Preventive Care and Sexual Health Information for Tweens and Teens Developed by: ACOG District XII Health Care for Underserved Women Committee

General Risk Factors for Tweens and Teens Poor Diet Lack of Exercise Smoking/Drugs/Alcohol Early initiations of Sexual Activity

When Should You See an Ob/Gyn? Ideally BEFORE there is a problem The American College of Obstetricians Gynecologists (ACOG) recommends young women see a obstetrician/gynecologist (Ob/Gyn) between the ages of 13-15 years

What to Expect from an Initial Visit? History and Physical History on menstrual (period) cycle Examine physical development Screen for emotional and behavioral conditions Discuss/obtain immunizations Generally does not involve a Pelvic Exam All females aged 10-18 should receive annual screening Annual screening should focus on: Healthy eating habits Regular exercise Tobacco/drug use Sexual activity

What is a Pap Smear???? It is not a pelvic exam Use of a speculum to look at the cervix to screen for pre-cancer and cancer cells Exams should begin at age 21

2002 Center for Disease Control (CDC) National Survey of Family Growth Just the Facts…….. 2002 Center for Disease Control (CDC) National Survey of Family Growth 11% of girls sexually active by age 13 24% of girls sexually active by age 15 40% of girls sexually active by age 16 70% of girls sexually active by age 18 Every 10 seconds, a teen loses their virginity

Every 10 seconds a teen loses their virginity!

CDC Trends in Sexual Début Girls, Ages 15-19

More facts……. 12 million NEW Sexually Transmitted Infections (STIs) cases per YEAR 3 million of them are TEENS 9,000 teen STIs per DAY

STI Facts Herpes Simplex Virus (HSV)- 20 million active cases Human Papilloma Virus (HPV)- 24 million active cases Human Immunodeficiency Virus (HIV) More than 1 million active cases

HIV in Florida Florida #3 nationwide 1999: 5,424 new cases 22% of new cases are female 12 % ages 15-24

Chlamydia in Florida (2008 Data) Total cases= 75,000 people 389.1 cases/100,000 people

Gonorrhea in Florida (2000 Data) Total cases: 25,000 people 127.8 cases/100,000 people

Teen Pregnancy 1997-183,324 births to 15-17 year olds in USA 35% of all teen pregnancies are aborted ADD TEEN PREGNANCY RATES IN FLORIDA

Teen Pregnancy 8 out of 10 teen moms live below the poverty level for 10 years 9 out of 10 teen moms never finish college

Consequences of Our Choices…… Emotional affects Physical affects Future Fertility (pregnancy) Possibility of Cancer (HPV) Consequences and affects on loved ones

Pregnancy Prevention Communicate with parents, counselors, trusted adults, partner Daily involvement Commit to your decision Date those that share your views Avoid alcohol Safe sex? Think of YOUR future

Invasive Cervical Cancer 12,360 cases in the USA/year 4,020 deaths in the USA/year 16% of reproductive tract cancers

Cervical Cancer is caused by HPV

Risk Factors for Contacting HPV the cause of Cervical Cancer #1 Highest Risk=HPV Number of partners Age at loss of virginity Smoking HIV infection

Prevalence of HPV Sexually active female college students baseline 26% positive for HPV Check every 6 months 60% positive at least once over 3 years.

Sexual Debut 62% 12th graders sexually active… ½ their mothers are unaware

Role of the Pap Smear in Cervical Cancer Prevention Age 21 Responsible for 70% decrease in cervical cancer deaths. Results 3% Low grade 1% High grade 0.1% Cancer

When Should My Daughter see a Ob/Gyn? Recommended first visit age 13-15 Annually to check for STIs (gonorrhea and chlamydia) testing if sexually active Problems with period Discussions about sexual activity

What is the HPV Vacccine?

Quadrivalent HPV Vaccine Protects against four strains of the virus 6,11,16,18 Approved by CDC in 2006 CDC/ACIP in mid-2006 after FDA approval Recommended for females ages 11-26 Vaccine may be given to females as young as 9 years old

How Safe is the HPV vaccine? Vaccine was studied for a period of over 10 years Included 25,000 people 1,124 adolescent girls age 9-14 Vaccine against a virus particle Rare complications noted from 5 year Scandinavian study

How Do I Get the Vaccine? Vaccine is dispensed in 3 doses 1st-dose at visit, 2nd dose at two months 3rd dose at six months Through the Florida Department of Health- Vaccine for Children (VFC) Program

Is the Vaccine Effective? HPV 16 and 18 responsible for 70% of cervical cancers State of Florida- 10 cases cervical cancer per 100,000 women

New Developments Gardasil was FDA approved for young men ages 9-26 in October 2009 Cervarix is an additional FDA approved HPV vaccine FDA approved for ages 9-25 Only covers HPV strains 16 and 18 Does NOT prevent HPV associated warts

New Developments New vaccine in development that covers 9 different HPV types

What we have done.. With only a 33% vaccination in US girls, and 10% vaccination rate in US boys, rate we have decreased the incidence of HPV by 56% in girls ages14-19!!!

We can do better… 80% adolescent girls vaccinated in Rwanda 33% US girls vaccinated 25.3% eligible Florida adolescent girls vaccinated

We can prevent close to 33,000 cases of HPV linked cancer cases annually with the HPV vaccine

QUESTIONS?

Resources ACOG Pamphlet AP073 Human Papillomavirus (HPV) Infection Jan 13 ACOG Pamphlet AP167 Human Papillomavirus Vaccines Feb 2014 cdc.gov/vaccines/teens cancer.gov/cancertopics/factsheet/Prevention/HPV-vaccine The initial reproductive health visit. Committee Opinion No. 598. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:1143–7. Human papillomavirus vaccination. Committee Opinion No. 588. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:712–8 www.ImmunizationforWomen.org/HPV  

References CDC. Human papillomavirus vaccination coverage among adolescent girls, 2007–2012, and postlicensure vaccine safety monitoring, 2006–2013—United States. MMWR 2013;62:591–5. CDC. Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices. MMWR 2007;56(No. RR-2):1–24. Markowitz, L. Hariri,S .Lin.C.,Dunnel,E. Steinau,E. McQuillan,G and Unge,E. Education in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 2006–2010J Infect Dis. June 2013. ACOG pratice Bulleton Number 131, November 2012 Screening for Cervical Cancer.