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  • Chlamydia and gonorrhea are most common among 15- to 19-year-old women.

  • Throughout the United States, medical care for sexually transmitted diseases (STDs) can be provided to all adolescents without parental consent or knowledge.

  • Human immunodeficiency virus (HIV) screening is recommended for patients seeking STD treatment in all health care settings. The patient should be notified that testing will be performed unless the patient declines (opt-out screening).

  • Oral antibiotics are no longer the treatment of choice for gonorrhea, but rather ceftriaxone parenterally.

  • Many STDs occur concurrently. Therefore, evaluate and treat the patient appropriately at the initial examination. Do not forget to recommend treatment for sexual partners.

STDs constitute a broad range of over 25 infectious organisms.1 These include bacteria, parasites, and viruses. The morbidity and economic impact to our health care system as a result of these infections is significant. It is estimated that almost 25% of female adolescents between the ages of 14 and 19 years are infected with a pathogen.1 Many infections go untreated as a result of the patient being asymptomatic, barriers to access of care, or the stigma associated with these disease processes. The National Institutes of Health (NIH) referred to STDs as the hidden epidemic. “They are hidden from public view because many Americans are reluctant to address sexual health issues in an open way and because of the biological and social factors associated with these diseases.”2

STDs are also referred to as sexually transmitted infections (STIs). This distinction is made to indicate that often these processes are not symptomatic. Hence, while they do not result in an apparent disease process, they are silent carriers of a contagious illness. This reinforces the recommendation for routine STD screening for sexually active individuals.



Chlamydia, caused by a bacterium Chlamydia trachomatis, is among the most common STDs.3 It is the most common treatable STD in the United States, occurring in 10% or more of sexually active adolescent female patients, with increasing rates of reported disease since the late 1980s.4 The burden of disease is likely at least double the 1,412,791 cases reported to the CDC in 2011. The reported rate is two-and-a-half times higher in females than males, likely a result of screening rates. There is a higher prevalence in African American adolescents as well as in patients of lower socioeconomic status. Approximately 33% to 45% of patients with gonorrhea are coinfected with C. trachomatis. Patients with chlamydial infections are at increased risk of acquiring HIV infection.5


Presentation of symptoms is variable, but many patients are asymptomatic. Vaginal discharge, mild abdominal pain, dysuria, urinary frequency, or postcoital/intermenstrual bleeding is observed in women. Physical examination reveals pyuria without bacteriuria, cervical edema, erythema, easily induced cervical bleeding, and mucopurulent discharge. In men, ...

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