Human immunodeficiency virus seropositivity in adolescents with syphilis.

OBJECTIVE: The purpose of this study was to assess the relationship between syphilis and human immunodeficiency virus (HIV) infection among inner-city, minority group adolescents. METHODS: From August 1989 through June 1990, serum from all positive serologic tests for syphilis, obtained from patients attending a comprehensive adolescent health center in an acquired immunodeficiency syndrome epicenter and its two school-based clinics, were frozen without patient identifiers and were subsequently screened for HIV by enzyme-linked immunosorbent assay with confirmatory Western blot for positives. In addition, a retrospective chart review was performed for all patients with a positive serologic test for syphilis during the study period. RESULTS: Of the 59 specimens with a positive syphilis serologic test, 9 (15.3%) were HIV seropositive. Of the patients with syphilis, 57.4% were black and 42.6% were Hispanic; 16.4% were male (mean age 18.1) and 83.6% were female (mean age 17.8). Only 1 subject (female) was an injection drug user; 4 of the male subjects self-identified as having had sex with other males. Of the subjects, 27.8% had primary, 19.7% had secondary, and 52.5% had latent syphilis at the time of diagnosis. A prior or concurrent sexually transmitted disease was present in 90% of the males and 80% of the females; gonorrhea was the most prevalent sexually transmitted disease in the males (89%) and chlamydia was most prevalent in the females (35%). A history of chancroid and/or herpes was present in 16.4% of the subjects. CONCLUSIONS: It is concluded that the diagnosis of syphilis in an adolescent is a risk factor for HIV infection. All sexually active adolescents should be routinely screened for syphilis, regardless of sexual practices. Those with syphilis should be specifically counseled about their increased risk for HIV infection and the importance of consistent condom use, and they should be referred for formal HIV pretest counseling.

Frequency of use, knowledge, and attitudes toward the contraceptive sponge among inner-city black and Hispanic adolescent females.

This study assessed the frequency of use, knowledge, and attitudes toward the contraceptive sponge in sexually active, inner-city, black and Hispanic adolescent females. A 54-item, self-administered questionnaire was completed by 208 adolescents (mean age 17.9 years) attending a gynecology/family planning clinic within a comprehensive adolescent health center. Twenty-nine (13.9%) had never used any birth control, and 49 (23.6%) had not used any form of birth control in the 3 months prior to the study. Fifty-three (25.5%) of the adolescents had used a less reliable method such as rhythm and/or withdrawal. The birth control method used least was the sponge. Only four (1.9%) of the adolescents had used the sponge in the 3 months prior to the study, and only ten (4.8%) had ever used it. Knowledge of the correct use of the sponge was poor. However, 69 (44.8%) of the 156 girls who knew about the sponge had a positive attitude toward it, and only 19% said they did not like it. The contraceptive sponge may be a viable option for adolescents, particularly those who are not using birth control or who are using a less reliable method.

PIP: This study assessed the frequency of use, knowledge, and attitudes toward the contraceptive sponge in sexually active, inner-city black and Hispanic adolescent females. A 54-item self-administered questionnaire was completed by 208 adolescents (mean age 17.9 years) attending a gynecology/family planning clinic within a comprehensive adolescent health center in New York City. 29 (13.9%) had never used any birth control and 49 (23.6%) had not used any form of birth control in the 3 months prior to the study. 53 (25.5%) of the adolescents had used a less reliable method such as rhythm and/or withdrawal. The birth control method used least was the sponge. Only 4 (1.9%) of the adolescents had used the sponge in the 3 months prior to the study and only 10 (4.8%) had ever used it. Knowledge of the correct use of the sponge was poor. However, 69 (44.8%) of the 156 girls who know about the sponge had a positive attitude toward it and only 19% said they did not like it. The contraceptive sponge may be a viable option for adolescents, particularly those who are not using birth control or who are using a less reliable method.

Characteristics of social networks in adolescents with end-stage renal disease treated with renal transplantation.

In adolescents, the establishment of same- and opposite-sex nonfamily peer relations facilitates the normal development of independence and separation from family. Adolescents with end-stage renal disease (ESRD) may be particularly vulnerable to delayed social development and isolation from their peers because of the unique physical and psychosocial aspects of their illness. The characteristics of the social networks of 16 adolescents with ESRD treated with renal transplantation were studied using the Social Networks of Youth Questionnaire. Compared with a matched group of healthy adolescents, these teenagers named fewer significant others in their total social networks, as well as fewer unrelated and opposite-sex peers. Family members comprised a greater proportion of the transplant patients' networks compared to controls. Self-esteem, measured by the Coopersmith Self-Esteem Scale, was similar for transplant and control groups, with the exception of home self-esteem, which was higher in the chronically ill adolescents. Body image was somewhat lower, but not significantly, in adolescents with ESRD. The characteristics of the chronically ill adolescents' social networks suggest that these patients may experience a degree of social isolation. Interventions that promote increased peer contacts and enhance interpersonal skills should be included in the psychosocial management of adolescents with ESRD after renal transplantation.

Anal intercourse and knowledge of acquired immunodeficiency syndrome among minority-group female adolescents.

PIP: Adolescent minority group females experience of anal intercourse and knowledge about and attitudes toward AIDS have been investigated. A questionnaire survey was administered to 148 largely black and Hispanic female patients at an adolescent health center. 111 of the girls reported that they were sexually active. 28 girls (25.2%) acknowledged having had anal sex, 19 of them within the preceding 3 months. Condoms were far less likely to be used during anal intercourse than during vaginal sex. Accurate knowledge about AIDS increased with age, but there was no relationship between age and any change in sexual behavior to avoid the disease. What little changes in sexual behavior reported were, however, strongly linked to fear of contracting AIDS. The most effective means of HIV transmission from males to females is through anal intercourse. Given the high incidence of anal intercourse practice by black and Hispanic females, their infrequent use of condoms during anal intercourse, and a large and increasing HIV infection rate among black and Hispanic males, it can be seen that adolescent minority group females are at increasing risk of heterosexual exposure to HIV infection. Lack of relationship between knowledge about AIDS and reduction of high-risk sexual behavior are discouraging to hopes of disease prevention through educational efforts.^ieng

Thrombocytopenia in a bisexual adolescent male with a history of intravenous drug use.

Immunologically mediated thrombocytopenia has been reported as a manifestation of human T-lymphotropic virus type III (HTLV-III) infection and intravenous (IV) drug abuse. The case report describes thrombocytopenia in a bisexual adolescent male with antibody to the HTLV-III virus and a history of infrequent IV drug abuse. The case underscores the need to consider HTLV-III infection and/or IV drug abuse in the differential diagnosis of thrombocytopenia in an adolescent.

Chlamydia trachomatis detection in adolescents. A comparison of direct specimen and tissue culture methods.

We compared tissue cell culture isolation with the Microtrak fluorescent monoclonal antibody direct specimen test for detection of endocervical Chlamydia trachomatis in an inner-city population of sexually active Black and Hispanic adolescent girls. Of the 95 patients screened, C. trachomatis was identified in 26.3%. The sensitivity of the direct specimen test was 91.7%, and its specificity was 98.6%. The positive predictive value was 95.6%, and the negative predictive value was 97.2%. No significant difference was found between Blacks (28.6%) and Hispanics (24.1%) in the incidence of endocervical C. trachomatis, nor was the use of an oral contraceptive significantly associated with the diagnosis of C. trachomatis (p greater than 0.10). Neisseria gonorrhoeae was isolated in 8.4% of the patients. The direct specimen test appears to be an accurate and convenient method of screening sexually active adolescent girls for genital C. trachomatis. Further study is needed to determine if an oral contraceptive increases the risk of Chlamydia infection in adolescents.

Isolation of Neisseria meningitidis from anogenital sites in adolescents: clinical implications.

Neisseria meningitidis is being increasingly isolated from the urethra, cervix, and anal canal of sexually active individuals. We found a similar phenomenon in inner-city black and Hispanic adolescents. In 1981, cultures of 92 isolates of Neisseria were made from the anogenital region of sexually active adolescents; 81 (88.0%) were N. gonorrhoeae, 3 (3.3%) could not be speciated, and 8 (8.7%) were N. meningitidis. Since N. meningitidis has been associated with urethritis and pelvic inflammatory disease, it should be considered a pathogen when identified in the urethra or cervix and should be appropriately treated. The health implications of isolating N. meningitidis from the anal canal are less clear, although it has been rarely associated with proctitis. Neisseria isolates from anogenital sites cannot be assumed to be gonococci and, therefore, should be distinguished from N. meningitidis.

A somaticizing adolescent: an approach to evaluation and therapy.

Adolescents may chronically somatize as part of the symptoms of an underlying psychological disorder. Unless the underlying psychological disorder. Unless the underlying psychopathology is recognized by the treating physician, chronic somatization may result in high cost to the health care system due to frequent use and unnecessary biochemical and radiographic evaluation. The case presented is illustrative of the differential diagnosis and management of such a patient.