2014's Pediatric 'Great Eight': The News You Need to Know

L. Gregory Lawton, MD

Disclosures

December 19, 2014

In This Article

The Good News About Teen Pregnancy Is Still Bad News

The AAP released a policy statement[17] this year describing current trends and issues in adolescent pregnancy that highlighted the following.

1. The downward trend of decreasing teen sexual activity and teen births and pregnancies in the United States that began in 1991 continues.

2. Teen birth rates in the United States are at a record low, owing to increased use of contraception at first intercourse and use of dual methods of contraception among sexually active teens.

3. With over 700,000 teen pregnancies per year, the United States still tops all other industrialized countries in terms of teen birth rates.

4. Surveys indicate that less than one third of sexually active females (aged 15-19 years) used contraceptive methods during their most recent engagement in intercourse.

These somewhat sobering facts underscore the need for better reproductive health education for our adolescent patients. This year, the AAP also issued a policy statement[18] on contraception asserting that pediatricians need to be clinically proficient when discussing the variety of contraceptive options. The significant recommendations are as follows:

1. Counseling about abstinence (100% effective in preventing pregnancy and sexually transmitted infections) and postponement of sexual intercourse is an import aspect of adolescent sexual health.

2. Long-acting reversible contraception, including the progestin implant and intrauterine devices (IUDs), should be considered first-line contraceptive choices for adolescents.

3. It is appropriate for pediatricians to prescribe contraceptives or refer for IUD placement without first conducting a pelvic examination. Screening for sexually transmitted infections (STIs) can be performed without a pelvic examination and should not delay the initiation of contraception.

4. Pediatricians should encourage the correct and consistent use of condoms "each time, every time" and should take the opportunity to pair this encouragement with a regular update of their patients' sexual histories in a confidential and nonjudgmental setting.

Which brings us to the third AAP policy statement on the subject of adolescent sexuality issued this year. Despite the somewhat better news regarding teen pregnancy rates in the United States, the fact remains that the prevalence rates of many STIs are very high among adolescents. The AAP policy statement[19] on screening for STIs makes some explicit recommendations about screening. The key recommendations are as follows:

1. Routine screening for Chlamydia trachomatis and Neisseria gonorrhoeae is recommended annually for all sexually active adolescents.

2. Routine screening for Trichomoniasis vaginalis in asymptomatic adolescents is not recommended (unless there are multiple partners, a history of STIs, exchanging sex for money, or injection drug use).

3. Rescreen all adolescents infected with Chlamydia or gonorrhea 3 months after treatment, regardless of whether they believe that their sex partners were treated.

4. Develop clinical procedures to incorporate STI risk assessments, screening and treatment, and prevention counseling into routine healthcare for sexually active adolescents.

According to the Office of Adolescent Health in the US Department of Health and Human Services, teen pregnancy rates vary considerably from state to state.[20] This is not a revelation. Cultural, religious, and economic considerations all contribute to a state's or region's teen pregnancy rate. The AAP is making a national recommendation in the area of adolescent health. Essentially, it is saying, "Let's continue the trend of declining pregnancy rates so that we no longer lead the industrialized world in this metric."

We are being encouraged to be more aggressive about screening for and treating STIs in our offices. And in order to screen, we have to have a conversation about these issues.

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