You are seeing a 15-year-old adolescent for her annual health supervision visit.

During the
assessment, she reveals that she is sexually active. She reports 2 lifetime sexual partners. Both
partners were male. She reports unprotected vaginal and anal sex. Her last menstrual period
was 2 weeks ago. Her physical examination is unremarkable. Her urine pregnancy test is
negative and screens for sexually transmitted infections are pending.
Of the following, the MOST appropriate counseling would be to
A discuss the importance of dual protection with hormonal contraceptives and barrier methods
.
B discuss the need for an initial Papanicolaou test to screen for cervical dysplasia
.
C discuss the need for the patient to have her partners screened for sexually transmitted
. infections
D explain to the patient that the age of sexual consent is 16 years of age
.
E explain to the patient that unprotected anal sex does not place her at risk for HIV acquisition
.
There are several established guidelines for the provision of preventive services for adolescents. Bright Futures is an
initiative of the American Academy of Pediatrics (AAP) that provides guidance and tools for pediatric and adolescent
health supervision visits. Bright Futures recommends that sexuality is addressed at each period of adolescence
starting at the early adolescent visit. Taking a sexual history allows the clinician to identify individuals at risk for
acquisition of sexually transmitted infections (STIs) or unintended pregnancy, as well as sites for anatomic testing
and guide risk reduction counseling. The US Centers for Disease Control and Prevention provides a tool to assist
clinicians with sexual history taking that emphasizes the 5 Ps: partners, practices, protection from
pregnancy, protection from STIs, and past history of STIs.

Sexually active adolescents should receive screening and counseling for sexually transmitted infections and
pregnancy prevention. In July 2014, the AAP Committee on Adolescence and the Society for Adolescent Health and
Medicine issued the policy statement Screening for Nonviral Sexually Transmitted Infections in Adolescents and
Young Adults, which recommends gonorrhea and chlamydia screening for all sexually active female adolescents and
young adults, sexually active adolescent and young adult males who have sex with males, and other males from
high prevalence areas. The United States Preventive Services Task Force (USPSTF) recommends HIV testing for
individuals 15 years of age and older, with subsequent testing based on risk.

Sexually active adolescents should be counseled about contraceptive options. The American College of Obstetricians
and Gynecologists and the AAP recommend that adolescents are counseled on the first line use of long acting,
reversible contraceptives (eg, intrauterine contraceptives, contraceptive implants) for pregnancy prevention.
Additionally, it is imperative to counsel adolescents on the dual use of hormonal contraceptives with barrier methods
for the prevention of pregnancy and STIs, and is recommended for the adolescent in this vignette.

The USPSTF recommends cervical cancer screening for women ages 21 to 65 years with cytology (Papanicolaou
smear) every 3 years or every 5 years for women ages 30 to 65 years, with a combination of cytology and human
papillomavirus testing. The USPSTF specifically recommends against screening for women younger than 21 years of
age.

While screening for STIs in sexual partners may be important, it does not negate the need for use of dual protection
for the prevention of STIs and unintended pregnancy. Unprotected anal sex is a significant risk factor for HIV
acquisition. The age of sexual consent varies by state.
PREP Pearls

 Sexuality should be addressed during the health supervision visit at each period of adolescence, starting at the early
adolescent visit.

 Taking a sexual history allows the clinician to identify individuals at risk for acquisition of sexually transmitted infections
or unintended pregnancy, as well as sites for anatomic testing and guide risk reduction counseling.

 The American Academy of Pediatrics Committee recommends gonorrhea and chlamydia screening for all sexually active
female adolescents and young adults, sexually active adolescent and young adult males who have sex with males, and
other males from high prevalence areas.

 Adolescents should be counseled on the dual use of hormonal contraceptives with barrier methods for the prevention of
pregnancy and sexually transmitted infections.

 The United States Preventive Services Task Force recommends HIV testing for all individuals 15 years of age and older,
with subsequent testing based on risk.

ABP Content Specifications(s)

 Provide appropriate counseling with regard to contraception and prevention of sexually transmitted infection for an
adolescent engaging in vaginal and/or anal intercourse

 Provide guidance regarding methods of contraception