Family Practice News (06.13.2013)
According to Dr. Katie Plax, director of the Adolescent Center at St. Louis Children’s Hospital and associate professor of pediatrics at Washington University in St. Louis, urine screening alone is not a reliable method of finding gonorrhea and chlamydia infections in young men who have sex with men (MSM). She noted that triple screening - pharyngeal, rectal, and genital - improved chlamydia and gonorrhea detection, particularly in an at-risk population.
In a study reported at the annual meeting of the Pediatric Academic Societies, Plax and colleagues screened 135 young MSM ages 14–24 years at a St. Louis drop-in youth center that provides healthcare and social services. Each young man had triple screening with nucleic acid simplification tests of urine, rectum, and pharyngeal specimens. During a 12-month period, only 17 percent of positive tests were from urine specimens, while 82 percent were from rectal or throat specimens.
In another study presented by Rachel Witt, a medical student at the University of Pennsylvania, researchers conducted a retrospective cross-sectional study of 1,000 randomly selected routine visits by patients ages 13–19 years. The patients were from 40,000 adolescents being treated at 29 primary care practices affiliated with Children’s Hospital of Philadelphia and Children’s National Medical Center in Washington. There was a documented sexual history for fewer than one-quarter of the patients. Of the patients who admitted to being sexually active, 38 percent had received sexually transmitted infection (STI) testing, 22 percent had been tested for HIV, and only 2.6 percent had been tested for STIs in the previous year and 1.1 percent for HIV.
Both studies emphasized that caregivers should take better sexual histories; conduct routine laboratory screening for all sexually active adolescents, particularly those from a high-risk population; and base screening tests on types of reported intercourse.