Adolescent patients present with specific risk factors, barriers to effective
treatment, and other issues that impact effective STI prevention (10). In 2003,
28% of girls in the 9th grade and 62% of girls in the 12th grade reported
having sexual intercourse. See Chapter 2 (page 35) for suggestions on how to
approach the discussion of sexual practices with teenage patients. Adolescents
have a number of risk factors for acquiring STIs, including lack of emotional development to recognize the consequences of risky behavior; use of alcohol
or other substances that increase the risk of intercourse without a condom,
with multiple partners, or with high-risk partners and in women, biologic
factors such as exposed cervical columnar epithelium that constitutes the
primary site of invasion for chlamydia and gonococcal infection.
Statutory, ethical, and financial issues also complicate STI prevention
and treatment in the adolescent population. Despite statutes in all states
allowing minors to receive STI testing and treatment without parental
consent, concerns about confidentiality and fears of parental discovery limit
the willingness of many adolescents to seek effective health care for STIs
Although discussions with adolescent patients can emphasize the parameters
for confidentiality, it is also important that clinicians encourage and possibly
facilitate open communication of sexual health matters between minors and
their parents. This is especially important if insurance billing for these services
may come to parental attention despite the best efforts of the clinician to
prevent disclosure. Out-of-pocket expenditures for office visits, testing, and