The romantic entanglements of
teenage patients can hardly seem important to most physicians,
but recent research suggests that taking an interest in
the love lives of your young charges could help you protect
them from risky sexual behaviour. "Healthcare providers
should seriously consider the romantic relationships of
their adolescent patients by discussing sexual expectations
and monogamy for established couples while addressing
setting personal sexual limits and consistent condom use
as well as communication skills for new or less established
relationships," says Dr Aaron Sayegh, health research
scientist at the Mid-America Adolescent STD Cooperative
Research Center at the Indiana University School of Medicine.
These updated recommendations for
Chlamydia prevention stem from a four-year study
that Dr Sayegh and his colleagues began in 1995. Their
findings are published in the August issue of the Journal
of Adolescent Health. The research team examined
factors associated with repeated sexually transmitted
infections (STIs) among 14 to 21-year-old women. The
142 participants, recruited from health clinics, had
all been treated either for C trachomatis, Neisseria
gonorrhoeae or Trichomonas vaginalis, or were sexual
contacts of other patients with these infections.
THE
DATING GAME
When first enrolled, the young women were interviewed
about their four most recent sexual relationships during
the previous two months, sexual behaviours (including
frequency of intercourse) and condom use. The interviewers
also assessed the quality of those relationships, from
casual sexual liaison to more serious partnerships,
using measures of emotional, affiliative and supportive
characteristics. Followup interviews were conducted
approximately one and three months after the enrollment
interview, at which time any new Chlamydia infections
were diagnosed and treated, and new partners were also
identified.
Previous studies have shown that
adolescent women, especially those in new relationships,
have higher rates of Chlamydia than any other
age group. The latest study shows that unprotected intercourse
was associated with an increased risk of Chlamydia.
But this factor went hand-in-hand with the increase
in frequency of intercourse in more 'established' relationships
(ie those that the young woman viewed as steady.)
The study also shows that condoms
can protect against Chlamydia but condom use
among adolescents seemed to decline as their relationships
evolved. The risk of infection is perceived to be lower
in a (presumed) monogamous relationship and forgoing
condoms is seen by these teens as an act of trust. The
"no glove, no love" message hammered into
their impressionable minds at sex ed classes or by more
liberal-minded parents doesn't seem to last beyond the
first month of the average teen's relationship. "Efforts
to encourage condom use must be persistent, and must
be adjusted to the relational needs of a given time,"
says Dr Sayegh. The authors also note that "the
introduction of a new partner into the individual's
sexual network increases risk of sexually transmitted
infections."
GOOD
GIRLS, BAD BOYS
Another much larger study on teens' sexual behaviour
helped dispel some common myths about what factors deter
teens from becoming sexually active. Results of the
US National Longitudinal Study of Adolescent Health,
which followed 14,322 middle and high school students
enrolled in the study between 1994 and 1995, turned
up some pretty startling results. The study, published
in the July issue of the Archives of Pediatric and
Adolescent Medicine, looked at what factors influence
a teen's decision to delay their first sexual encounter.
These factors were also examined to determine their
role in the longterm prevention of C trachomatis,
N gonorrhoea or T vaginalis.
The researchers found that teens
with a higher grade point average and parents who strongly
disapproved of teenage sexual activity were less likely
to have STIs six years later. These findings held true
for teenage girls but not for boys. However, feelings
of connection to family or school, reported importance
of religion, attending a parochial school, and pledges
of virginity during adolescence had no bearing on STI
status six years later.
PARENTS,
JUST SAY "NO"
After completing followup interviews and STI testing
in 2001-02, lead author Dr Carol Ford, associate professor
of pediatrics and medicine at the University of North
Carolina concludes, "effective parental communication
about sexuality issues during adolescence can have important
health benefits six years later. From a practical perspective,
if parents who disapprove of their adolescent children
engaging in sexual intercourse convey this attitude
effectively, even within the context of broader discussions,
then longterm risks of sexually transmitted infection
may be reduced. This is something that family physicians
can explain to parents."
J Adolesc Health Aug
2005;37(2):163
Arch Pedtric Adolesc Med July 2005;159(7):657-64
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