Audio

In this episode, we explore how pediatricians can create safe, inclusive spaces for discussing sexual health. Our hosts review evidence-based recommendations for STI screening and treatment, emphasizing how to tailor care to the diverse needs of young patients. We also discuss practical approaches to communicating results, preserving confidentiality, and empowering youth with tools for STI prevention.

STI Pearls

Take an inclusive sexual health history, orientation does not always align with sexual behaviors
Prioritize adolescent privacy and confidentiality
Discuss prevention with patients including condoms, PreP, DoxyPEP and consent

STI Show Notes

Importance of discussing STI evaluation with adolescents

Adolescents and young adults have the highest prevalence of certain STIs in the United States. There are additional risk factors that place adolescents at increased risk including those who have multiple sex partners, failure to use barrier protection and limited access to health care (CDC, 2021). There are also disparities in prevalence along the lines of racial/ethnic groups. Left untreated, infections can develop into Pelvic Inflammatory Disease ( #83: Ascend Your Understanding of Pelvic Inflammatory Disease), increase risk of HIV acquisition (Spach et al, 2025), and lead to adverse birth outcomes (Gerwen, 2021).

Take an inclusive sexual health history

Taking an inclusive sexual health history is necessary to counsel adolescents on their sexual and reproductive health. The CDC outlines the 5 Ps as a framework to discuss sexual health with patients. The 5 Ps include: Partners, Practices, Protection from STIs, Past History of STIs, Pregnancy Intention. Routinely asking these questions ensures that you are able to provide appropriate guidance to adolescents. For more information on talking to adolescents about sexual health, check out our past episodes (# 83: Let’s Talk About Sex and # 158: Plan A, B, and C).

Confidentiality matters and is supported by the American College of Obstetricians and Gynecologists, the Society for Adolescent Health and Medicine, the American Academy of Pediatrics, the American Academy of Family Physicians, and the North American Society for Pediatric and Adolescent Gynecology (ACOG, 2020). Set expectations with families early that you will speak with their adolescent privately during well child visits.

Screening Recommendations

The AAP supports screening adolescents for STI based on risk assessment and at least one screen for HIV between the ages of 15 and 21. The STI Treatment Guidelines published by the CDC outlines screening guidance which is listed in brief below. There are additional populations including pregnant persons, persons living with HIV and persons receiving HIV Pre-exposure Prophylaxis who are not included. For full screening recommendations, visit their website or download the phone app.

Population	Brief Screening Recommendations based on the CDC
Women	Chlamydia for sexually active women under 25 Gonorrhea for sexually active women under 25 Syphilis for adults at increased risk Herpes can be considered for women presenting for an STI evaluation Trichomonas for women receiving care in high prevalence settings and in asymptomatic women at increased risk HIV for all women 13 – 64 (opt – out) and all women who seek evaluation for STIs
Men who have sex with women	Chlamydia for young men in high prevalence clinical settings Gonorrhea has insufficient evidence for men who are at low risk Syphilis for asymptomatic adults with increased risk Herpes can be considered for men presenting for an STI evaluation HIV for all men 13 – 64 (opt – out) and all men who seek evaluation and treatment for STIs
Men who have sex with men	Chlamydia for sexually active men at sites of contract regardless of condom use Gonorrhea for sexually active men regardless of condom use Syphilis for adults at increased risk Herpes can be considered for women presenting for an STI evaluation HIV annually if HIV status is unknown or negative and the patient or their partner(s) have had more than one sex partner since most recent HIV test
Transgender and Gender Diverse Persons	Chlamydia should be considered based on anatomy Gonorrhea should be based on anatomy Syphilis should be considered annually based on sexual behaviors and exposures HIV should be discussed and offered with frequency based on risk

How to screen for STIs

Optimal screening for persons with female anatomy is a nucleic acid amplification test (NAAT) using a vaginal swab. For persons with female anatomy, self collected vaginal swab and provider collected swabs are equivalent in sensitivity and specificity (CDC, 2021). Optimal screening for persons with male anatomy is NAAT using a first void urine sample. Rectal and pharyngeal swabs can be offered as well.

If you need patient instructions or posters for screening, the University of Washington STD Prevention Training Center has TestYourself Visual guides for pharyngeal, rectal and vaginal self testing available in 21 languages.

HIV and Syphilis require a blood test. For more information on HIV and Syphilis, check out our past episodes (# 25: HIV for the Pediatrician and Curbsiders # 326 Screening for syphilis).

For herpetic appearing lesions, test for HSV using NAAT via PCR or culture. Dr. Galindo cautions around sending HSV serologic testing in the absence of a genitial lesion. Reasons to use serologic testing includes: patient who has recurrent or genitial symptoms with negative HSV PCR, patient with clinical diagnosis of genitial herpes without PCR or partner who has genitial herpes. This should happen in the context of shared decision making.

Sharing test results

Dr. Galindo emphasizes privacy in disclosure. Prior to sending the lab results, obtain either a personal cell phone or email to communicate with the patient (and let the adolescent know that you will call and they should pick up the phone!). Discuss with adolescents the importance of treating the infection. Be prepared to help navigate young people through a diagnosis and treatment plan which includes the steps of understanding the diagnosis, receiving treatment and partner disclosure. Expedited Partner Treatment is dependent on state laws. Be mindful of adolescent safety in disclosure.

Treatment for STIs

The STI Treatment Guidelines published by the CDC outlines treatment guidance which is listed in brief below. For full treatment recommendations, visit their website or download the phone app. In Dr. Galindo’s expert opinion, consider alternative treatment regimens to optimize treatment adherence.

STI	Recommended Regimens Adolescents and Young Adults
Chlamydia Infection	Doxycycline 100 mg BID for 7 days
Gonococcal Infection	Ceftriaxone 500 mg IM
Syphilis Infection	Benzathine penicillin G 2.4 million units IM
Thrichomonas	Metronidazole 500 mg BID for 7 days
Herpes	Acylovir 400 mg TID for 7 – 10 days

Read more about partner treatment for bacterial vaginosis.

Prevention for STIs

Talk to adolescents about condoms, PrEP and DoxyPep and enthusiastic consent!

Links

STI CDC Treatment Guidelines

University of Washington National STD Curriculum

SisterSong – Reproductive Justice

Goal

Learners will be able to provide inclusive, evidence-based sexual health care to adolescents and young adults, including comprehensive STI screening, treatment, counseling, and prevention strategies.

Learning Objectives

After listening to this episode listeners will…

Describe key components of an inclusive sexual health history that supports open, nonjudgmental communication with adolescents
Identify current CDC recommendations for STI screening, testing sites, and appropriate treatments for common infections in pediatric and adolescent populations.
Discuss best practices for sharing STI test results with patients and families while maintaining confidentiality.

Disclosures

Dr Galindo reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures.

Citation

Nwora C, Galindo E, Berk J, Chiu C, Masur S. “#161: Swab Goals: STI Screening and Management in Adolescents”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ 3rd December, 2025.

Episode Sponsors

Freed

Use code: CURB50 to get $50 off your first month when you subscribe!

Factor

Eat smart at FactorMeals.com/cribsiders50off and use code cribsiders50off to get 50% off your first box, plus Free Breakfast for 1 Year.

Episode Credits

Written and Produced by: Christle Nwora MD
Showrunner: Sam Masur MD
Infographic: Christle Nwora MD
Cover Art: Chris Chiu MD
Hosts: Christle Nwora MD
Technical Production: Pod Paste
Guest(s): Elena Galindo MD

CME Partner

The Cribsiders have partnered with Penn Medicine Continuing Education to offer continuing education credit—including AMA PRA Category 1 Credit™ and ABP MOC Part 2—for physicians and other healthcare professionals. An annual subscription gives you unlimited access to the full course catalog. Enrol Now.

Contact Us

Got feedback? Suggest a Cribsiders topic. Recommend a guest. Tell us what you think.

We love hearing from you.

#161: Swab Goals: STI Screening and Management in Adolescents