Treating STDs in Teens More Effectively

Teens experiencing recurring STD infections need expedited therapy

(RxWiki News) Are teenagers getting enough help in treating sexually transmitted diseases (STD)? A new study reveals that teenagers may not be getting adequate STD treatment. It's possible that doctors are not aware how they can help.

Research shows that 40 percent of teenage gonorrhea and chlamydia patients are diagnosed for a second time within a year -- even after antibiotics are given to the patient.

Better education of pediatric medical residents on how they can treat partners of STD patients could help.

"If you test positive for a STD, tell your partner."

This study — conducted at the Stanford University School of Medicine and the Lucile Packard Children's Hospital — examines what is called the "ping-pong effect". It happens when a patient continually gets reinfected because their partner has not been treated for the STD.

Expedited partner therapy (EPT) is a practice that can help doctors prevent the ping-pong effect from happening by allowing doctors to prescribe antibiotics to the partner of gonorrhea or chlamydia patients without having to see the partner of the patient.

Researchers surveyed 289 pediatric resident physicians enrolled in fourteen of California's seventeen pediatric resident programs. The pediatricians-in-training were given a questionnaire regarding their usage of EPT , as well as their familiarity with EPT laws and their comfort level in using the practice.

The results revealed that only 51 percent of the pediatric residents had ever employed the practice, even though 83 percent of the doctors had diagnosed patients with STDs. Seventy percent of the doctors were aware of the EPT laws, but many of them incorrectly thought that the practice could be used in other STD cases other than chlamydia and gonorrhea.

Eighty-seven percent of the doctors named their lack of familiarity with EPT as the reason they never use it. Surprisingly, only 24 percent of the doctors said they had actually been taught about EPT, and the doctors who were further along in their residency lacked superior understanding and knowledge of EPT.

These results suggest a significant opportunity to start increasing EPT instruction in residency programs. Especially since it was also found that knowledge of EPT was well known mainly in California's three residency programs that specifically offer fellowships (programs after residencies that allow doctors to have a more hands-on training in their specialty) in adolescent medicine.

Neville Golden, MD, is an adolescent medicine specialist from the Packard Children's Hospital, a professor of pediatrics at Stanford, and was the senior author of the study. Dr. Golden and team argue that these ping pong incidences happen often because many pediatricians-in-training are not fully educated in the correct treatment and prevention methods of recurring STD cases in teenagers.

The study authors believe this is because the patient's partner is not also a patient in these cases, the partner can remain untested and untreated while still infected, thus allowing the STD to bounce back and forth between partners repeatedly.

Laws governing this practice were introduced in California in 2001 and have since been adopted in thirty other states. Before 2001, the partners of patients had to be contacted by state health departments in order to get tested and receive treatment. 

However, most of health departments don't have the resources to effectively test and treat every partner. EPT has since been a successful alternative -- especially in cases where the patient's partner is unlikely to contact or visit a doctor.

The research team concluded that more experienced doctors seem to be unfamiliar with EPT practices, many of which act as mentors.

However, they also stress that it is specifically the doctor's job to talk to their teen patients about STD prevention — regardless of parents' involvement. But it is the parents' job to make sure that their teens have the opportunity to have confidential discussions with their doctors.

The study received no external funding.

This study was published in the September issue of Pediatrics.

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Review Date: 
October 14, 2012