"For me, the first time you should always take precautions. Myself, I never have sex without a condom. It's better to prevent than to treat."
Young man in Senegal |
Adolescents may think they are too young or too sexually inexperienced to acquire STIs. They may also think they are not at risk, because they incorrectly believe that STIs only occur among people who are promiscuous or who engage in "bad" behaviors. As a provider, you can play an important role not just in treating young people who contract STIs, but in helping them learn about prevention.
Young people are particularly vulnerable to STIs and consequent health problems because:
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They lack information about how to prevent STIs.
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They are less likely to seek proper information or treatment due to fear, ignorance, shyness or inexperience.
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The risk of acquiring trichomoniasis, chlamydia, genital herpes or human papilloma virus (HPV) is greater at first exposure to the STI.
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Adolescent females are more susceptible to infections than older women due to their immature cervices.
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Early sexual experience can result in trauma to vaginal tissue, increasing adolescent women's vulnerability to STIs.
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Adolescents who begin sexual activity early are more likely to have a greater number of lifetime sexual partners.
Other risk factors for adolescents are:
- Unprotected sex (without condoms).
- Sex with multiple partners.
- Having a partner with other sex partners.
- Having a partner with STI symptoms.
- Sex with a new partner or more than one partner in the last three months.
- Sex with strangers or sex in exchange for money.
- Vulnerability to sexual violence, coercion and abuse.
- Use of vaginal drying agents.
- A history of STIs or pelvic inflammatory disease (PID).
One of the most important facts you can help adolescents learn is that male latex condoms provide the best protection from STIs including HIV. Condoms must be used consistently and correctly with each act of intercourse.
Young people also need to know symptoms that may indicate they have an STI. These include:
- Urethral discharge or painful urination in young men.
- Genital sores or ulcers in young women or men.
- Lower abdominal pain or tenderness in young women.
- Unusual vaginal discharge or vaginal itching in young women.
- Painful urination or painful intercourse for young women.
Adolescents should be counseled to seek treatment as soon as possible if they have any of these symptoms.
Young people who contract STIs risk serious long-term health problems, including:
- Permanent infertility.
- Chronic pain.
- Cancer of the cervix.
- Heart and brain damage. (Without treatment, can develop 10 to 25 years after initial exposure to syphilis.)
Also, STIs are a risk factor for HIV transmission and acquisition.
STIs can be transmitted from mother to infant during pregnancy and birth. Infants of mothers with STIs may:
- Have lower birth weights.
- Be born prematurely.
- Be at increased risk of other disease, infection and blindness.
Sexually Transmitted Infections: Key Issues to Discuss |
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Syphilis (bacterial)
- If untreated, long-term effects include damage to major organ systems, paralysis, deafness, blindness, insanity and death, spontaneous abortion, stillbirth, premature birth.
- Women can transmit to infants during birth. Health workers should test all women during the prenatal period.
- Can be cured with antibiotics.
- Important to take medications as directed and to finish all medications.
- Genital ulcers can increase the risk of HIV acquisition, so client should be tested for HIV.
Gonorrhea (bacterial)
- Women: scarring of fallopian tubes can lead to infertility.
- Men: scarring can lead to sterility and urination difficulty.
- Newborns' eyes can be infected during birth.
- Can be cured with antibiotics.
- Important to take all medicines as directed and to finish all medications.
- Can increase risk for HIV.
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Chancroid (bacterial)
- Men: can lead to urethral stricture, causing urination difficulty.
- Can be cured with antibiotics.
- Important to take medications as directed and to finish all medications.
- Clients should see provider 3-5 days after treatment begins, then return weekly until infection is gone.
- Can increase risk for HIV.
Chlamydia (bacterial)
- Bacteria can infect urethra, cervix or other pelvic organs.
- Women: scarring of fallopian tubes can lead to infertility or ectopic pregnancy.
- Newborns' eyes and lungs can be infected at birth.
- Can be cured with antibiotics.
- Important to take medications as directed and to finish all medications.
- Can increase risk for HIV.
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HIV/AIDS (viral)
- No cure, so prevention is crucial.
- Persons with HIV may live with minimal symptoms or be symptom-free for many
- years. However, they may still infect others during this period.
- Drug therapies may reduce HIV levels in blood and semen, reduce symptoms and
- delay onset of AIDS. However, treatments are expensive, have severe side effects and are not widely available in developing countries.
- Can be transmitted to infant during pregnancy, childbirth or breastfeeding.
HPV (viral)
- May increase risk of cervical cancer. Client should undergo Pap smears, if possible.
- No cure.
- Can cause genital warts, which can be removed by burning, freezing or using chemicals.
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Genital herpes (viral)
- Women: pregnancy loss and pre-term delivery.
- Can be transmitted from mother to infant during vaginal delivery if symptoms are present.
- No cure.
- Medications can be given to relieve pain, reduce length of outbreak.
- Abstain from sex while ulcers are present.
- Can be transmitted even when symptoms are not present.
- Can increase risk for HIV.
Hepatitis B (viral)
- Long-term problems can include chronic hepatitis, cirrhosis, liver cancer, liver failure.
- Death possible.
- Can be transmitted from mother to infant.
- No cure.
- Symptoms can be treated.
- Preventive vaccine available in many industrialized countries.
Trichomoniasis (protozoan)
- Women: premature childbirth, low-birth weight and risk of HIV acquisition.
- Can be treated.
- Important to take medications as directed and to finish all medications.
- Return if not cured or problem recurs.
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STIs and Young Women |
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Generally, the long-term health consequences of an STI can be more numerous and severe for women than for men.
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A woman's risk of contracting an STI during a sexual encounter appears to be greater than a man's risk because women are biologically more susceptible to STIs.
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The surface of the vagina is larger and more vulnerable than the skin-covered penis.
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The amount of ejaculate deposited in the vagina during intercourse is greater than the amount of cervical and vaginal secretions to which a man is exposed.
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Young women often have a condition called cervical ectopy, in which the cells that line the inside of the cervix extend to the outer surface of the cervix. These cells are more vulnerable to infections such as chlamydia.
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Once they have an STI, young women are at greater risk of reproductive cancers and infertility. Other health problems can include pelvic inflammatory disease, ectopic pregnancy and spontaneous abortion.
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Young women are less likely than men to experience symptoms, so some STIs go undiagnosed until a major health problem develops.
Because young women are especially vulnerable to STIs and their long-term consequences, one of the best ways to protect them is to protect young men. You can:
- Encourage abstinence.
- Encourage young men to use condoms.
- Help young men learn and identify the signs of STIs.
- Promptly treat STIs or refer young men to a treatment center.
- Encourage young men with STIs to notify their sexual partners immediately.
- Encourage young women to seek diagnosis and treatment promptly if their partners have an STI.
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The "good" news about STIs is that they can be prevented, and many can be cured. Preventive measures include abstinence, mutual monogamy or using male latex condoms correctly during each act of intercourse. Female condoms offer protection against bacterial and possibly viral STIs. Other barrier methods, such as diaphragms or spermicides, may offer some protection from bacterial STIs for women whose partners do not use male condoms.
STIs caused by bacteria can usually be treated successfully with antibiotics. These include gonorrhea, syphilis, chlamydia and chancroid. Trichomoniasis, a protozoan infection, can also be treated. STIs caused by viruses cannot be cured, although the symptoms of some, including hepatitis B, genital herpes and HPV, can often be managed so that the client's quality of life is improved. Although there are drugs that can help to manage the symptoms and illnesses of HIV-positive patients, these drugs are prohibitively expensive and are not widely available in developing countries. And even with their use, HIV/AIDS results in death. We will discuss HIV more in Chapter 5.
The following chart outlines key STI counseling issues for providers working with young people. Additional information about counseling can be found in Chapter 6. It is important to remember:
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Anyone at risk of STIs should use male latex or female condoms for protection.
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Notifying sexual partners is an important element of STI treatment and prevention. Sexual partners should be evaluated and treated, if necessary. Adolescents may have an especially difficult time discussing STIs with sexual partners. You can help by volunteering to notify partners.
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Clients who are infected should abstain from sex until their infection is resolved or use condoms to protect their partners.
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Questions for Providers and Program Managers about Preventing STIs |
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? Are STIs a concern in your community?
? Are data available on STI prevalence in your community? If so, what are the most common STIs?
? Does your clinic or program see adolescent STI clients?
? Are you able to offer adolescent clients counseling? Partner referral?
? What types of services does your clinic or program offer to educate adolescents about their STI risks and about prevention and treatment?
? How can you improve adolescents' access to STI information? What steps can you take to encourage adolescents to protect themselves and their partners? Does your clinic or program provide STI treatment for adolescents?
? If not, are there other clinics or organizations that you can link with that provide these services? What are the names and locations of these clinics? How will you make adolescents aware of them? What factors would encourage you to refer young people to these programs? What would discourage you? |
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