Understanding pediatric STIs: Trends, management, and more

Approximately half of sexually transmitted infections (STIs) are reported among patients aged 15 to 24 years, making it vital to understand their impact on this population.¹ In this article, we discuss outcomes in young patients, general STI trends, and human papillomavirus (HPV) vaccination coverage.

Recently, Jill S. Blumenthal, MD, associate professor of medicine at UC San Diego Health, outlined STI trends among adolescents and young adults. These patients are undergoing hormonal changes that increase the risk of STIs. Many of these patients also have a lack of STI knowledge compared with adults.

Overall, STI prevalence has increased in the United States.² Cheruba Prabakar, MD, FACOG, of Alta Bates Summit Medical Center, noted that an STI has been reported in approximately 1 in 5 US patients, with gonorrhea, chlamydia, and trichomoniasis commonly reported.

While a prevalent cause behind the rise in STI cases has not been identified, Prabakar theorized increased education among the public and providers, alongside improved testing mechanisms, has led to fewer cases going unnoticed. However, young adults may not know how to discuss STIs with their provider, creating an additional barrier to STI testing.¹

Guidelines have been implemented to improve rates of STI testing.² These include strict reporting requirements for diseases such as gonorrhea, chlamydia, and HIV, as well as recommendations that all patients aged under 25 years receive gonorrhea and chlamydia testing.

Even with these guidelines, providers may not always consider obtaining information about STIs among their pediatric patients vs adults.¹ Their patients may be unsure if their insurance will cover STI care without parental consent and may want to avoid disclosing their STI status to their parents.

These issues, alongside transportation barriers, may prevent young patients from receiving STI testing. Additionally, young adults may be experimenting with multiple or new sexual partners and may not always discuss STIs, further increasing their risk.

Another common STI, trichomoniasis, currently does not have adequate testing.² There are no reporting requirements, leading many patients and providers to be unaware about the condition, especially since STIs are often asymptomatic. Increased awareness about testing and symptoms such as vaginal discharge is necessary to increase testing rates.

Trichomoniasis is a parasitic infection and the most common nonviral STI in the United States. The condition can lead to significant discomfort because of symptoms such as irritation, discharge, painful sex, and cervical bleeding.

These symptoms, alongside increased odds of infection with other STIs, indicate a need for adequate treatment. According to Prabakar, it is not difficult to detect and treat trichomoniasis when testing for the condition.

Of STIs, HPV is the most common, making vaccination vital to prevent infections and related outcomes such as precancerous lesions, genital warts, and cervical, vulvar, anal, vaginal, penile, and oropharyngeal cancers.³ HPV vaccination is recommended in patients aged 11 to 12 years, and may be started as early as age 9 years.

Recently the Centers for Disease Control and Prevention (CDC) provided a report about HPV vaccination rates among patients aged 9 to 17 years. Data was collected from the 2022 National Health Interview Survey.

According to the data, 38.6% of children aged 9 to 17 years had received at least 1 HPV vaccination dose in 2022. An increase in the rate of vaccination was observed based on age, at 7.3% in those aged 9 to 10 years, 30.9% in those aged 11 to 12 years, 48.8% in those aged 13 to 14 years, and 56.9% in those aged 15 to 17 years.

An increased rate was observed among female pediatric patients vs male pediatric patients, at 42.9% and 34.6%, respectively. The odds were also increased in non-Hispanic White children vs Hispanic children, at 39.9% and 34.4%, respectively.

Health insurance coverage was linked to increased rates of HPV vaccination. The rate of HPV vaccination was 41.5% among children with private health insurance vs 37% for children with Medicaid coverage, 30.2% for children with other government coverage, and 20.7% for children without insurance.

When evaluating vaccination based on parental education, a rate of 31.1% was reported for children of parents with high school level or less education, vs 42.1% for children of parents with bachelor’s degree or higher education. For family income, a rate of 29.9% was reported for an income under 100% of the federal poverty level vs 45.7% for an income of 400% or more of the federal poverty level.

Urbanization level also impacted HPV vaccination, with a rate of 39.4% among children living in large central metropolitan areas vs 41.1% for large fringe metropolitan areas, 39.4% for small and medium metropolitan areas, and 30% for nonmetropolitan areas.

The CDC recommends pediatric patients receive a 2-dose vaccine regimen against HPV, administered within 6 to 12 months when aged 11 to 12 years. However, further steps must also be taken to protect adolescents and young adults from STIs.

Blumenthal discussed how stigma is an additional risk factor for STIs among pediatric patients.¹ Patients’ emotional, mental, and physical health may all be impacted by the stigma surrounding the STI, making it seem like a significant issue when they are infected even when the disease is easily treatable.

According to Blumenthal, many young patients are concerned about herpes. However, the disease is very common, and while it is not curable, it can be managed, and transmission can be reduced.

Additionally, improved education may improve STI awareness, with Prabakar wishing to see a broader campaign for STI education among young patients and providers.² While HIV and HPV have received significant attention in the past, gonorrhea, chlamydia, and trichomoniasis need further education.

Education can be provided in school, college, and the office. Patients should be taught about the long-term consequences of STIs, as this will increase general awareness and the ease of testing.

One of the most important aspects of STI care is for young patients to feel comfortable talking about STIs with their doctor as another part of their health and well-being, as discussed by Blumenthal.¹ This will allow doctors to discuss potential sexual activity with their patients and provide appropriate testing as part of routine health care.

Blumenthal also noted that there are many vaccinations for STI preventions, and being able to discuss these vaccinations and their effects can help young patients. For example, alongside HPV prevention, the HPV vaccine can protect patients from certain cancers and warts, which can more easily be discussed with younger patients than STIs.

“Doctors and other providers have a responsibility to make sure that they’re discussing sex with their patients,” Blumenthal said. “Being what we call ‘sex positive’ can really help patients feel comfortable…talking about sex.”

References

1. Krewson C. Understanding the impact of STIs on young adults. Contemporary OB/GYN. April 2, 2024. Accessed May 3, 2024. https://www.contemporaryobgyn.net/view/understanding-the-impact-of-stis-on-young-adults
2. Krewson C. Trends in STI prevalence and testing guidelines. Contemporary OB/GYN. April 11, 2024. Accessed May 3, 2024. https://www.contemporaryobgyn.net/view/trends-in-sti-prevalence-and-testing-guidelines
3. Human papillomavirus vaccination coverage in children ages 9–17 years: United States, 2022. Centers for Disease Control and Prevention. February 2024. Accessed May 3, 2024. https://www.cdc.gov/nchs/products/databriefs/db495.htm