Guest Commentary: Actually, Doctor, There's This One Thing . . .

March 1, 2006

Your patient, Keith, is a 19-year-old college freshman who is currently on spring break following the successful completion of his midterm exams. You have known him since he was 9 years old and you are looking forward to hearing about his first few months away at school.

Your patient, Keith, is a 19-year-old college freshman who is currently on spring break following the successful completion of his midterm exams. You have known him since he was 9 years old and you are looking forward to hearing about his first few months away at school.

Keith tells you that he has come for a routine physical examination, and he initially denies any health concerns. During your review of systems, however, he blurts out, "Actually there's this one thing that I have been worried about the past week or so. . . . "

The plot thickens. "About 2 weeks ago, my fraternity brothers and I were celebrating the end of our exams. We had a few drinks at a party and I met this sophomore girl I know who has always liked me and I liked her. We ended up going back to her place and the next thing I knew . . . well . . . let's just say that I didn't have any protection on me but that didn't stop us from having sex. I know, I know, it was pretty stupid, but she promised me that she didn't have any diseases or anything. I pretty much put the whole situation out of my mind until 2 days ago when it suddenly started to hurt when I pee."

On further questioning, Keith reports that he has noticed moderate amounts of thick green discharge coming from his penis over the past day. He denies chills, fever, and other constitutional symptoms. Physical examination reveals inguinal lymphadenopathy and purulent discharge coming from the urethral meatus. His testes are nontender, and the scrotal examination is unremarkable.

Keith asks, "You don't think I have some kind of disease down there, do you?"

A wealth of data suggest that teenagers of all races, locales, and socioeconomic backgrounds experiment with various types of sexual contact. (That stubborn toddler who screamed in your office during an ear examination 14 years ago may return to your office wanting to know how he or she can get rid of a terrifying infection in the genital region!)While some pediatric practitioners have little interest in managing teen sexuality and sexually transmitted diseases, it is important that they possess the information and openness that their patients feel comfortable discussing these issues with them.

In the next few issues of Consultant for Pediatricians, I will review some of the most common sexually transmitted diseases. As you probably can surmise from the opening vignette, the first diseases I will discuss (see page 155 of this issue) are infections with Neisseria gonorrhoeae and Chlamydia trachomatis. Future installments will focus on infections with herpes simplex virus and genital human papillomavirus, syphilis, and some of the less common infections that can affect adolescents.