The results of a study carried out in nine hospitals in five autonomous communities have shown that in Spain there has been an increase in sexually transmitted infections (STIs) among adolescents and has revealed the profile of the new cases, which confirms that STIs are diagnosed at an early age, regardless of biological sex and sexual orientation. The data have been presented at the XIV Gesida Congress, held in La Coruña.
The research has included episodes that have been treated both in hospitals and in primary care on a sample of 529 cases diagnosed between 2018 and 2022. The study includes cases of new diagnoses of the following STIs: HIV or episode of syphilis throughout the period referred, and infection by C. trachomatis, N. gonorrhoeae, M. genitalium or herpes simplex virus (HSV) in the first 15 days of each trimester, during those five years.
Almost 53% of cases were diagnosed in men. Regarding sexual orientation, 40% of STIs were diagnosed in heterosexual adolescents, 20% in gay and lesbian adolescents, and 3% in bisexual adolescents (orientation not reported in 30% of cases). Regarding age, 20 of the 529 episodes analyzed (almost 4%) are those under 15 years of age (early adolescents); 176 (more than 33%) were middle adolescents, between 15 and 17 years old; and 333 (almost 63%) were late adolescents (between 18-19 years old).
It was observed that in 17% of cases there was at least one coinfection. HIV, syphilis and N. gonorrhoeae were mainly associated with male adolescents (in 81%, 67% and 72% of cases), while herpes simplex virus (HSV), M. genitalium and C. trachomatis were associated with greater frequency to adolescent women (in 77%, 86% and 68% of cases). HIV was diagnosed more frequently in homosexual adolescents (57.6% of cases), while C. trachomatis and HSV in heterosexuals (58% and 75% of cases).
Improve the diagnosis and treatment of STIs in adolescents
Although the majority of STIs were diagnosed in Primary Care (44% of cases), they were also detected in hospital care (43%) and, in a smaller percentage, (10%) in STI reference centers. The researchers conducted another evaluation at the same centers to analyze possible improvements in diagnoses. This study, on a total sample of 492 cases, highlights the need to introduce improvements in the information, management and treatment of adolescents with STIs.
HIV was diagnosed more frequently in homosexual adolescents (57.6% of cases), while ‘C. trachomatis’ and HSV in heterosexuals (58% and 75% of cases)
The findings reveal that in 12.8% of STI diagnoses no treatment was recorded, something that also happened in 21% of syphilis cases. Furthermore, in 27% of the episodes the treatment received was inadequate (no treatment was received or it was incorrect), with syphilis being the STI that accounts for the largest number of cases (37% of cases). Overall, treatment was inadequate in 1/4 of STI episodes overall; 1/3 in case of syphilis diagnosis and 1/5 if C. trachomatis or N. gonorrhoeae was diagnosed.
The authors of the work have also found that screening for other STIs, in search of coinfection, is carried out in a minority. Thus, 43% of adolescents diagnosed with herpes simplex virus (HSV), M. genitalium, C. trachomatis or N. gonorrhoeae were not requested serology to screen for HIV or syphilis. While 70% of patients diagnosed with syphilis or HIV did not undergo exudate or urine analysis to screen for other STIs. For this reason, these researchers have highlighted the need to improve the training of health professionals in the care of adolescents with suspected STIs.
