2024 STI Prevention Conference: STI Testing and Diagnosis in Adolescents and Young Adults

intro-background[00:00] Intro and Background

Hello, everyone. My name is Meena Ramchandani. I'm an infectious disease physician at the University of Washington in Seattle. This podcast is dedicated to an STI [sexually transmitted infections] literature review for health care professionals who are interested in remaining up to date on the diagnosis, management, and prevention of STIs. 

We'll continue to review oral abstracts presented at the STD Prevention Conference in September of 2024 in Atlanta, Georgia. I'd like to focus on the topic of STIs in adolescents and young adults for this episode. STIs in adolescents and young adults account for half of all new infections, and there is a notable trend of co-occurring STIs in this population. For example, two pathogens causing disease at the same time. Adolescents make up 25% of the sexually active population in the U.S., and so we're going to go through a brief summary of a few oral presentations on this topic that were discussed at the conference.

abstract-1[00:59] Abstract #1

The first abstract we'll review was presented by Dr. Szucs, from the CDC, and is titled, Teen parent differences in perceived usefulness and comfort with sexual health information: Teen and parent surveys of health 2022. This group surveyed a nationally representative sample of adolescents ages 15 to 17 years, as well as their parents, on 12 different sexual and reproductive health resources. So, these resources included social media, a health care provider that the adolescent was in touch with, or even a website. There were 522 teen parent pairs, so they had quite a big cohort. What they found, according to teens, is that the top three useful information resources for sexual and reproductive health information was a medical website, their parents or caregiver, and health care providers who were outside of their school environment.

Now, taking a look at parents, parents were most comfortable with their teens getting information about sexual and reproductive health from their parents or a caregiver, the health care provider outside the school, or even health classes in school. In a subgroup analysis, the authors found that the highest reported resources from which teens did not receive sexual and reproductive health information included parent or caregiver at 79%, health care professional outside the school at 75%, health care provider in school at 63%, health education classes at 63%. Despite these being the resources that parents felt most comfortable with, so maybe some opportunities for intervention. Many teens reported never using a romantic partner, teen website, or sibling for information on this topic.

So, this helps us to better understand teen perspectives on the usefulness of information around sexual and reproductive health. Teens receive information from multiple sources, and some information or sources are more useful than others. They also might be more reliable than others. In the survey, there was an agreement, it seemed like, between teen perceived usefulness of, as well as parent comfort, with particular sexual and reproductive health resources, and that's reassuring. These include information directly from their parents or caregiver, health education classes, and health care providers outside the school environment. So possibly prioritizing schools and youth serving providers to educate teens about sexual and reproductive health or build parent and teen skills around communication. These might be good opportunities to improve adolescent knowledge of sexual health topics.

abstract-2[03:38] Abstract #2

Dr. Douglas from the University of Washington and Seattle Children's Hospital presented the next abstract titled, Which healthcare settings diagnose most STIs in youth? A descriptive analysis in King County, Washington. So, using King County STI surveillance for chlamydia, gonorrhea, and syphilis, the authors analyzed cases in persons ages 15 to 24 years from 2019 to 2023. In this population, over 8,000 cases of bacterial STIs reported, and there were around 3,000 cases of chlamydia, 4,700 cases of gonorrhea, and 700 cases of syphilis. Most of these bacterial STIs, or 81%, occurred in those ages 18 to 24 years.

The authors found that 30% of the STI diagnoses were in Black youth, even though Black persons make up 7% of the population in King County. About 20% of diagnoses were in Hispanic/Latino youth, even though this population is 11% in the county. Around 30% of STI diagnoses were in White youth, and White persons make up about 54% of the population in this county. And 7% of the diagnoses were in Asian youth, and this population makes up about 20% of persons in King County.

Most chlamydia cases were in females, and the majority of gonorrhea and syphilis cases were in males. The most common STI diagnosing facility was in primary care settings, which diagnosed 29% of cases, and this was followed by emergency or urgent care settings, which diagnosed 20% of cases. Family planning clinics diagnosed about 12% of cases. Now, for syphilis specifically, this was most likely to be diagnosed in correctional facilities or STI clinics in this population. 

What they found is that school-based health centers accounted for less than 1% of all STI diagnoses. So, this information is helpful to better understand where youth are going for STI diagnosis and management. 

Overall, a high number of bacterial STIs are diagnosed in this population. It seems like emergency settings, such as the emergency department or urgent care, is a common location for STI diagnosis in youth, while school-based health centers seem to be underutilized for sexual health. Based on this abstract, as well as the one presented by Dr. Szucs, school-based health care providers and centers might be a good location to increase resources and management of sexual and reproductive health for teens.

abstract-3[06:05] Abstract #3

The next oral presentation was presented by Dr. Addison from Boston Children's Hospital and is titled, Quality improvement initiative to improve STI screening in adolescent and young adult males. From 2021 to 2023, this group implemented interventions in their clinic to increase STI testing in young males, and they focused on males because they noticed STI screening rates in the male population were lower compared to females in their medical practice. So, based on feedback regarding barriers on testing, they added a couple of things to their clinic to make things easier. For example, bathroom signage indicating urine would not be used for drug testing, as well as creating a gonorrhea and chlamydia testing alert in the electronic health record for male medical visits when the patient was overdue for STI testing.

What they found in this study that the rates of gonorrhea and chlamydia screening increased from 58% to over 75% for male patients attending their clinic. So, these were manageable interventions to help increase STI screening for adolescents and young adults in busy clinics where providers have multiple medical issues to address. These interventions can be applied to a variety of health care settings. I'd be curious to hear more about positivity rates for STIs in this population and if this intervention led to increased treatment outcomes.

abstract-4[07:30] Abstract #4

The next oral abstract to review was presented by Lynn Barclay from the American Sexual Health Association, and is titled, “Let’s Tok about sex”: Reaching young women 18-24 with sexual health messaging on TikTok. According to the Harris Poll, which is a global market research and consulting firm that provides insights on digital tools, over 60% of Gen Z TikTokers use the app regularly to learn, and 40% of young people turn to TikTok over Google for search.

Of note, the authors didn't refer to what time period this data was gathered, but I think the topic is relevant because it applies to learning about sexual health topics via social media and nontraditional resources, especially for a younger generation.

So, this group partnered with six relevant TikTok creators to post a 30-second TikTok video, each that highlighted the importance of STI testing as part of the YES Means TEST campaign. YES Means TEST is an initiative to educate and empower young adults to get tested for STIs. And the creators included two OB/GYNs [obstetrician-gynecologists], one pediatrician, two Gen Z content creators, and one sex educator. And the target audience were young women 18 to 24 years on the platform.

The Gen Z creators tapped into trends, and the health care providers lent expertise to short videos on the topic of STI testing as part of sexual health care. They promoted content over a one-month period in 2022. Overall, what they found is that these videos resulted in an almost 15% video view rate with 3.4 million video views and 23 million impressions. One video by an OB/GYN provider had the highest number of video views, and it resulted in 1.5 million views and in 10 million impressions for this video alone. The campaign drove around 16,000 unique visitors to YES Means TEST website, and it actually resulted in 2,400 clicks to search for a local clinic using a zip code that they had on the YES Means TEST website.

This project outperformed TikTok benchmarks, resulting in engagement and action from the audience, and it suggests using the most relevant social media platform might be helpful to deliver sexual health information, especially to the Gen Z or younger demographic.

summary[09:53] Summary

To conclude, I'd like to summarize some key points for the session. 

• In a survey of teens ages 15 to 17 years, the top three useful information sources for sexual and reproductive health information were a medical website, their parents or caregiver, and health care providers outside school. These were similar resources parents also felt comfortable with.
• Most STIs in youth are diagnosed in primary care, emergency or urgent care settings, and family planning clinics in King County. School-based clinics have an overall low proportion of STI diagnosis among youth in this area.
• Based on feedback, a clinic in Boston decreased barriers around STI testing for male adolescents by providing reassurance that urine samples would not be used for drug testing and an STI testing alert to remind providers to screen patients when due.
• Using the social media platform TikTok, creators were able to highlight the importance of STI testing for young women ages 18 to 24 years, and their videos resulted in 3.4 million video views, 23 million impressions, and 16,000 visitors to the YES Means TEST website, which is an initiative to educate and empower young adults to get tested for STIs.

credits[11:11] Credits

This podcast is brought to you by the National STD Curriculum, the University of Washington STD Prevention Training Center, and is funded by the Centers for Disease Control and Prevention. Transcripts and references for this podcast series can be found on our website, the National STD Curriculum at www.std.uw.edu. Thank you, and have a wonderful day.