Self-collection of vaginal swabs for the detection of Chlamydia, gonorrhea, and trichomoniasis: opportunity to encourage sexually transmitted disease testing among adolescents.

BACKGROUND: Many sexually transmitted diseases (STDs) are prevalent among adolescents, yet compliance to undergo STD testing by this population is suboptimal. Efforts to enhance compliance with testing among at-risk youth are needed. GOAL: To determine the feasibility and acceptability of self-collection of vaginal swabs for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis among high-school students attending a school health clinic. STUDY DESIGN: Enrolled in the study were 228 female students between the ages of 15 and 19 years. Each student self-collected a single vaginal swab that was tested for C trachomatis, N gonorrhoeae, and T vaginalis by polymerase chain reaction amplification. Acceptability of self-collection of vaginal swabs was assessed. RESULTS: The prevalence of any STD was 18%. Trichomoniasis, chlamydia, and gonorrhea were diagnosed in 10%, 8%, and 2% of students, respectively. Nearly 13% of females who had never previously had a gynecologic examination tested positive for an STD, and 51% of infected students would not have pursued testing by traditional gynecologic examination if self-collection was not offered. Self-collection of vaginal swabs was almost uniformly reported as easy to perform (99%) and preferable to a gynecologic examination (84%). Nearly all (97%) stated that they would undergo testing at frequent intervals if self-testing were available. CONCLUSIONS: Self-collected vaginal swabs for STD testing can be easily implemented in a high-school setting with high acceptability among students, enabling the detection of many STDs that would otherwise remain undetected and untreated.

Providing primary care to the HIV-at-risk and infected child.

Pediatric HIV disease is a growing epidemic in the United States. As the incidence of pediatric HIV disease increases, so will the need for primary care providers knowledgeable in pediatric HIV disease. Primary care providers must have the knowledge and expertise to identify those infants at risk for HIV and be able to implement essential interventions to ensure the most optimal outcomes for these at-risk infants. It is no longer feasible for all at-risk children to be cared for by tertiary care facilities. Community based, primary care centers will need to fill an increasingly large role in this area of care.

Teenagers' perceptions of unplanned adolescent pregnancies and oral contraceptive use.

Adolescent women who are sexually active often do not use contraceptives consistently and correctly. Adolescents are sexually active for an average of 15 months before initiating regular contraceptive use and the majority of young women who initiate use discontinue within the first year after initiation. This study enrolled 50 young women who initiated oral contraceptive use and was designed to provide more understanding of their perceptions about the possibility of an unplanned pregnancy and about contraceptive use. They were again contacted 6 weeks after initiation of oral contraceptives to assess continuation. Findings revealed that 90% of the subjects were sexually active at the time of the first visit; the mean period of sexual activity was 15 months. Only 30% had used a nonprescription birth control method during this period. While perceiving themselves to be highly susceptible to pregnancy, many young women continue to have psychosocial barriers to contraceptive use. Follow-up contact revealed more than 10% of the subjects were not using oral contraceptives.

PIP: In Pennsylvania, 2 nurses practitioners analyzed data on 50 13-19 year old nonpregnant adolescents who intended to use oral contraceptives (OCs) for the 1st time. The nurses wanted to expand understanding of clients' perceptions of unplanned adolescent pregnancies and OC use to prevent these pregnancies. 90% were sexually active at the 1st visit. Sexual activity averaged 15 months. Since they visited a family planning clinic, it was assumed the adolescents considered OCs as a means to prevent unwanted pregnancy. Yet 6 weeks after the initial visit, 13% had either already stopped or had not even begun using OCs. In 3 cases, pregnancy or medical advice were the reasons for discontinuation. Only 30% used any contraceptive during their 1st and last sexual intercourse. Nevertheless they did perceive an unplanned pregnancy as serious and considered themselves susceptible. They even tended to believe OC use was beneficial to their relationships with their partners. Psychosocial and physical barriers to OC use included perception by other people that taking OCs indicated plans to have sexual intercourse and worries about side effects. At least 1 event (mean=2.7) cued 94% to visit the family planning clinic. The most common cues were a friend's pregnancy and a friend's suggestion. These results and results from other studies should guide nurse practitioners on how to counsel adolescents. Specifically they should concentrate more on perceptions rather than anatomy and physiology. They should follow up with participants within the last few weeks which may increase contraception continuation.

Factors in adolescent contraceptive use.

This study examined three variables--knowledge of contraception, self-esteem and religiosity-and the relationship of each variable to the use of contraception among unmarried adolescent women. A questionnaire designed to measure contraceptive knowledge, self-esteem and religiosity was administered to 28 pregnant, unmarried adolescents and to 31 unmarried, never-pregnant, adolescent contraceptive users. A t-Test was used to measure the significance of the relationship of the three independent variables to the dependent variable, contraceptive use. Upon analysis of the data, no significant difference was found between either group in relation to their knowledge of contraception, self-esteem scores or religious attitudes; however, some additional data were gathered from the research tool that may provide areas for future investigation.