention Study, a multisite study in the USA. PARTICIPANTS Mothers of 1366 gastroschisis cases and 11 238 healthy controls. MAIN OUTCOME MEASURES Crude and adjusted ORs (aORs) with 95% CIs. RESULTS Genitourinary infections were frequent in case (19.3%) and control women (9.9%) during the periconceptional period (defined as 3 months prior to 3 months after conception). UTI and/or STI in the periconceptional period were associated with similarly increased risks for gastroschisis (aOR 1.5, 95% CI 1.3 to 1.8; aOR 1.6, 95% CI 1.2 to 2.3, respectively). The risk was increased with a UTI before (aOR 2.5; 95% CI 1.4 to 4.5) or after (aOR 1.7; 95% CI 1.1 to 2.6) conception only among women ≥25 years of age. The risk was highest among women <20 years of age with an STI before conception (aOR 3.6; 95% CI 1.5 to 8.4) and in women ≥25 years of age, the risk was similar for before (aOR 2.9; 95% CI 1.0 to 8.5) and after (aOR 2.8; 95% CI 1.3 to 6.1) conception. A specific STI pathogen was reported in 89.3% (50/56) of cases and 84.3% (162/191) of controls with Chlamydia trachomatis the most common (25/50 cases, 50%; 58/162 controls, 36%) and highest among women <20 years of age (16/25 cases, 64%; 22/33 controls, 67%). CONCLUSIONS UTI and/or STI were associated with an increased risk for gastroschisis, with the strength of the association varying by maternal age and timing of infection.
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Affiliation(s)
- Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kathryn E Arnold
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sergey Krikov
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lynn M Almli
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Carter Consulting, Inc, Atlanta, Georgia, USA
| | - Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Sieving RE, Gewirtz O'Brien JR, Saftner MA, Argo TA. Sexually Transmitted Diseases Among US Adolescents and Young Adults: Patterns, Clinical Considerations, and Prevention. Nurs Clin North Am 2019; 54:207-225. [PMID: 31027662 DOI: 10.1016/j.cnur.2019.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article describes prevalence and recent trends in the most common sexually transmitted diseases (STD) among young people in the United States. Common clinical presentations and best practices related to screening and treatment of these conditions are summarized. Clinical considerations for working with adolescents and young adults in the area of sexual and reproductive health are highlighted. Key approaches for sexually transmitted disease prevention with adolescents and young adults are presented.
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Affiliation(s)
- Renee E Sieving
- School of Nursing and Department of Pediatrics, University of Minnesota, University of MN School of Nursing, 5-140 Weaver Densford Hall, 308 Harvard Street Southeast, Minneapolis, MN 55455, USA.
| | - Janna R Gewirtz O'Brien
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware Street Southeast Suite 353, Minneapolis, MN 55414, USA
| | - Melissa A Saftner
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard Street Southeast, Minneapolis, MN 55455, USA
| | - Taylor A Argo
- Department of Pediatrics, Pediatric Education Office, University of Minnesota, Room M136, 1st Floor, East Building, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
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Abstract
BACKGROUND AND PURPOSE Primary care providers who encounter children are often the first line of contact for individuals with gender dysphoria, which occurs when sex assigned at birth is incongruent with one's true, expressed sexual identity. Because those with untreated gender dysphoria are at risk of a variety of negative outcomes, including mood symptomatology, suicidality, substance use disorders, and other psychosocial risk factors, it is critical that health care providers are adept in the provision of holistic, patient-centered care. The purpose of this report is to provide an updated review of the current evidence from the literature pertaining to the identification, treatment, and coordination of care among children with gender dysphoria within the primary care setting or medical home. METHODS Using PubMed and CINAHL, a literature review spanning from 2012 to the present was conducted using the following key words: gender dysphoria, transgender health, LGBT health, and hormone therapy. Reference lists of identified articles were also explored for relevance. CONCLUSIONS Treatment may include a social transition, hormone antagonist therapy, or the administration of cross-sex hormone therapy, with a medical home needed to facilitate coordination of care. Best practice guidelines vary across pediatric and developmental groups and include both reversible and nonreversible modalities. Screening for negative psychosocial sequelae must be completed to include mood symptomatology, suicidality, substance use disorders, and risky sexual behavior, so that appropriate screening, identification, and treatment interventions can be implemented. IMPLICATIONS FOR PRACTICE The primary care medical home must act as a foundation for the identification of gender dysphoria and/or associated comorbidities and must treat, when able, or refer, when indicated. In addition, because of structural barriers and stigmatization, public policy often fails the transgender community and can exacerbate the aforementioned psychosocial comorbidities faced by the transgender youth community. Health care providers, particularly nurse practitioners, are in a unique position to expand on the face-to-face care provided to the community and engage in advocacy efforts to dismantle structural barriers impeding transgender individuals and communities while also providing primary health care, anticipatory guidance, and care coordination.
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Reisner SL, Jadwin-Cakmak L, Sava L, Liu S, Harper GW. Situated Vulnerabilities, Sexual Risk, and Sexually Transmitted Infections' Diagnoses in a Sample of Transgender Youth in the United States. AIDS Patient Care STDS 2019; 33:120-130. [PMID: 30844303 PMCID: PMC6442265 DOI: 10.1089/apc.2018.0249] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In the United States, sexually transmitted infections (STIs) confer significant morbidity in adolescents and young adults. STIs are not well characterized in transgender and other gender minority youth (TGMY) who have a gender identity that differs from the sex assigned to them at birth. This study sought to fill this gap. In 2015-2016, the Adolescent Medicine Trials Network for HIV/AIDS Interventions conducted Protocol 130, Affirming Voices for Action, enrolling a diverse sample of TGMY 16-24 years of age from 14 US geographic locations. Multivariable analyses regressed lifetime STI diagnosis on "situated vulnerabilities" (demographics, social/economic issues, mental/behavioral health conditions, and health care experience). Approximately one-third were living with HIV infection (31%); 33% had a history of one or more STIs, excluding HIV. The most frequently diagnosed STIs were 55% chlamydia, 48% syphilis, and 47% gonorrhea. The odds of STI was 4.06 times higher for trans feminine youth assigned a male sex at birth compared to trans masculine youth assigned a female sex at birth (p = 0.03). Additional risk factors for lifetime STI were as follows: nonbinary gender identity (p = 0.004), medical gender affirmation (p = 0.03), and transactional sex (p = 0.01). Nearly one-third (31%) reported condomless vaginal and/or anal sex in the last 6 months, suggesting a need for ongoing STI prevention, screening, diagnosis, and treatment. TGMY are a vulnerable group to STIs in need of public health attention. Clinical care for STIs will benefit from considering risk factors facing youth in general (e.g., sex work), alongside those vulnerabilities unique to TGMY (e.g., medical gender affirmation).
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Affiliation(s)
- Sari L. Reisner
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lauren Sava
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - ShanShan Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
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Masonbrink AR, Stancil S, Reid KJ, Goggin K, Hunt JA, Mermelstein SJ, Shafii T, Lehmann AG, Harhara H, Miller MK. Adolescent Reproductive Health Care: Views and Practices of Pediatric Hospitalists. Hosp Pediatr 2019; 9:100-106. [PMID: 30622112 DOI: 10.1542/hpeds.2018-0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Many hospitalized adolescents are at increased risk for pregnancy complications due to an underlying medical condition, however sexual risk assessment is not consistently performed in this setting. While adolescents and their parents are supportive of sexual health discussion in the inpatient setting, a thorough understanding of factors that influence provision of this care among pediatric hospital physicians is lacking. This formative information is needed to facilitate efforts to improve and standardize clinical care provision. Our objective is to assess the frequency and factors that influence the provision of adolescent sexual and reproductive care by pediatric hospitalists. METHODS We performed a cross-sectional computerized survey of hospitalists at 5 pediatric hospitals who cared for ≥1 adolescent (14-21 years old) in the past year. Sexual and reproductive care practices were assessed by using a 76-item novel survey informed by the theory of planned behavior. We used descriptive statistics to summarize the data. RESULTS Sixty-eight pediatric hospitalists participated (49% response rate): 78% were women and 65% were aged <40 years. Most (69%) reported treating >46 adolescents annually, including many who are at an increased risk for pregnancy complications due to teratogenic medication use or a comorbid condition. A majority felt that sexual and reproductive services are appropriate, although many endorsed barriers, including concern about follow-up after emergency contraception (63%) and time constraints (53%). Most reported insufficient knowledge regarding contraception (59%), desired contraception education (57%), and were likely to increase contraceptive provision if provided education (63%). Hospitalists rarely provided condoms or referral for an intrauterine device. CONCLUSIONS Pediatric hospitalists frequently care for adolescents who are at risk for pregnancy complications and generally agree that reproductive care is appropriate in the inpatient setting. With these findings, we highlight the critical need for effective comprehensive reproductive health service interventions that are tailored to address the numerous actionable barriers identified in this study.
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Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; .,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Stephani Stancil
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Kathy Goggin
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.,Division of Health Services and Outcomes Research and
| | - Jane Alyce Hunt
- Department of Pediatrics, St Louis Children's Hospital and School of Medicine, Washington University, St Louis, Missouri
| | - Sarah J Mermelstein
- Department of Pediatrics, St Louis Children's Hospital and School of Medicine, Washington University, St Louis, Missouri
| | - Taraneh Shafii
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Amber G Lehmann
- Department of Pediatrics, East Carolina University, Greenville, North Carolina; and
| | - Haleema Harhara
- Department of Pediatrics, Children's Hospital of San Antonio, San Antonio, Texas
| | - Melissa K Miller
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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Abstract
This article discusses sexually transmitted infections (STI) screening and focuses on reportable STIs. This includes gonorrhea, chlamydia, syphilis, and human immunodeficiency virus. Hepatitis B and C, trichomonas, and herpes are covered as well. Recommendations are summarized from the various organizations that produce screening recommendations. These screening recommendations only apply to asymptomatic individuals. Once an individual has symptoms, testing becomes diagnostic. It is important to know the prevalence of STIs within your population. If you work in a population with a high prevalence of a specific disease, you may want to screen regardless of the recommendations.
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Affiliation(s)
- Shoshana B Levy
- Residency in General Preventive Medicine and Public Health, Florida Department of Health, Palm Beach County, 800 Clematis, West Palm Beach, FL 33401, USA.
| | - Jyothi Gunta
- Residency in General Preventive Medicine and Public Health, Florida Department of Health, Palm Beach County, 800 Clematis, West Palm Beach, FL 33401, USA
| | - Peter Edemekong
- Residency in General Preventive Medicine and Public Health, Florida Department of Health, Palm Beach County, 800 Clematis, West Palm Beach, FL 33401, USA
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Karas D, Sondike S, Fitzgibbon J, Redding M, Brown M. Using a Clinical Decision Support Tool to Increase Chlamydia Screening Across a Large Primary Care Pediatric Network. Clin Pediatr (Phila) 2018; 57:1638-1641. [PMID: 30264577 DOI: 10.1177/0009922818803397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aim to demonstrate increased chlamydia screening across a large pediatric network using an electronic health record-based intervention. We developed a pop-up notification that alerted providers that chlamydia screening was recommended during a well adolescent visit, when appropriate. We compared chlamydia screening rates before and after the implementation of the alert. The screening rate for chlamydia improved from 2.40% in the year before intervention to 5.01% in the year after intervention ( P < .01). In conclusion, an electronic health record intervention was successfully able to significantly increase rates of chlamydia screening across a large pediatric network.
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Affiliation(s)
- David Karas
- 1 Akron Children's Hospital Medical Center, Akron, OH, USA
- 2 Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Stephen Sondike
- 1 Akron Children's Hospital Medical Center, Akron, OH, USA
- 2 Northeastern Ohio Medical University, Rootstown, OH, USA
| | - James Fitzgibbon
- 1 Akron Children's Hospital Medical Center, Akron, OH, USA
- 2 Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Mark Redding
- 1 Akron Children's Hospital Medical Center, Akron, OH, USA
- 2 Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Miraides Brown
- 3 Rebecca D Considine Research Institute, Akron, OH, USA
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Yonts AB, Kronman MP, Hamdy RF. The Burden and Impact of Antibiotic Prescribing in Ambulatory Pediatrics. Curr Probl Pediatr Adolesc Health Care 2018; 48:272-288. [PMID: 30337150 DOI: 10.1016/j.cppeds.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Antibiotics are one of the most commonly prescribed classes of medication for children and adolescents. While they are arguably the most powerful tool we possess against bacterial infections, they are frequently given to children whose illnesses are due to viruses or other non-infectious etiologies. When antibiotics are not used judiciously, the consequences can be serious and accumulate over time. This review article quantifies the burden of antimicrobial use in the pediatric outpatient setting in the United States, reviews recommended first line antibiotic regimens for common outpatient pediatric and adolescent conditions, investigates the reasons for inappropriate prescribing of antibiotics in outpatient healthcare settings, and explores the range of consequences of overuse and inappropriate use of antibiotics, from adverse drug reactions to impact on the microbiome to rising rates of antimicrobial resistance in common ambulatory conditions.
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Affiliation(s)
- Alexandra B Yonts
- Division of Infectious Diseases, Children's National Medical Center, Washington, D.C., United States
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Rana F Hamdy
- Division of Infectious Diseases, Children's National Medical Center, Washington, D.C., United States; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States.
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Physician Adherence to Centers for Disease Control and Prevention Guidelines for Sexually Active Adolescents in the Pediatric Emergency Setting. Pediatr Emerg Care 2018; 34:767-773. [PMID: 27749798 PMCID: PMC5378669 DOI: 10.1097/pec.0000000000000873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES There is limited literature about physicians' adherence to 2010 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases Treatment Guidelines specific to specimen collection testing methods in adolescent females in the emergency setting is limited. The objectives are to (1) determine physician adherence to CDC guidelines for specimen collection/testing for chlamydia and gonorrhea, (2) determine physician characteristics associated with guideline adherence, and (3) describe physicians' knowledge of expedited partner therapy (EPT) laws. METHODS This is a cross-sectional, anonymous, Internet-based survey of physician members of the American Academy of Pediatrics Section of Emergency Medicine. Questions addressed practice patterns and knowledge through clinical scenarios of adolescent girls. Descriptive statistics are used to report frequency. Fisher exact and χ analyses are used to compare physician subgroups: gender, years in practice, practice setting, and geographical region. RESULTS Overall, 257 physicians responded and 231 were analyzed; 62.4% females; 46.0% in practice for ≤ 7 years; 86.2% in academic medicine. Specimen collection/testing in an asymptomatic patient were consistent with guidelines for 85.6% of respondents, but decreased to 37.4% for a symptomatic patient. Guideline adherence was not different between physician subgroups. Only 30.4% of physicians reported state EPT law knowledge. CONCLUSIONS Adherence with the CDC guidelines for chlamydia/gonorrhea specimen collection/testing for adolescents in the emergency setting is inadequate, and EPT knowledge is poor. With increased emergency department use by adolescents, it is critical that physicians know and implement the current recommendations to improve adolescent health outcomes.
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Pickett ML, Melzer-Lange MD, Miller MK, Menon S, Visotcky AM, Drendel AL. Perceived Patient Preference and Clinical Testing for Chlamydia and Gonorrhea in Females: How Closely Are These Aligned? Clin Pediatr (Phila) 2018; 57:106-108. [PMID: 28081613 PMCID: PMC6290991 DOI: 10.1177/0009922816687331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Seema Menon
- Medical College of Wisconsin, Milwaukee, WI, USA
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Wang LY, Chang MH, Burstein G, Adkins SH. Human Immunodeficiency Virus, Chlamydia, and Gonorrhea Testing in New York Medicaid-Enrolled Adolescents. Sex Transm Dis 2018; 45:14-18. [PMID: 28876281 PMCID: PMC10658586 DOI: 10.1097/olq.0000000000000686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although growing public health efforts have been expended on increasing adolescents' access to human immunodeficiency virus (HIV) and sexually transmitted infection (STI) testing, little is known about the current utilization of those services in clinical settings. METHODS Using 2010 to 2012 New York State Center for Medicare and Medicaid Services Medicaid Analytic eXtract data, we estimated the annual percentage of 13- to 19-year-olds who were tested for HIV, chlamydia (CT), and gonorrhea (GC). A regression analysis was performed to identify factors independently associated with testing utilization. We further examined testing utilization in all adolescent females with 1 or more health care encounter, pregnant females, and adolescents at increased risk for HIV/STI. RESULTS From 2010 to 2012, HIV, CT, and GC testing rates increased in the overall study population and in most demographic subgroups. Female adolescents, black and Hispanic adolescents, at-risk adolescents, and adolescents with 6 months or longer of enrollment were significantly more likely to be tested. Among adolescent females with 1 or more health care encounter, 19.2% were tested for CT and 16.9% tested for GC in 2012. Among pregnant females, 35.2%, 53.9%, and 46.1% were tested for HIV, CT, and GC, respectively. Among at-risk adolescents, 39.9%, 63.7%, and 54.4% were tested for HIV, CT, and GC, respectively. CONCLUSIONS Although progress had been made by New York State providers to adhere to recommended testing for adolescents, there was a clear gap between the recommended level of testing and the actual level of utilization among sexually active females, pregnant females, and at-risk adolescents. Opportunities exist for community provider and public health collaboration to increase adolescent HIV and STI testing.
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Affiliation(s)
- Li Yan Wang
- Centers for Disease Control and Prevention, Atlanta, GA
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47
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Maraynes ME, Chao JH, Agoritsas K, Sinert R, Zehtabchi S. Screening for asymptomatic chlamydia and gonorrhea in adolescent males in an urban pediatric emergency department. World J Clin Pediatr 2017; 6:154-160. [PMID: 28828298 PMCID: PMC5547427 DOI: 10.5409/wjcp.v6.i3.154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/16/2017] [Accepted: 06/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) in young men seeking care in the emergency department (ED) for non-sexually transmitted infection (STI) related symptoms.
METHODS This was a prospective, cross-sectional study in an urban ED. The main outcome was the rate of positive CT and GC on urine nucleic acid amplification testing in males aged 16-21 presenting with non-STI related complaints.
RESULTS Two hundred and eighty-four patients were enrolled, 271 were included in the final data analysis [age range 16-21, median: 18 (quartiles 16-18, 19-21)]. Overall, 17 (6.3%, 95%CI: 4%-10%) tested positive for CT and 0% (95%CI: 0%-2%) were found to have GC. The proportion of sexually active subjects was 71% (95%CI: 65%-76%) and 2% (95%CI: 0.6%-4%) reported sex with men. Previous STI testing was reported in 46% (95%CI: 43%-54%) and 13% (95%CI: 8%-20%) of those patients previously tested had a history of STI. Of the patients who tested positive for CT in the ED, 88% (95%CI: 64%-98%) were successfully followed up.
CONCLUSION The prevalence of CT infection found by screening was 6.3%. Screening and follow-up from the ED was successful. The findings justify routine STI screening in male adolescents presenting to the ED with non-STI related complaints.
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48
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Abstract
Adolescents are at high risk for acquisition and transmission of sexually transmitted infections (STI) secondary to both cognitive and biological susceptibility. The prevention, diagnosis, and treatment of STIs are a critical part of adolescent health care. This article discusses the most common bacterial, parasitic, and viral STIs encountered in this age group with an emphasis on new guidelines for screening and management.
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49
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Affiliation(s)
- Harold C Wiesenfeld
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, and the Sexually Transmitted Diseases Program, Allegheny County Health Department - both in Pittsburgh
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50
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Goyal MK, Teach SJ, Badolato GM, Trent M, Chamberlain JM. Universal Screening for Sexually Transmitted Infections among Asymptomatic Adolescents in an Urban Emergency Department: High Acceptance but Low Prevalence of Infection. J Pediatr 2016; 171:128-32. [PMID: 26846572 PMCID: PMC4808598 DOI: 10.1016/j.jpeds.2016.01.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/25/2015] [Accepted: 01/06/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate acceptance of sexually transmitted infection (STI) screening and measure STI prevalence in an asymptomatic adolescent emergency department (ED) population. STUDY DESIGN This was a prospectively enrolled cross-sectional study of 14- to 21-year-old patients who sought care at an urban pediatric ED with non-STI related complaints. Participants completed a computer-assisted questionnaire to collect demographic and behavioral data and were asked to provide a urine sample to screen for Chlamydia trachomatis and Neisseria gonorrhoeae infection. We calculated STI screening acceptance and STI prevalence. We used logistic regression to identify factors associated with screening acceptance and presence of infection. RESULTS Of 553 enrolled patients, 326 (59.0%) agreed to be screened for STIs. STI screening acceptability was associated with having public health insurance (aOR 1.7; 1.1, 2.5) and being sexually active (sexually active but denying high risk activity [aOR 1.7; 1.1, 2.5]; sexually active and reporting high risk activity [aOR 2.6; 1.5, 4.6]). Sixteen patients (4.9%; 95% CI 2.6, 7.3) had an asymptomatic STI. High-risk sexual behavior (aOR 7.2; 1.4, 37.7) and preferential use of the ED rather than primary care for acute medical needs (aOR 4.0; 1.3, 12.3) were associated with STI. CONCLUSIONS STI screening is acceptable to adolescents in the ED, especially among those who declare sexual experience. Overall, there was a low prevalence of asymptomatic STI. Risk of STI was higher among youth engaging in high-risk sexual behavior and those relying on the ED for acute health care access. Targeted screening interventions may be more efficient than universal screening for STI detection in the ED.
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Affiliation(s)
- Monika K Goyal
- Children's National Health System, Washington, DC; Departments of Pediatrics and Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Stephen J Teach
- Children's National Health System, Washington, DC; Departments of Pediatrics and Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Maria Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - James M Chamberlain
- Children's National Health System, Washington, DC; Departments of Pediatrics and Emergency Medicine, the George Washington University School of Medicine and Health Sciences, Washington, DC
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