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Loris Y. Hwang, MD; Kathleen P. Tebb, PhD; Mary-Ann B. Shafer, MD; Robert H. Pantell, MD

Arch Pediatr Adolesc Med. 2005;159:1162-1166.

Objective  To document the comprehensive management of Chlamydia trachomatis infections in sexually active 14- to 19-year-old adolescents.

Design  A chart review of both paper and electronic records to examine documentation of treatment and follow-up of adolescents who tested positive for C trachomatis infection.

Setting  Five pediatric clinics of a large northern California health maintenance organization.

Participants  Consecutive sample of 122 adolescent girls and boys aged 14 to 19 years who tested positive for C trachomatis infection beginning May 1, 2001, for 20-month (4 sites) or 4-month (1 site) study periods.

Main Outcome Measures  Antibiotic treatment, counseling regarding safer sex, management of patients’ partners, screening for other sexually transmitted infections, and retesting for C trachomatis infection.

Results  The median age of participants was 16.9 years. All but 4 teenagers (97%) were treated with appropriate antibiotics. During follow-up, safer-sex counseling was documented for 79% of the patients. Partner management was addressed for 52% of the patients. Only 36% of the patients were tested for other sexually transmitted infections, and 10% received C trachomatis retesting during the Centers for Disease Control and Prevention–recommended time frame of 3 to 12 months after treatment. Significantly fewer boys than girls received safer-sex counseling (P = .02) and partner management (P = .02).

Conclusions  Most teenagers received appropriate antibiotics, but fewer received other recommended care. The current study highlights important "missed-opportunity" clinical encounters for counseling to address high-risk behaviors, management of partners, detection of other sexually transmitted infections, and retesting for reinfections. Systems to address these gaps in care should be incorporated into the clinical management of adolescents infected with C trachomatis.

Author Affiliations: Department of Pediatrics, Division of Adolescent Medicine, University of California, San Francisco.

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