Terry's case: A Youth at Risk

Key messages

1. The health care provider should always consider the client's STI risk by doing a full STI risk evaluation questionnaire. This is an essential component of a complete medical evaluation. The best medical practice to evaluate a client for STIs is always to consider the six (6) following essential elements of the STI risk evaluation questionnaire:

   1. Relationship history

   2. Psycho-social health history

   3. Reproductive and medical events history

   4. STI history

   5. Sexual risk behavior history

   6. Substance use history.

2. To adequately screen a youth at risk for STI you need to test for gonorrhea, chlamydia, syphilis, hepatitis B virus, and human immunodeficiency virus (HIV) with pre- and post-test counselling. TB and hepatitis C screening may need to be considered.

3. Nucleic acid amplification tests (PCR, LCR), even if not the first choice for gonorrhea infection screening because of sensitivity and specificity issues, are adequate for clients who refuse tests for culture and for use in mobile units or street programs.

4. STI prevention plans specific to youth most at risk should include strategies such as vaccination against hepatitis A and B, risk reduction with respect to drug use and proper linkage to social, mental and health resources.

5. It is the cumulative high risk behaviours that put people at risk, not their age or sexual orientation.