News from the frontline: sexually transmitted infections in teenagers attending a genitourinary clinic in south east London

Objectives: To determine the prevalence of sexually transmitted infections (STIs) and the mental health needs of female child and adolescent survivors of rape and sexual assault who were referred to a specialist genitourinary medicine (GUM) clinic. Method: Retrospective case notes review of 98 females aged 16 or less, who attended over a 5 year period (1996)(1997)(1998)(1999)(2000). Results: The overall prevalence of STIs was 26%. Among the girls who were aged 0-12 years (n = 16), one had gonorrhoea and another had Trichomonas vaginalis infection. Prevalence of STIs in those aged 13-16 years, who were not sexually active before the index assault, was 24% and in those who gave a history of previous consensual sexual activity it was 39% (p = 0.17). Chlamydial infection was more common among the girls who disclosed previous consensual sexual activity than in those did not disclose previous sexual activity (p = 0.012). The overall prevalence of vaginal candidiasis was 17% and bacterial vaginosis 13%. More than one third of the study population gave a history of previous sexual, physical, or other abuse. 81% reported having current psychological difficulties. Mood changes and sleep disturbances were reported more frequently than other psychological symptoms; 15% attempted self harm. All types of psychological difficulties, except mood changes, were not affected by the time interval between index assault and first presentation to the clinic and the type of assailant. 29% had no involvement with social and mental health services before their attendance at the clinic Conclusions: The prevalence of STIs among female child and adolescent survivors of rape and sexual assault attending a specialist clinic was high. The range of mental health and social difficulties was wide and multiple. The importance of an early assessment for the presence of STIs and mental health difficulties was demonstrated. S exual abuse of children and adolescents is widespread.

Section: Discussionmentioning

confidence: 59%

Prevalence of sexually transmitted infections and mental health needs of female child and adolescent survivors of rape and sexual assault attending a specialist clinic

Kawsar

Anfield²,

Walters³

et al. 2004

“…18 One exception was a study in racially diverse adolescents, which reported a significant fall in vaginal pH as gynaecological age increased. 19 Vaginal pH could account for increased risk of BV in less mature adolescents.…”

Section: Discussionmentioning

confidence: 99%

Biological and hormonal markers of chlamydia, human papillomavirus, and bacterial vaginosis among adolescents attending genitourinary medicine clinics

Brabin

2005

Objective: To assess maturity indices, menstrual patterns, hormonal factors, and risk of adolescent genital tract infections. Methods: Cross sectional study in three genitourinary medicine clinics. Females 17 years or less, within 5 years of menarche, or reporting oligo-amenorrhoea were screened for genital tract infections and menstrual cycle characteristics determined. The outcome measures were risk factors associated with chlamydia, human papillomavirus (HPV DNA) and bacterial vaginosis (BV), separately and pooled. Correlations between estrone-3-glucuronide (E3G) and pregnanediol-3a-glucuronide (P3G) hormone concentrations and chlamydia, HPV, and BV. Results: Among 127 adolescents, HPV was present in 64.4% (95% CI: 54.5 to 74.3), BV in 33.9% (19.1 to 34.5), and chlamydia in 26.8% (19.1 to 34.5). Breast maturity, oligomenorrhoea, and older gynaecological age were associated with lower risk of all infections. After adjustment for calendar age, race, and behavioural factors, gynaecological age remained significant (OR = 0.7, 0.6-0.9; p = 0.008). Behavioural risk factors differed by infection. Smoking was protective for HPV (OR = 0.1, 0.0 to 0.9; p = 0.007), and a recent new partner for chlamydia (OR = 0.3, 0.1 to 0.9; p = 0.024). Sex during menses was associated with increased BV risk (OR = 3.3, 1.5 to 7.2; p = 0.003). Chlamydia was higher among adolescents who used emergency contraception (2.5; 1.1 to 5.9, p = 0.029) and lower among those using condoms at last sex (OR = 0.3, 0.1 to 0.9; p = 0.015). Among 25 adolescents not using hormonal contraceptives, 15 had disturbed or anovulatory cycles. Chlamydia risk was inversely associated with P3G concentrations (Mann-Whitney; p = 0.05). Conclusions: Adolescents engaging in high risk behaviour at a young gynaecological age are susceptible to multiple infections. Adolescent clinical assessment should include gynaecological age. I n the United Kingdom, rates of sexually transmitted infections are very high in female adolescents.1 Age at first intercourse has declined, adolescents do not always use condoms effectively and consistently, and the number of lifetime and concurrent partnerships has increased.2 Sexual behaviour does not entirely explain the high infection rates, and biological and hormonal factors are almost certainly implicated.3 Adolescents develop at different rates, and those exposed to genital infections before maturation is complete could be more susceptible to infection. Menarche, the most common maturity marker, follows the pre-pubertal growth spurt, may occur early or late in adolescence, and is not the culmination of maturation. Following menarche, menstrual cycle disturbances, 4 persisting ectopy, 5 penetrable cervical mucus, 6 low IgA levels 6 and hormonal contraception 7 8 could each increase susceptibility to, or ability to clear, genital infections.Our aim was to assess whether adolescent maturity indices, menstrual patterns, and hormonal factors were associated with higher frequency of genital infections. METHODS Recruitment Study populationWe ...

“…17 A study of under 16s attending a GUM clinic in London found that 19% of all female attendees were pregnant, and 76% of those who were not pregnant were not using any contraception at the time. 18 Over half of these women reported that they did not receive advice on contraception during their visit.…”

Section: Logisticsmentioning

confidence: 99%

One stop shop versus collaborative integration: what is the best way of delivering sexual health services?

French

Coope²,

Graham³

et al. 2006

Objectives: To examine various models of integrated and/or one stop shop (OSS) sexual health services (including general practice, mainstream specialist services, and designated young people's services) and explore their relative strengths and weaknesses. Methods: Literature review and interviews with key informants involved in developing the National Strategy for Sexual Health and HIV (n = 11). Results: The paper focuses on five broad perspectives (logistics, public health, users, staff, and cost). Contraceptive and genitourinary medicine issues are closely related. However, there is no agreement about what is meant by having ''integrated'' services, about which services should be integrated, or where integration should happen. There are concerns that OSSs will result in over-centralisation, to the disadvantage of stand alone and satellite services. OSS models are potentially more user focused, but the stigma that surrounds sexual health services may create an access barrier. From staff perspectives, the advantages are greater career opportunities and increased responsibility, while the disadvantages are concern that OSSs will result in loss of expertise and professional status. Cost effectiveness data are contradictory. Conclusion: Although there is a policy commitment to look at how integrated services can be better developed, more evidence is required on the impact and appropriateness of this approach.