Taraneh Shafii

Is condom use habit forming?: Condom use at sexual debut and subsequent condom use.

Objective: The objective of this study was to assess whether using a condom at adolescent sexual debut is associated with an increased likelihood of subsequent condom use. Study Design: A nationally representative sample was used, including 4024 sexually active adolescents (12–18 years) from the National Longitudinal Study of Adolescent Health. Logistic regression was used to model the association of condom use at sexual debut on condom use at most recent sex (mean interval, 23 months). Results: Condom use at adolescent sexual debut was associated with a twofold increased likelihood of condom use during most recent sex (odds ratio, 2.28; 95% confidence interval, 1.91–2.73). Conclusions: Among adolescents, early condom use is associated with an increased likelihood of subsequent condom use.

Association Between Condom Use at Sexual Debut and Subsequent Sexual Trajectories: A Longitudinal Study Using Biomarkers

OBJECTIVES We compared subsequent sexual behaviors and risk of sexually transmitted infections among adolescents who did and did not use a condom at their sexual debut. METHODS We derived data from the National Longitudinal Study of Adolescent Health, which followed a sample of 4018 sexually active adolescents between 1994 and 2002. During waves I, II, and III of the study, data on sexual behavior were gathered, and at wave III urine specimens were collected to test for sexually transmitted infections. RESULTS Among interviewed adolescents, those who reported condom use at their debut were more likely than those who did not use condoms at their debut to report condom use at their most recent intercourse (on average 6.8 years after sexual debut), and they were only half as likely to test positive for chlamydia or gonorrhea (adjusted odds ratio=0.50; 95% confidence interval=0.26, 0.95). Reported lifetime numbers of sexual partners did not differ between the 2 groups. CONCLUSIONS Adolescents who use condoms at their sexual debut do not report more sexual partners, are more likely to engage in subsequent protective behaviors, and experience fewer sexually transmitted infections than do adolescents who do not use condoms at their sexual debut.

Rising rates of syphilis in the era of syphilis elimination.

Objective: The objective of this study was to assess the impact of syphilis control activities in King County, Washington. Study Design: We calculated rates of early syphilis and trends in numbers of persons tested and diagnosed through screening and partner notification from 1998 to 2005. Results: Early syphilis cases increased from 38 in 1998 to 188 in 2005 with 92% occurring among men who have sex with men (MSM). Our health department conducted public awareness campaigns, increased publicly financed syphilis screening among MSM by 179%, and intensified partner notification efforts. Despite these efforts, the prevalence of syphilis among screened populations was only 1.1%, and 71% syphilis cases were diagnosed after seeking care for symptoms. The proportion of cases diagnosed through screening and partner notification did not significantly change during the evaluation period. Early syphilis incidence among MSM more than doubled between 2003 and 2005. Conclusions: New, innovative approaches to syphilis control are needed.

Expedited Partner Therapy for Adolescents Diagnosed with Chlamydia or Gonorrhea: A Position Paper of the Society for Adolescent Medicine

Chlamydia and gonorrhea, the most frequently reported sexually transmitted infections (STIs), present substantial public health challenges among adolescents. Although these infections are easily treated with antibiotics, many adolescents are reinfected within 3–6 months, usually because their partners remain untreated. The standard approaches to notifying and treating a partner of an STI-infected patient are patient referral, whereby the patient notifies his/her partners to seek care, and provider referral, whereby the provider or public health disease intervention specialist notifies the partner and directs him/her toward treatment. These methods rely on the accuracy of the disclosed partner information as well as other limitations, such as compliance and staffing resources. Another approach to partner notification is expedited partner therapy (EPT), treating sex partners without requiring a prior clinical evaluation. In randomized trials, EPT has reduced the rates of persistent or recurrent gonorrhea and chlamydia infection; however, its routine use is limited by concerns related to liability, cost, compliance, and missed opportunities for prevention counseling. The Society for Adolescent Medicine (SAM) recommends that providers who care for adolescents should do the following: use EPT as an option for STI care among chlamydiaor gonorrheainfected heterosexual males and females who are unlikely or unable to otherwise receive treatment; through SAM and AAP chapters, collaborate with policy makers to remove EPT legal barriers and facilitate reimbursement; and collaborate with health departments for implementation assistance.

The Adolescent Sexual Health Visit

Addressing sexual health, screening, and counseling to prevent sequelae of risky sexual behavior are essential components of the adolescent visit to the gynecologist. Discussing sexuality and taking a sexual history may cause feelings of discomfort for the provider and adolescent patient alike. Taking the time to build rapport and trust and the guarantee of confidentiality are key to engaging adolescent patients to discuss their personal health concerns with their provider. This article offers recommendations to facilitate dialog with the adolescent patient, addresses special considerations for the adolescent examination, discusses the use of some of the newly available tests for sexually transmitted infections (STIs), and suggests the recommended approach to management of STIs in adolescents.

Diagnosis and treatment of chlamydia, gonorrhea, and trichomonas in adolescents.

CME EDUCATIONAL OBJECTIVES: 1.Determine and discuss issues surrounding consent, confidentiality, and billing for sexually transmitted infection (STI) care delivery in the adolescent population.2.Review currently available testing modalities for STIs and their applicability in the adolescent population.3.Provide treatment and prevention strategies for the most commonly encountered STIs in the adolescent demographic. Adolescents and young adults, 15 to 24 years of age, carry a disproportionate burden of sexually transmitted infections compared with other age groups in the United States (see Figure 1).1.

Condom use at sexual debut and subsequent condom use: a test of the imprinting hypothesis

Conclusions: Among sexually active adolescents using a condom during sexual debut is strongly associated with subsequent use which supports the imprinting hypothesis. Therefore early sexual education messages emphasizing condom use may be particularly important and hopefully effective at establishing a norm of regular condom use behavior thereby protecting adolescents from STIs and reducing levels of STIs in the adolescent population. (excerpt)

Adolescent Perspectives on Patient-Provider Sexual Health Communication: A Qualitative Study:

Background: Adolescents in the United States are disproportionately affected by sexually transmitted infections and unintended pregnancy. Adolescent-centered health services may reduce barriers to health care; yet, limited research has focused on adolescents’ own perspectives on patient-provider communication during a sexual health visit. Methods: Twenty-four adolescents (14-19 years old) seeking care in a public health clinic in Washington State participated in one-on-one qualitative interviews. Interviews explored participants’ past experiences with medical providers and their preferences regarding provider characteristics and communication strategies. Results: Interviews revealed that (1) individual patient dynamics and (2) patient-provider interaction dynamics shape the experience during a sexual health visit. Individual patient dynamics included evolving level of maturity, autonomy, and sexual experience. Patient-provider interaction dynamics were shaped by adolescents’ perceptions of providers as sources of health information who distribute valued sexual health supplies like contraception and condoms. Participant concerns about provider judgment, power differential, and lack of confidentiality also emerged as important themes. Conclusions: Adolescents demonstrate diverse and evolving needs for sexual health care and interactions with clinicians as they navigate sexual and emotional development.