Management Of Sexually Transmitted Infections In Children And Young People

prof drram hiv & aids,hepatitis expert,India

profdrram@gmail.com,+917838059592

The sexual and reproductive health day (12 February) is an opportunity to raise awareness about sexual and reproductive health issues and to educate to reduce the spread of sexually transmitted infections. Health awareness events create publicity for health issues and aims to improve the condition and help save lives, sometimes these events encourage preventative action against conditions becoming more serious. This guideline “United Kingdom National Guideline on the Management of Sexually Transmitted Infections and Related Conditions in Children and Young People” offers guidance on consent and confidentiality on children and young people presenting to health care professionals working in sexual health services. It is also applicable to young people aged 16-18 who have learning difficulties or who are ‘vulnerable’. It includes recommendations on the assessment, examination, diagnostic tests, treatment regimens and prophylaxis for the effective management of children and young persons under 16 at risk of, or who have, an STI. Young people need to be able to access sexual health services in order to prevent, diagnose and treat STIs and gain advice to protect against unintended pregnancy. It is essential that these sexual health services are confidential. This encourages young people to come forward for sexual health care and facilitates disclosure of consensual and non-consensual sexual activity. Many young people enjoy mutually consenting sexual relationships. Although those under 16 years may be involved in consensual sexual activity, they may also be the victims of sexual abuse or exploitation, as many those aged 16-17 yrs. They may not recognise that their relationship is abusive, may have been groomed, or they may be too afraid of the consequences to disclose or acknowledge it. The issue of sexual abuse by other young people is often not recognised. All young people accessing sexual health services should have care guided by the following principles: - An expectation of confidentiality. Trust and confidence in the service. Be consulted and have choices. Remain in control of the process, wherever possible. Be seen in the most appropriate site for optimal care and ‘fast-tracked’ according to local facilities, resources, demand, and Trust regulations. A risk assessment performed on all under 16 year olds using a standardised proforma. The latter should be used if they re-present as a new case. Whenever possible the young person should be seen by an experienced senior member of staff. When this is not possible the case should be discussed with a senior member of staff either immediately or subsequently. Be assessed for competency according to Fraser guidelines. Any under 13 year old must be discussed with a nominated professional either within the clinic or in the Trust and should normally be referred but a decision made on a case-by-case basis. There should not be automatic referral to child protection services of all cases Information sharing on any young person should be individualised and undertaken in the best interests of the child. The best interests of the child should include all aspects of their wellbeing – physical, psychological and social. 16-18 year olds should have risk assessments if there is cause for concern. There should be clear documentation on whether disclosure to child protection services is or is not to be undertaken - If disclosure is to be undertaken without consent, the young person should be informed unless to do so would put them in danger. The young person should not routinely be entered on the Children’s database. If this is done express consent must be obtained. Information on partners obtained for partner notification purposes should not be checked on the police data base as a routine. Follow up appointments should be given to under 16 year olds whenever possible as further information may come to light subsequently. All under 13 year olds, and preferably under 16 year olds, should be given an appropriate follow up appointment. Training should be provided for all staff at induction and on a regular basis thereafter, at an appropriate level. The quality of training should be reviewed at intervals to ensure it is in line with current good practice. Training should include child protection and the management of children and young people. Chain of evidence procedures or pathways of care for them should be available. Vaccination and/or prophylaxis should be considered where appropriate. Sexual activity, abuse and exploitation Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative (e.g. rape, buggery or oral sex) or non-penetrative acts. They may include non-contact activities, such as involving children in looking at, or in the production of, sexual online images, watching sexual activities, or encouraging children to behave in sexually inappropriate ways. Assessing risk of abuse/exploitation Issues that should be considered include: Competency Emotional maturity Psychological wellbeing Physical development, e.g. pre- or post-pubertal Drug or alcohol abuse - age of partner(s) Number of partners (current and lifetime) Disclosure of current or previous sexual abuse or exploitation Other young people who may be at risk, e.g. siblings/other family members, friends, vulnerable adults etc. Social networks and support Age of young person, with decreasing age causing higher concern. Homelessness Out of school 13 14 - other, e.g. commercial sex work, internet grooming etc Physical disability affecting communication Learning difficulties Presence of an STI or pregnancy The risk of a child or young person acquiring a sexually transmitted infection (STI) is dependent on several factors including: The prevalence of STIs within the local population. Maternal STI during pregnancy leading to vertical transmission to the infant. The type of sexual activity, e.g. penile-vaginal or penile-rectal penetration is more likely to lead to infection than other types of sexual activity. Injuries of the genital tract. Trauma increases the susceptibility to infection. The sexual maturity of the young person. A young person has an increased biological susceptibility to carcinogens and STIs due to physical and immunological immaturity of the genital tract. The lack of use of barrier contraception. Age at first intercourse and previous sexual activity as these may lead to a longer period of exposure to transmissible agents and an increased number of partners. Co-existence of other risk behaviours such as drugs or alcohol misuse. Risk of infection The risk of a child or young person acquiring a sexually transmitted infection (STI) is dependent on several factors including: The prevalence of STIs within the local population. Maternal STI during pregnancy leading to vertical transmission to the infant. The type of sexual activity, e.g. Penile-vaginal or penile-rectal penetration is more likely to lead to infection than other types of sexual activity. Injuries of the genital tract. Trauma increases the susceptibility to infection. The sexual maturity of the young person. A young person has an increased biological susceptibility to carcinogens and STIs due to physical and immunological immaturity of the genital tract. The lack of use of barrier contraception. Age at first intercourse and previous sexual activity as these may lead to a longer period of exposure to transmissible agents and an increased number of partners. Co-existence of other risk behaviours such as drugs or alcohol misuse. Accidental transmission (e.g. fomite, close physical contact or autoinoculation) varies according to the STI. Whereas it can never be completely ruled out there is minimal evidence of this as a mode of transmission for most STIs. Vertical transmission is a possibility. There is no research indicating a definitive cut-off age after which it cannot occur. Sexual abuse can occur at any age including in neonates. The presence of one STI indicates the need to look for others.