••• Chapter 40^ Pediatric and Adolescent Gynecology^397
❍ What is the role of empiric treatment with GnRH agonists for endometriosis in adolescents?
A trial of a GnRH agonist is reasonable in adolescents aged 18 years or older who do not have an ovarian mass or
tumor. In younger adolescents, a diagnostic or therapeutic laparoscopy is the preferred first step in treatment if
pain persists despite medical therapy.
❍ Which infections are diagnostic of sexual abuse in infants and children?
Gonorrhea, Chlamydia, HIV, and syphilis are considered diagnostic for sexual abuse. The presence of Trichomonas,
condyloma, or herpes is considered highly suspicious for abuse. Conversely, bacterial vaginosis is considered
inconclusive.
❍ What situations indicate the need for STD testing in children?
(1) Signs and symptoms consistent with STD, such as vaginal discharge or pain, genital itching or odor, urinary
symptoms, genital ulcers or lesions, even if there were no suspicion for abuse.
(2) A suspected assailant is known to have an STD or high-risk behavior.
(3) Evidence of genital, oral, or anal penetration.
(4) The patient or a parent requests testing.
❍ What is the treatment of choice for gonorrhea in infants and children?
Ceftriaxone IV/IM is the agent of choice for infants; however, exudates must be cultured and tested for antibiotic
susceptibilities. Spectinomycin is also suitable for children. Fluoroquinolones are not recommended due to concern
over potential damage to cartilage.
❍ What percentage of sexually active adolescents report consistent condom use?
45%.
❍ Who is eligible to purchase emergency contraception without a prescription?
Women age 17 or older may purchase emergency contraception without a prescription.
❍ What clinical evaluation is needed prior to prescribing or dispensing emergency contraception?
None. Emergency contraception should be made available to any woman who believes she is at risk of an undesired
pregnancy. Clinical examination and/or pregnancy testing is not necessary.
❍ What is the effect of over-the-counter availability of emergency contraception though the pharmacy on the
frequency of its use among adolescents?
A study of 2117 patients from San Francisco aged 15 to 24 showed that pharmacy access did not improve the
frequency or promptness of emergency contraceptive use overall, when compared with clinic access. However,
condom users were twice as likely to use emergency contraception if they could obtain it over-the-counter, possibly
because a high proportion of women in this subgroup did not have an established relationship with a clinic doctor.
❍ What is the effect of access to emergency contraception on the sexual behavior of adolescents?
Adolescents as a group are more likely to rely on condoms rather than hormonal methods for contraception,
and are more likely to engage in unprotected intercourse than adults. Adolescents with access to emergency
contraception were more likely to use it more frequently; however, their behavior in terms of the rates of
unprotected intercourse, condom use, STD acquisition, and pregnancy was similar to those adolescents who did
not have access to emergency contraception.