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Docs Don't Test Kids for STDs, HIV

Study finds that physicians administer tests to adolescents less than three percent of the time.

By David Pittman, MedPage Today

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MONDAY, May 6, 2013 (Medpage Today) — WASHINGTON —Despite guidelines calling for universal testing for HIV and other sexually transmitted diseases (STDs), physicians administered these tests to adolescents less than 3 percent of the time, a study showed.

A retrospective, cross-sectional study of 1,000 patients found that only 2.9 percent of all patients, ages 13 to 19, received a test for gonorrhea and chlamydia and 1.6 percent of received an HIV test, reported Rachel Witt, a student at the University of Pennsylvania School of Medicine in Philadelphia, at the Pediatric Academic Societies annual meeting.

"This study shows that there is both a need and a potential to create quality improvement resources to improve guideline adherence," Witt explained.

Witt's work, which also examined testing of those adolescents who reported being sexually active, found STD screening rates were still low at 9.9 percent. The HIV screening rate in these sexually active teens was 6.1 percent.

Two other studies reported that screening for STDs with urine testing alone may be insufficient in younger gay men, and that STD testing may be feasible in asymptomatic youth in an emergent care setting.

The U.S. Preventive Services Task Force recommends that all individuals, ages 15 to 65, undergo HIV testing regardless of sexual risk. The CDC says testing should start as young as age 13.

The CDC recommends screening sexually active women younger than age 25 for gonorrhea and chlamydia each year and high-risk adolescent and young adult men for chlamydia each year as well. The agency advises that all sexually active women at risk for gonorrhea infection undergo annual screening.

Witt's work randomly selected 1,000 out of 40,000 routine visits by 13- to 19-year-olds who went to 29 primary care practices affiliated with a pediatric hospital.

In addition to admission to sexual activity, patients who were older, black, and had public insurance were more likely to be tested for either HIV or an STD.

More study is still needed to understand provider beliefs, clinical decision making, and perceived barriers to administering such tests, Witt said.

Improvements can start by providers taking better sexual histories. Their analysis of charts found that roughly 80 percent of adolescents had no documentation of sexual history in their charts.

"Care may actually be altered based on the information that's obtained in these histories, which is why it's so critical to ask," Witt said.

She said her group found no correlation between testing rates, parents or caregivers being present, and physician testing habits.

In a second study, researchers found that urine screening alone would fail to detect more than three-fourths of gonorrhea and chlamydia infections in gay youth.

"Urine screening alone is not a reliable proxy for all sites for gonorrhea and chlamydia infections in a youth, men-who-have-sex-with-men population," reported Katie Plax, MD, from the Adolescent Center at St. Louis Children's Hospital.

Her group screened 189 men, ages 14 to 24, who had sex with men from April 2012 to March 2013 at a St. Louis youth center. All 189 received urine, rectum, and throat STD tests.

They found that screening via urine alone would have missed 85 percent of chlamydia cases and 72 percent of gonorrhea infections.

Throat or rectum alone would have missed 11 percent of chlamydia cases and 12 percent of gonorrhea infections.

Physicians should incorporate greater use of extra-genital screenings to detect possible infections of the sexually transmitted diseases, Plax advised.

"For HIV uninfected patients, this is a public health emergency because we know that an STD diagnosis is both a marker for possible high-risk activity and also a potential co-factor for HIV acquisition," she said.

Also with greater prevalence of treatment-resistant gonorrhea, finding infected patients becomes more important, she said.

The last study looked at the possibility of screening asymptomatic youth in pediatric emergency department setting. About 85 percent of gonorrhea and chlamydia infections are asymptomatic.

Devra Gutfreund, MD, of the Newark Beth Israel Medical Center in New Jersey, and colleagues, screened 328asymptomatic patients, ages 14 to 24, visiting the Newark hospital for any reason.

In 328 urine samples collected, 16 percent were positive for either gonorrhea and chlamydia.

Gutfreund's group concluded that in communities with high rates of symptomatic infection, testing of asymptomatic infection is feasible and at a relatively low cost as each test-kit costs about .

However, they cautioned that the results may not be generalizable, and test administration depended on whether it was convenient for the treating physician.

The CDC estimates 19 million new STD cases each year, about half of which are in those ages 15 to 24. Treating those diseases and complications costs more than billion a year.






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Date: 13.12.2018, 10:41 / Views: 85283