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

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

3. 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 years

4. 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 should receive annual screening
Annual screening should focus on:
Healthy eating habits
Regular exercise
Tobacco/drug use
Sexual activity

5. 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

7. 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

8. Every 10 seconds a teen loses their virginity!

9. CDC Trends in Sexual Début Girls, Ages 15-19

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

11. 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

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

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

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

15. 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

16. 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

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

18. 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

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

20. Cervical Cancer is caused by HPV

21. 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

22. 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.

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

24. 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

25. 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

26. What is the HPV Vacccine?

27. 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

28. 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

29. 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

30. 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

31. 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

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

33. 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!!!

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

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

36. QUESTIONS?

37. 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 American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:1143–7.
Human papillomavirus vaccination. Committee Opinion No American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:712–8  

38. 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 ACOG pratice Bulleton Number 131, November 2012 Screening for Cervical Cancer.