Sex questions inhibit STD testing
|By Jeremy Olson, Star Tribune (Minneapolis)|
|McClatchy-Tribune Information Services|
But it does. Many teens and even early twenty-somethings don't want to disclose they have had sex -- a standard question before chlamydia testing -- or get screened if there is a chance their parents could find out, state and clinic officials say.
The result is that fewer than half of sexually active females aged 16 to 24, a high-risk group for infection, get tested at their primary care clinics, and that chlamydia infections in
"You go into a teenager's mind, which can be a very interesting place, and in their world, it's a very, very big deal," said
While doctors can promise confidentiality in the clinic, they have no control over off-site labs sending results in the mail or insurance companies listing STD tests on their benefit statements.
The trend is disheartening for public health officials because untreated carriers are spreading the bacteria without knowing it and exposing women to eventual risks of infertility and birth complications. Worse, this isn't a new problem.
Even in the parent-free confines of the residence halls at the
"I still feel like it's almost taboo to talk about STDs or STIs in a public forum," Andrews said. "There are still people who are embarrassed to come to me to ask for a condom."
"That may get a little uncomfortable, especially when a father has brought his 17-year-old daughter in because she has strep throat and a 101-degree fever."
One alternative is to just screen all young men and women, without asking if they are sexually active. So-called universal screening isn't recommended by federal authorities, though, because some chlamydia tests can produce "false positives," leaving sexually active teens stressed and abstinent teens bewildered.
Among high-school juniors in
A group of
"Privately, they may admit they are sexually active, but they are very clear that they don't want their parents to know," said
Strategies to improve screening rates include a "tool kit" created in 2013 and funded by four health insurers to teach doctors how to talk to young patients about STDs. A chlamydia partnership in north
"It's a very gentle conversation, and you don't start it unless you know how to finish it," said
Fairview primary care clinics have adopted a sort of "opt out" strategy, presuming that young patients will be tested even if they aren't sexually active or are in monogamous relationships. Instead of saying "?'I know you've been with Bill for 10 years. You should be low risk for chlamydia. Do you really want that test?" doctors are telling such patients that "?'The medical literature still says I should test you,'" Overton said.
Pop-up reminders in electronic medical records also emphasize that screening is medically recommended, and Fairview doctors are given performance bonuses for improving their screening rates.
Data on clinic screening in
Another step in reducing chlamydia is follow-up testing for infected patients after treatment, because of the chance that they could be reinfected if their sexual partners aren't treated. Teens won't return unless clinics nag them to, Fink said. "If you remember when you were 22 years old and somebody told you to do something in three months, you probably said, 'Yeah, whatever.'"
Such strategies might cut chlamydia infections in future years, Fink said, but major progress will require more honest discussions between sexually active teens and their parents about STD testing.
"You use your teeth and you get your teeth cleaned," she said. "Think of it like that. It's just something you do. It doesn't mean you're bad if you have to get some plaque cleaned off."
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