398 Obstetrics and Gynecology Board Review •••
❍ What are the components of proper STD counseling for adolescents?
(1) Discussing what constitutes responsible and consensual sexual behavior.
(2) Saying that abstinence is the only effective way of preventing pregnancy and STD.
(3) Reinforcing correct and consistent condom use.
❍ What are the risk factors in adolescents that make them more susceptible to STD infection?
(1) Cervical ectropion presenting a large area of exposed columnar epithelium.
(2) Immature local immunity.
(3) Lack of foresight to understand the consequences of sexual acts.
(4) Need for peer approval.
(5) Use of alcohol or drugs.
(6) Presence of tattoos or body piercings.
❍ Forty percent of all Chlamydia cases present in sexually active adolescents aged 15 to 19 years. What is the
incidence of infection in this population?
1 in 10.
❍ What are the indications of annual screening for HIV and syphilis in adolescents?
(1) Diagnosis of a STD.
(2) Multiple partners, or a high-risk partner.
(3) Engaging in sex for drugs or money.
(4) Recreational IV drug use.
(5) Admission to jail or a detention facility.
(6) Residing in an area of high prevalence for HIV or syphilis.
❍ What are the important components of the initial examination of an adolescent victim of sexual assault?
(1) Gonorrhea and Chlamydia testing from penetration sites.
(2) Wet mount or swab culture for Trichomonas, Candida, or bacterial vaginosis.
(3) Serum tests for HIV, hepatitis B, and syphilis.
❍ When is it appropriate to repeat serologic testing for HIV in adolescent victims of sexual abuse?
Repeat evaluation is recommended at 6 weeks, 3 months, and 6 months after the assault if the initial testing is
negative, but HIV infection in the assailant cannot be ruled out.
❍ What is the appropriate prophylaxis given to adolescent victims of sexual assault?
(1) Postexposure vaccination for hepatitis B, without hepatitis B immune globulin.
(2) Empiric antibiotics for gonorrhea, Chlamydia, Trichomonas, and bacterial vaginosis; ceftriaxone, metronidazole,
azithromycin, or doxycycline are all appropriate agents.
(3) Emergency contraception.