In this section
STIs are a major cause of female reproductive morbidity and have been associated with spontaneous abortion, preterm labour, and pelvic inflammatory disease (PID), ectopic pregnancy, chronic pelvic pain, and tubal-factor infertility.
STIs are among the most common infectious diagnoses in adolescents. Any adolescent diagnosed with any STI should undergo through STI screening including: gonorrhea, Chlamydia, trichomoniasis, syphilis and HIV and proper referral to Infectious Disease Specialist.
50% of adolescents will be sexually active by age 18 (end of Year 12 completion).
Sexually transmitted infections are increasing in incidence in Australian Adolescents.
Consider screening of any young person who has been previously or is currently sexually active. Screening involved testing young females and males who are asymptomatic. In general young men are more likely to be symptomatic of infection.
Provide a confidentiality statement, including the 3 exclusions:
Risk assessment including: age of onset of sexual activity, gender of partner (increased risk associated with male to male intercourse), contraceptive use, associated risk factors (in both your patient and their partners) for transmission including intravenous drug use, sex work, body piercing, tattoos and type of intercourse (anal, vaginal or oral).
Remember to consider the risk of pregnancy and test where appropriate.
Assess the need for emergency contraception. Please discuss with the Gynaecologist on call or gynae fellow for advice.
Consider referral for ongoing contraceptive needs.
Urethral discharge is usually in the morning with mild dysuria (less copious and purulent than gonococcal)
Women may have vaginal discharge, mid-cycle and/or post coital bleeding
First pass urine sample for screening for Chlamydia (PCR)
Culture, direct inmunoflourescense and nucleic acid amplification tests (NAATs) for endocervical specimen.
Uncomplicated infection of cervix, urethra and rectum (adult doses)
Vaginal discharge, mid-cycle or post coital bleeding and dysuria.
Urine sample for screening of Neisseria Gonorrhoeae
Culture and NAATs on endocervical specimen
Adolescents may be asymptomatic
Presence of diffuse, malodorous, yellow-green vaginal discharge and vaginal itching.
Microscopy of vaginal secretions
Culture of vaginal secretions
Presentation can range from asymptomatic to severe peritonitis and tubo-ovarian abscess formation.
Classic PID: dull abdominal pain, fever, vaginal discharge, abnormal vaginal bleeding and symptom duration typically of 3 weeks.
50% can present: Gastrointestinal symptoms, nausea and vomiting
Patients with the following criteria should be considered for admission and parenteral therapy
All patients should be referred to Gynaecology
Darkfield examinations and direct fluorescent antibody (DFA) tests of lesion exudate
Nontreponemal tests : VDRL and RPR
Treponemal tests: FTA-ABS and TP-PA]
Benzathine penicillin G50,000 units/kg IM, up to the adult dose of 2.4 million units, administered as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million units)
All patients should be referred to Infectious Diseases
Australian STI Management Guidelines