Adolescent and pediatric gynecology最新文献

Study Objective: To make clinicians aware of the possibility of children being coinfected with human immunodeficiency virus (HIV) and human papillomavirus (HPV) and discuss the clinical dilemmas and legal implications.

Design and Participants: Two illustrative case reports of children simultaneously infected by HIV and HPV and evaluated for sexual abuse.

Setting: The patients were evaluated in the Child Abuse Pediatric Clinic at the Columbia Presbyterian Medical Center, New York City.

Interventions: The patients were treated with topical 5% 5-fluorouracil cream.

Results: Sexual abuse transmission of HIV was strongly suggested in one patient. Sexual abuse transmission of HPV could not be proven in either case.

Conclusions: Genital condyloma may be a clinical manifestation of progressive immunosuppression secondary to vertically or sexually acquired HIV infection in children. Legal issues of children with sexually transmitted diseases need to be addressed in the future.

The unique aspects of children and adolescents as they undertake sports and exercise are examined. Considerations include the physiologic features of the growth, development, and maturation processes, as well as the responses of the young body to aerobic, anaerobic, and strength training. Medical conditions and musculoskeletal injuries unique to this population will be presented. The emotional and psychologic ramifications of sports and exercise on young people will be discussed.

Study Objective: The study focuses on partner notification by examining adolescent girls' discussions of STD acquisition with partners. The relationship between aspects of sexual history and partner notification were examined.

Design: Cross-sectional study.

Setting: An urban hospital-based primary care adolescent clinic.

Participants: The sample consisted of 182 girls who had a history of STD.

Main Outcome Measures: Adolescents were interviewed regarding the discussion of STD acquisition with partners.

Results: Sixty-seven percent of girls reported telling a partner and 22% had been told by a partner. Eleven percent had told a partner as well as had been told by a partner, and 22% had never talked about STD acquisition with her partner. Adolescents who had talked about STD acquisition in the past were more likely to respond to a hypothetical situation by saying they would “always” tell a partner. The most common reasons for adolescents reporting that they did not tell a partner were: they were no longer involved with the individual, they expected a negative response, or they blamed the partner for the acquisition. When asked about the nature of the experience of telling a partner, most reported that it was a negative emotional experience.

Conclusions: Although most adolescents had some experience discussing STD with a partner, there was a substantial minority who had not, representing a potential public health problem. Adolescents may not have discussed STD acquisition with their partners because they anticipated a negative experience or because they did not believe it was important when no longer involved with a partner.

Objective: To survey the opinions of adolescent health care providers regarding the availability of over-the-counter (OTC) oral contraceptives (OCs) to adolescents and whether this intervention may decrease the number of unintended adolescent pregnancies.

Methods: Academic hospitals, neighborhood health centers, and family planning centers in the city of Boston were contacted. The health care providers who were most involved in adolescent contraceptive counseling were surveyed.

Results: Forty-nine providers participated. Ninety percent of providers (44 of 49) were against making OCs available OTC to adolescents. Seventy-three percent did not think that OTC OCs would decrease the number of unintended adolescent pregnancies.

Conclusions: Our survey shows that adolescent health care providers surveyed in Boston are opposed to making OCs available to adolescents over the counter. The majority do not think this would decrease the number of unintended adolescent pregnancies. The providers predicted that without the interactive counseling provided by clinicians, adolescents would be unlikely to utilize OCs effectively. Additionally, adolescents would be seen less for sexually transmitted diseases (STDs) screening and other routine health care.

Uterus didelphys with an obstructed hemivagina and ipsilateral renal agenesis, Wunderlich-Herlyn-Werner syndrome (WHWS), is a complex congenital anomaly, with approximately 170 cases previously reported, affecting both miillerian and wolffian systems. Possibly due to an anomalous ovarian secretion of miillerian inhibitory factor, it consists of two müllerian hemiapparati, one of which is occluded, and unilateral renal agenesis (mostly on the obstructed side). Four main variants are known: complete hemivaginal obstruction, incomplete hemivaginal obstruction, complete hemivaginal obstruction with laterally communicating hemiuteri, and complete hemivaginal atresia. WHWS is mostly diagnosed in adolescents, with earlier and more severe symptoms when no communication exists between the hemiapparati. The authors report on three cases with different clinical presentations detected in adolescent girls. New etiologic insights, diagnostic procedures, and treatment are discussed. To preserve fertility, early diagnosis and conservative surgery are recommended.