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Try out PMC Labs and tell us what you think. Learn More. The increase is especially pronounced in adolescents 15—24 years of age.

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Despite making up only a quarter of the population, adolescents for approximately half of new STIs in the United States every year. This review summarizes recent developments in the field of STIs, excluding human immunodeficiency virus, in adolescents.

In this paper, we examine the epidemiology, screening, management, and prevention of STIs in adolescents. STI rates in adolescents have been rising sincewith young women and men who have sex with men at particularly high risk. Barriers to STI screening for adolescents include confidentiality concerns and lack of access to health services. Prevention through STI vaccines represents a promising way to combat the epidemic. STIs are a growing concern for adolescents. Proper screening and management are of critical importance. Furthermore, prevention efforts such as human papillomavirus HPV vaccination should be prioritized.

Much of the current literature on STIs does not address the unique nature of STIs in adolescents, and additional research into effective prevention and treatment strategies of STIs in adolescents is urgently needed. Of approximately 20 million new sexually transmitted infections STIs each year in the United States, half of cases occur among adolescents age 15—24 years.

It is estimated that 1 out of 4 sexually active adolescent females have an STI, most commonly Chlamydia trachomatis CT infection and human papillomavirus HPV infection see Table 1 for abbreivations. STI rates in the United States are on the rise, in both males and females, and much of this increase is occurring in adolescents [ 1 ]. Adolescents are uniquely at risk for STIs from both behavioral and biological perspectives. Behaviorally, adolescents are more likely to engage in high-risk sexual behavior such as concurrent partners or sex without a condom [ 2 ].

This is due in part to the fact that the prefrontal cortex, responsible for executive function, is still developing throughout adolescence [ 3 ]. Furthermore, adolescents are less likely than adults to access and utilize sexual health services [ 2 ]. Those factors lead to a higher chance of exposure and a lower chance of diagnosis and treatment. From a biological perspective, adolescent females are particularly susceptible to STIs like CT and HPV due to lower production of cervical mucous and increased cervical ectopy [ 24 ].

Therefore, if exposed to an STI, adolescent females are more likely than adults to get Galvin Washington girls blowjobs. STIs can cause long term health problems if left untreated. Tertiary Galvin Washington girls blowjobs syphilis can lead to nervous system and cardiovascular system damage, and congenital syphilis can cause serious complications or infant death [ 5 ]. Certain strains of HPV can lead to cervical, oropharyngeal, or rectal cancer [ 9 ]. Despite the high prevalence and high morbidity, there are relatively limited data on STIs in adolescents.

Most studies and guidelines focus on infections and treatment in adults.

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However, in order to adequately address the STI epidemic, it is essential to understand and prevent adolescent infections. The aim of this review is to describe current trends and recommendations regarding STIs, excluding HIV, in adolescent populations. Specific attention is given to populations at increased risk of acquiring an STI, including women and young men who have sex with men YMSM.

Future directions of STI screening and prevention are also discussed.

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Sexually transmitted infection rates are increasing among adolescents in the United States. However, infection rates vary by sex, geography, and sexual practices. The rate of CT infection among females aged 15—19 years increased by 4. CT infection rates among adolescents aged 20—24 years followed similar patterns. Rates of NG infection, though lower than CT infection, are increasing as well.

From — alone, the rate of NG infection increased by Primary and secondary syphilis infections have seen the most dramatic increase, with total national rates at their highest since From —, syphilis rates increased by Specific prevalence data and trends can be seen in Table 2 and Figure 1 [ 2 ]. Description: The figure describes the prevalence of CT, NG, and syphilis infections among adolescents, broken down by age group and sex.

There are less data on the total prevalence of HPV in adolescents. In a study of HPV prevalence from —, it was estimated that While there are over strains of HPV, the majority present no symptoms and resolve spontaneously. Prevalence of those four strains specifically was 4.

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The data suggest high vaccine effectiveness and the importance of continued efforts to increase vaccination coverage. Neither are reported nationally, making it difficult to assess epidemiologic trends [ 2 ]. Several studies have shown that, although HSV-2 typically causes genital herpes and HSV-1 typically causes orolabial herpes, the prevalence of genital HSV-1 in adolescents has increased ificantly [ 1718 ].

The Galvin Washington girls blowjobs may be the result of the decreasing prevalence orolabial HSV-1 in adolescents and thus a lack of HSV-1 antibodies upon sexual debut [ 20 ]. It may also be due to increasingly common oral sex practices among adolescents [ 21 ]. A map of CT prevalence among adolescent females can be seen in Figure 2. Geographic and racial differences in STI prevalence reflect higher levels of poverty and decreased access to and utilization of sexual health services [ 22 ].

Description: The figure shows CT infection rates in adolescent females, broken down by state. YMSM are at an increased risk for STIs due to both individual-level risk behaviors, such as of partners and frequency of sex without a condom, as well as population-level factors, such as overlapping sexual networks [ 2 ].

As syphilis rates are highest among young men aged 20—24, YMSM are at particularly high risk of syphilis infection [ 2 ]. Description: The figure highlights the distribution of primary and secondary syphilis infections by sex and sexual behavior. Homeless, incarcerated, and drug-using youth represent additional high-risk populations. A recent review found STIs among homeless adolescents to be associated with length of homelessness, coercive sex, and unmet survival needs [ 25 ]. Adolescent drug use and incarceration are also associated with higher rates of STIs due to combination of behavioral risk factors and unequal access to the health care system [ 2627 ].

Syphilis screening is recommended for YMSM and pregnant women. Cervical cancer screening via a Pap test is recommended in women starting at age 21 years [ 1 ]. In a study of men screened at a college health clinic, it was found that Another study found that patient-reported exposure was not necessarily a reliable indicator for anogenital CT and NG screening in young black MSM.

While reported anal sexual exposure predicted rectal infection, Despite recommendations for widespread screening, a relatively small percentage of adolescents receive the recommended Galvin Washington girls blowjobs screening. A national survey of youth age 15—25 years found that most had never received an STI test: only Confidentiality concerns were a large barrier to testing. Although all 50 states allow adolescents to access STI screening and treatment without parental consent, 18 states allow for parental notification if a minor is seeking STI services [ 32 ].

According to the National Survey of Family Growth, This was higher, Others reported foregoing screening because they felt they were not at risk for STIs Galvin Washington girls blowjobs 31 ]. Confidentiality concerns are important to address when working with adolescents. Adolescent females who had time alone with a provider were more than twice as likely to receive STI screening than those whose parents were in the room, suggesting the value of private discussions between adolescents and their providers [ 33 ]. Other options, such as self-collected swabs or home-based specimen collection and testing, may also reduce confidentiality concerns among adolescents and should be further evaluated [ 34 ].

Research into the effectiveness of STI treatment in adolescent populations is needed. The CDC recommends treating both urogenital and extragenital CT infections with 1 gm oral azithromycin. However, over the past few years, there has been critical appraisal of the effectiveness of treating rectal CT with azithromycin versus doxycycline.

Numerous studies have shown doxycycline to be more effective than azithromycin [ 353637 ]. Azithromycin failure is more likely in patients with a higher organism load [ 39 ]. While European guidelines recommend treating oral and rectal CT infections with doxycycline, the CDC has not yet updated recommendations [ 140 ]. Large, randomized controlled trials are urgently needed.

An emerging challenge in the management of STIs is the shortage of penicillin benzathine G, both in the United States and globally. Penicillin benzathine G is the recommended treatment for syphilis, and the only recommended syphilis treatment option for pregnant women [ 1 ]. While syphilis rates are at their highest in 20 years, penicillin benzathine G has become unavailable in many hospitals [ 41 ]. In Japan, amoxicillin has been successfully used as an alternative to penicillin benzathine G to treat syphilis infection and prevent mother-to-child transmission [ 4243 ].

Inthe Gonococcal Isolate Surveillance Project reported that Furthermore, the past decade has shown an increase in isolates with an elevated minimal inhibitory concentration to the cephalosporins cefixime and ceftriaxone [ 45 ]. There have also been reports of treatment failures to cefixime and ceftriaxone [ 4647 ].

Due to the emergence of resistance, two-drug therapy is now recommended, utilizing both 1 gm azithromycin and mg injectable ceftriaxone. There are no data on the rates of resistance in adolescent populations specifically, but the two-drug treatment recommendations apply regardless of age or anatomical site of infection [ 1 ]. Partner notification and treatment is another essential aspect of STI management. In adolescent populations, this can be particularly challenging due to the higher frequency of concurrent partners and relationships of shorter duration.

However, high rates of STI reinfection among youth indicate the critical importance of partner management [ 48 ]. Expedited partner therapy, where the patient delivers medication or a prescription to the partner, has been shown to be a successful option to treat CT or NG infection in heterosexual adult couples.

Data are limited regarding the effectiveness of expedited partner therapy in adolescents or MSM. Expedited partner therapy is recommended for MSM in most states, although not universally [ 249 ]. Prevention efforts are particularly important in adolescents, as sexual health habits are often still developing. Adolescent STI prevention efforts should come from a combination of sources. Traditional sources of information, such as parents and schools, play an important role.

Sexual communication between adolescents and their parents has been shown to lead to safer sex behavior [ 51 ]. HPV vaccination is also a critical component of adolescent sexual health. It is recommended that both boys and girls age 11—12 years receive the vaccine series. The vaccine is recommended through age 26 for females, MSM, and HIV-infected patients, and through age 21 for heterosexual males [ 1 ].

The vaccine is safe and highly effective in preventing most HPV infections [ 5253 ]. There is also potential for powerful prevention efforts via social media. Social media campaigns are an effective way to communicate prevention messages to specific, targeted audiences [ 54 ].

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Numerous campaigns promoting STI testing and safe sex practices have been shown to increase STI testing and safer-sex behaviors [ 555657 ]. As mobile dating apps become more popular, especially among adolescents, they represent a unique venue through which to reach adolescents at high-risk for STIs. It would be valuable to evaluate a similar model for home-based STI testing. Pre-exposure vaccines are the most powerful method for infection prevention.

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However, broader coverage through HPV vaccination requirements represents the potential for a further ificant decrease in HPV-related cancer and associated costs. Effective vaccines for other STIs would ificantly improve sexual health.

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Vaccine development efforts vary by specific STI. HSV and CT vaccine candidates are in clinical trials, while NG and syphilis vaccine candidates are still in preclinical development [ 6061 ]. Meanwhile, a TV vaccine development program will require a better fundamental understanding of the TV parasite and the epidemiology of the infection [ 60 ]. STI vaccines represent a worthy research investment due to the high burden of STIs and the increasing challenges posed by antibiotic resistance. A study indicated high acceptance of a CT vaccine among adolescents [ 64 ]. Rapid point-of-care diagnostic testing represents another exciting development in the field of STIs.

Rapid point-of-care testing creates a large potential for improved management, as patients could be screened and treated in the same day, reducing loss to follow up [ 66 ]. The advent of rapid diagnostic tests has important implications globally as well. In the majority of low and middle income countries, STIs such as CT and NG are managed through symptom-based management due to the high cost of testing [ 50 ]. However, symptom-based management le to a large of untreated infections due to the often asymptomatic nature of STIs.

Furthermore, it likely le to unnecessary antibiotic treatment. As new rapid diagnostic tests become available, evaluations will be needed to demonstrate the cost-effectiveness of point-of-care STI testing Galvin Washington girls blowjobs the global setting. STIs are a common cause of disease in adolescents.

As STI rates in the United States rise, it is critical to understand and address the epidemic from both medical and public health perspectives.

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Abstract: Protective Factors Associated with Sexual Risk Behaviors and Drug Use Among African American Adolescent Girls in Child Welfare (Society for Social Work and Research 23rd Annual Conference - Ending Gender Based, Family and Community Violence)