Leslie R. Jaffe

Anal intercourse and knowledge of acquired immunodeficiency syndrome among minority-group female adolescents

Adolescent minority group females experience of anal intercourse and knowledge about and attitudes toward AIDS have been investigated. A questionnaire survey was administered to 148 largely black and Hispanic female patients at an adolescent health center. 111 of the girls reported that they were sexually active. 28 girls (25.2%) acknowledged having had anal sex, 19 of them within the preceding 3 months. Condoms were far less likely to be used during anal intercourse than during vaginal sex. Accurate knowledge about AIDS increased with age, but there was no relationship between age and any change in sexual behavior to avoid the disease. What little changes in sexual behavior reported were, however, strongly linked to fear of contracting AIDS. The most effective means of HIV transmission from males to females is through anal intercourse. Given the high incidence of anal intercourse practice by black and Hispanic females, their infrequent use of condoms during anal intercourse, and a large and increasing HIV infection rate among black and Hispanic males, it can be seen that adolescent minority group females are at increasing risk of heterosexual exposure to HIV infection. Lack of relationship between knowledge about AIDS and reduction of high-risk sexual behavior are discouraging to hopes of disease prevention through educational efforts.

Predictors of repeat pregnancy outcome among black and Puerto Rican adolescent mothers.

This prospective study investigated predictors of repeat pregnancies by 12 months after the delivery of a first child and their outcomes in inner-city adolescent mothers. The sample included four groups: those who had therapeutic abortions, miscarriages, full-term deliveries, and no repeat pregnancy. The therapeutic abortion group had more pregnancies before their first delivery (41%) than did full term (20%) and no repeat (15%), p < .01. More delayed grade placement was found in therapeutic abortion −1.6 years (1.3) and full term −1.8 years (.9) than in no repeat pregnancy −.6 years (1.1), p < .001. Reading achievement scores were higher in no repeat 86.3 (17.1) than in full term 75.0 (16.5), p < .05. School attendance was higher in no repeat (65%) than in therapeutic abortion (35%) and full-term (24%) p < .01 groups. Depressive symptoms at baseline were higher among therapeutic aborters 18.9 (9.9) than among full term 10.2 (8.2) and no repeat pregnancy groups 12.2 (6.2). Logistic regression analyses identified delayed grade placement as the most important predictor of pregnancy outcome. J Dev Behav Pediatr 13:89–94, 1992.

Chlamydia trachomatis detection in adolescents: A comparison of direct specimen and tissue culture methods

We compared tissue cell culture isolation with the Microtrak fluorescent monoclonal antibody direct specimen test for detection of endocervical Chlamydia trachomatis in an inner-city population of sexually active Black and Hispanic adolescent girls. Of the 95 patients screened, C. trachomatis was identified in 26.3%. The sensitivity of the direct specimen test was 91.7%, and its specificity was 98.6%. The positive predictive value was 95.6%, and the negative predictive value was 97.2%. No significant difference was found between Blacks (28.6%) and Hispanics (24.1%) in the incidence of endocervical C. trachomatis, nor was the use of an oral contraceptive significantly associated with the diagnosis of C. trachomatis (p greater than 0.10). Neisseria gonorrhoeae was isolated in 8.4% of the patients. The direct specimen test appears to be an accurate and convenient method of screening sexually active adolescent girls for genital C. trachomatis. Further study is needed to determine if an oral contraceptive increases the risk of Chlamydia infection in adolescents.

Isolation of Neisseria meningitidis from Anogenital Sites in Adolescents: Clinical implications

Neisseria meningitidis is being increasingly isolated from the urethra, cervix, and anal canal of sexually active individuals. We found a similar phenomenon in inner-city black and Hispanic adolescents. In 1981, cultures of 92 isolates of Neisseria were made from the anogenital region of sexually active adolescents; 81 (88.0%) were N. gonorrhoeae, 3 (3.3%) could not be speciated, and 8 (8.7%) were N. meningitidis. Since N. meningitidis has been associated with urethritis and pelvic inflammatory disease, it should be considered a pathogen when identified in the urethra or cervix and should be appropriately treated. The health implications of isolating N. meningitidis from the anal canal are less clear, although it has been rarely associated with proctitis. Neisseria isolates from anogenital sites cannot be assumed to be gonococci and, therefore, should be distinguished from N. meningitidis.

Frequency of use, knowledge, and attitudes toward the contraceptive sponge among inner-city black and hispanic adolescent females

This study assessed the frequency of use, knowledge, and attitudes toward the contraceptive sponge in sexually active, inner-city, black and Hispanic adolescent females. A 54-item, self-administered questionnaire was completed by 208 adolescents (mean age 17.9 years) attending a gynecology/family planning clinic within a comprehensive adolescent health center. Twenty-nine (13.9%) had never used any birth control, and 49 (23.6%) had not used any form of birth control in the 3 months prior to the study. Fifty-three (25.5%) of the adolescents had used a less reliable method such as rhythm and/or withdrawal. The birth control method used least was the sponge. Only four (1.9%) of the adolescents had used the sponge in the 3 months prior to the study, and only ten (4.8%) had ever used it. Knowledge of the correct use of the sponge was poor. However, 69 (44.8%) of the 156 girls who knew about the sponge had a positive attitude toward it, and only 19% said they did not like it. The contraceptive sponge may be a viable option for adolescents, particularly those who are not using birth control or who are using a less reliable method.

Thrombocytopenia in a bisexual adolescent male with a history of intravenous drug use.

Immunologically mediated thrombocytopenia has been reported as a manifestation of human T-lymphotropic virus type III (HTLV-III) infection and intravenous (IV) drug abuse. The case report describes thrombocytopenia in a bisexual adolescent male with antibody to the HTLV-III virus and a history of infrequent IV drug abuse. The case underscores the need to consider HTLV-III infection and/or IV drug abuse in the differential diagnosis of thrombocytopenia in an adolescent.

A somaticizing adolescent: An approach to evaluation and therapy

Adolescents may chronically somatize as part of the symptoms of an underlying psychological disorder. Unless the underlying psychological disorder. Unless the underlying psychopathology is recognized by the treating physician, chronic somatization may result in high cost to the health care system due to frequent use and unnecessary biochemical and radiographic evaluation. The case presented is illustrative of the differential diagnosis and management of such a patient.