When performing a preemployment physical on a 16-year-old adolescent, given that the girlfriend was recently treated for a vaginal infection, the PNP should:

When performing a preemployment physical on a 16-year-old adolescent, given that the girlfriend was recently treated for a vaginal infection, the PNP should:

• A. Contact the primary care provider of the adolescent's sexual partner for further information
• B. Obtain a urine specimen to rule out chlamydial infection
• C. Treat immediately with doxycycline
• D. Do no further workup because the patient is asymptomatic

Answer: (B)

Adolescents who are sexually active can harbor silent infections, so exposure history with a partner who had a vaginal infection makes screening essential even if the patient feels well. The best approach is to obtain a urine specimen for nucleic acid amplification testing to detect chlamydia (and other STIs). NAAT on urine is noninvasive, highly sensitive and specific, and it provides results that guide appropriate treatment without unnecessary antibiotics. Empirically treating with doxycycline in an asymptomatic patient isn’t the preferred first step because therapy should be guided by test results to avoid unnecessary antibiotics and resistance. Notifying the partner’s clinician isn’t routinely needed in this scenario, and doing nothing isn’t appropriate given the exposure risk.

Adolescents who are sexually active can harbor silent infections, so exposure history with a partner who had a vaginal infection makes screening essential even if the patient feels well. The best approach is to obtain a urine specimen for nucleic acid amplification testing to detect chlamydia (and other STIs). NAAT on urine is noninvasive, highly sensitive and specific, and it provides results that guide appropriate treatment without unnecessary antibiotics.

Empirically treating with doxycycline in an asymptomatic patient isn’t the preferred first step because therapy should be guided by test results to avoid unnecessary antibiotics and resistance. Notifying the partner’s clinician isn’t routinely needed in this scenario, and doing nothing isn’t appropriate given the exposure risk.