Sexually Transmitted Diseases Health Article

When to call the doctor

If a child or adolescent develops any of the symptoms of STDs, he or she should be evaluated for possible infection. Routine pelvic exams are recommended for all sexually active females and all females over the age of 18.

Diagnosis

A history of sexual activity is collected from all individuals at increased risk of contracting an STD, including adolescents who admit to being sexually active or who are pregnant or have undergone therapeutic abortion, adolescents or children with symptoms indicative of infection with an STD, and adolescents or children suspected of being victims of sexual abuse or rape. The healthcare provider will take a complete medical history and perform a thorough physical examination. Depending on the STD in question, additional tests may be performed such as blood work, Papanicolaou (pap) smear, rectal swabs, or biopsy.

Treatment

The treatment of sexually transmitted diseases varies according to the diagnosed infection. Gonorrhea, chlamydia, and syphilis are curable in most cases with antibiotics, although antibiotic-resistant strains do exist. As viruses, HSV, HPV, and HIV are treatable but not curable. The frequency and duration of HSV lesions can be reduced with antiviral therapy, including acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). Common methods to reduce genital warts include application of a topical cream called imiquimod (Aldara), cryotherapy (freezing of the wart), elecrosurgery (applying an electrical current to the wart), and surgical removal. The course of HIV infection can be slowed with a number of different kinds of drugs, including reverse transcriptase inhibitors, protease inhibitors, nonnucleoside reverse transcriptase inhibitors, and fusion inhibitors.

Alternative treatment

A number of different alternative therapies may be pursued to treat STDs, such as the use of herbs, homeopathy, acupuncture, and nutritional supplements, although minimal research has been done to establish their efficacy.

Nutritional concerns

In some cases, supplementation with specific nutrients may enhance immunity and minimize outbreaks. Examples are vitamin C (to boost the immune system), zinc (to reduce the frequency of HSV outbreaks), aloe (a possible antiviral), lemon balm (to speed healing), and licorice (with anti-inflammatory and antiviral effects).

Prognosis

Most STDs have excellent prognoses and respond well to treatment. While HSV and HPS are not curable, outbreaks can be managed and infection generally has little effect on quality of life. HIV, however, is a potentially fatal disease which can be treated but not cured.

Prevention

The prevalence data on STDs, HIV, and AIDS in adolescents indicate that younger women, gay and bisexual teens, and poor, urban and racial/ethnic minority young people have higher rates of STDs and HIV relative to their peers. Primary prevention of initial STD infections through prevention and risk reduction programs are essential for stemming the tide of these sexually acquired diseases. Moreover, secondary prevention through screening at risk adolescents for asymptomatic STD infections and effectively treating the index case and his or her sexual contact(s) are the most effective means of eliminating long-term medical and psychosocial consequences from STDs.

Prevention of high risk sexual, contraceptive, and substance use behaviors through cognitive-behavioral skills training and prevention and risk reduction counseling programs is a key strategy for decreasing the high incidence of STDs in adolescents. Prevention and risk reduction strategies should be developed and implemented in settings in which most adolescents can be reached, including schools or community-based programs in which there are multiple opportunities to intervene with adolescents or clinical settings where one-to-one risk reduction counseling can occur and actual risk can be assessed.

Cognitive-behavioral skills building interventions

In order to prevent new STD infections, adolescents must not only be informed about the risk and prevention of STDs, they must also have skills to resist peer pressure, negotiate the use of condoms, and project the future consequences of their behaviors. In addition, prevention of STDs in adolescents requires that they have the necessary means, resources, and social support to develop self-regulative skills and self-efficacy to effectively reduce their risk of disease transmission. Such cognitive-behavioral skills building programs have been shown to be effective in developing skills, delaying the onset of sexual activity, and changing high risk behaviors associated with pregnancy, STDs, and HIV infection. Moreover, cognitive-behavioral skills building programs should be immediate, sustained, and cost-effective. Specifically, these programs should be designed to increase knowledge about the prevention and transmission of STDs and their consequences; formulate realistic attitudes and perceptions about personal susceptibility to acquiring infections; enhance self-efficacy and self-motivation; monitor and regulate STD-related risk behaviors; address the role of social peer norms; and develop appropriate decision-making, problem-solving, and communication skills.