STD-prevention counseling practices and human papillomavirus opinions among clinicians with adolescent patients--United States, 2004

Abstract

In 2000, an estimated 18.9 million new cases of sexually transmitted diseases (STDs) occurred in the United States. Although young persons aged 15-24 years represented only 25% of the sexually active population, approximately 48% of STD cases in 2000 occurred in this age group. The most common sexually transmitted infection in persons aged < or =24 years was attributed to human papillomavirus (HPV). Although the natural immunity of most young persons can clear HPV infections with no clinical consequences, certain infections persist and result in warts, precancerous changes, and invasive cancers of the anogenital region in both males and females. In 2000, an estimated 4.6 million new HPV infections occurred among persons aged 15-24 years, resulting in expected direct medical lifetime costs of 2.9 billion dollars. In June 2006, the Food and Drug Administration licensed the first HPV vaccine for females aged 9-26 years for the prevention of cervical cancer (U.S. 2000 incidence rate: 9.4 cases per 100,000), precancerous genital lesions, and genital warts associated with HPV types included in the vaccine (HPV 6, 11, 16, and 18). Protection has been demonstrated for genital infections associated with HPV types included in the vaccine; therapeutic efficacy for persons already infected has not been demonstrated. To assess 1) STD risk assessment, counseling, and education practices of U.S. health-care providers during routine adolescent check-ups and 2) provider opinions regarding methods to prevent HPV acquisition, CDC and Battelle Centers for Public Health Research and Evaluation surveyed clinicians who provided adolescent primary care. The results of this survey indicated that most of the clinicians assessed STD risk in their adolescent patients, addressed STD prevention, and recommended various STD-prevention methods; however, clinician opinions varied regarding the effectiveness of methods for preventing HPV infection and whether their patients would adopt these methods for the long term. Clinicians periodically should assess STD risk in their adolescent patients and provide STD counseling and education to reduce the incidence of STDs in this age group at high risk.