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Where does the time go? Like an uninvited houseguest, Fall has arrived. As the month creeps forward, the upcoming school year looms larger on the horizon and thousands of 17- and 18-year-olds prepare to depart for college.
Many of the young women I have seen in clinic this past month are actively culling together their vaccination records and health information to submit to their respective colleges and student health centers. These appointments have been excellent opportunities to discuss some essential tenets of preventative medicine, especially as it pertains to protection against sexually transmitted infections.
While I cringe when I imagine how uncomfortable my 17-year-old self would have been if confronted by such a conversation, I have no recollection of my care providers ever discussing any of these topics. I suppose the subtext was evident, but I think this information should be explicit. Thus, I am confident that over the past few weeks I made more than a few of my teenage patients a little uncomfortable. However, I took great care to diminish the potential for awkwardness and addressed them just as I would if I were speaking with one of my adult patients. (Acknowledging that my 17-year-old self would have been exceedingly indignant if anyone treated her like an idiot.)
The information I disseminated to these young women included, in no particular order, the following: distribution of pamphlets regarding the HPV vaccine, differences between HSV I and HSV II strains, various routes of sexually transmitted infections, the importance of using condoms and dental dams, a reminder that hormonal birth control whether OCT or IUDs do not confer protection against STIs, a reminder that some STIs are not curable, and recommendations regarding first Pap smear and pelvic exam (starting at the age of 21 or 3 years after the first time they have had sex).
I think it is poor form to use fear tactics as a means to influence and affect patient behavior. Conversely, I think the opposite is true regarding continuing education amongst health practitioners. The latest information regarding antibiotic resistant gonorrhea should compel everyone to consider the quantifiable importance of disease prevention. Knowing that this preventable, but common, STI can cause PID, fallopian tube scarring, and increase the probability for ectopic pregnancies, emboldens me to discuss this topic with my patients whenever the opportunity presents itself.
According to the CDC’s morbidity and mortality weekly report from July 8th, 2011, epidemiological patterns of cephalosporin susceptibility in the West are reminiscent of the emergence of fluoroquinolone resistant N. gonorrhoeae in the U.S. While there is no conclusive evidence for the inevitability of the spread of cephalosporin resistance N. gonorrhoeae, it stands to reason that health practitioners should assume extra vigilance in their treatment of gonorrhea. Historically, the emergence and spread of gonococcal antibiotic resistance was addressed by altering antibiotic recommendations. However, with the exclusion of fluoroquinolones and the potential loss of cephalosporins, no other well studied and effective antibiotic treatment options are currently available. That’s enough to scare me straight into action and reminds me that an ounce of prevention is worth a pound of cure.
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