‘HAD four or five sex partners since I turned 12,’ glares the wisp of a girl, barely a woman, spilling a confession to the health professional she turned to for succor, a shoulder to sob on.
Keep that calm, no matter how jolting or revolting her statement– healing a patient with sexually transmitted infection (STI) entails a lot more than a diagnosis and the consequent treatment protocol; the physician needs to rely on vast reserves of understanding, what it takes to be human to reach out to the afflicted. Because sympathy sees and says, ‘I’m sorry.’ Compassion discerns, says, ‘I’ll help.’ Reckoning the difference, the health professional makes a difference.
‘Maybe you don’t say anything but your behavior in the clinic (can tell more to a patient); that patient may clam up. You should be able to receive information no matter how shocking they are but keep a straight face. Ask questions that will help you manage your patient but don’t be too intrusive. It is important to get a good sexual history especially in adolescents,” so cautions Dr. Christine Dobles Dizon. She currently serves as vice-president for internal affairs of the Philippine Infectious Diseases Society for Obstetrics and Gynecology and clinical mentor at the Ateneo School of Medicine and Public Health.
In turning up a sound diagnosis, “we need to get a very good sexual history. The challenge is the stigma involved. And because of this stigma there’s actually a bit of discomfort or difficulty, not only with the patient but also the provider—they are really uncomfortable asking help from the doctor, they may be even be reluctant to divulge everything. What could complicate matters, if this patient is an adolescent, you have a parent who may have a different agenda or may inhibit the adolescent from freely sharing.
“To get a good sexual history is to be able to talk to the patient alone,” Dr. Dobles Dizon avers.[pq]STI management, to the wizened health expert, entails fetching “three big buckets, which would be (1) diagnosis, (2) treatment, and (3) prevention.[/pq]
(But there’s more to) giving the medicines, or what to prescribe, or what test to do… with STI management in the young population,” she cites before an audience of specialists in the 5thBiennial Convention of the Pediatric and Adolescent Gynecology Society of the Philippines held in May 2015 at the Quezon City Sports Club. The forum tackled the theme, “Reproductive Concerns of Girls.”
She notes that female adolescents are more susceptible to STTI, and “more susceptible to having more serious long-term consequences, (including) their predisposition to increased risk of genital cancer if exposed to the human papilloma virus, including ectopic pregnancy, and infertility.”
Crucial to diagnosis is “to really get a good sexual history especially in adolescents—because they are more likely to have multiple sexual partners, they are more likely to engage in unprotected intercourse. Adolescents are more susceptible to STI… because of cervical ectopy that happens during puberty, low immunity in the vagina to fight off any pathogenic organism, a smaller introitus, the lack of lubrication in the introitus that could possibly lead to more traumatic sex.”
Accurate diagnosis largely stems from data gleaned from sexual history the patient disclosed “but remember that some victims of sexual abuse might not even disclose any intercourse. As much as possible, do the smallest number of testing, and (do) the less invasive test for the adolescent to minimize any distress.
“Treatment regimen in young people does not vary from that of adults. Do ensure completed treatment since adolescents are really notorious for poor compliance. If there’s a recommended single-dose therapy, then use that. It’s important that the (patient’s sex) partner also gets evaluated and also gets treatment. Counseling would be the same as your patient. To be able to control STI, we need to also treat the partner or partners,” she relates.
All told, Dr. Dobles Dizon enjoins her peers: “Determining the most appropriate advice screening and clinical management depends on (eliciting) an active sexual history. STI management does not only mean making the right diagnosis, for finding the test and prescribing the recommended treatment regimens.
“STI management is heavy on counseling and patient and partner management. Clinicians caring for these patients must be fondly professional and non-judgmental.”
– Dong delos Reyes, Medical Observer