MMWR Morb Mortal Wkly Rep. 2006 Oct 20;55(41):1118-20.
In 2000, an estimated 18.9 million new cases of sexually transmitted diseases (STDs) occurred in the United States. Although young persons aged 15-24 years represented only 25% of the sexually active population, approximately 48% of STD cases in 2000 occurred in this age group. The most common sexually transmitted infection in persons aged < or =24 years was attributed to human papillomavirus (HPV). Although the natural immunity of most young persons can clear HPV infections with no clinical consequences, certain infections persist and result in warts, precancerous changes, and invasive cancers of the anogenital region in both males and females. In 2000, an estimated 4.6 million new HPV infections occurred among persons aged 15-24 years, resulting in expected direct medical lifetime costs of 2.9 billion dollars. In June 2006, the Food and Drug Administration licensed the first HPV vaccine for females aged 9-26 years for the prevention of cervical cancer (U.S. 2000 incidence rate: 9.4 cases per 100,000), precancerous genital lesions, and genital warts associated with HPV types included in the vaccine (HPV 6, 11, 16, and 18). Protection has been demonstrated for genital infections associated with HPV types included in the vaccine; therapeutic efficacy for persons already infected has not been demonstrated. To assess 1) STD risk assessment, counseling, and education practices of U.S. health-care providers during routine adolescent check-ups and 2) provider opinions regarding methods to prevent HPV acquisition, CDC and Battelle Centers for Public Health Research and Evaluation surveyed clinicians who provided adolescent primary care. The results of this survey indicated that most of the clinicians assessed STD risk in their adolescent patients, addressed STD prevention, and recommended various STD-prevention methods; however, clinician opinions varied regarding the effectiveness of methods for preventing HPV infection and whether their patients would adopt these methods for the long term. Clinicians periodically should assess STD risk in their adolescent patients and provide STD counseling and education to reduce the incidence of STDs in this age group at high risk.
2000年，美国估计有1890万例新发的性传播疾病（STD）病例。虽然15至24岁的年轻人仅占性活跃人群的25%，但2000年约48%的STD病例发生在该年龄组。24岁及以下人群中最常见的性传播感染归因于人乳头瘤病毒（HPV）。虽然大多数年轻人的自然免疫力可以清除HPV感染且无临床后果，但某些感染会持续存在，并导致男性和女性的肛门生殖器区域出现疣、癌前病变和浸润性癌症。2000年，估计15至24岁人群中有460万例新发HPV感染，导致预期的直接医疗终身成本达29亿美元。2006年6月，美国食品药品监督管理局批准了首款用于9至26岁女性的HPV疫苗，以预防宫颈癌（2000年美国发病率：每10万人中有9.4例）、生殖器癌前病变以及与疫苗中所含HPV类型（HPV 6、11、16和18）相关的生殖器疣。已证明该疫苗对与疫苗中所含HPV类型相关的生殖器感染具有保护作用；但尚未证明对已感染人群具有治疗效果。为评估1）美国医疗保健提供者在青少年常规体检期间进行的性传播疾病风险评估、咨询和教育实践，以及2）提供者对预防HPV感染方法的看法，美国疾病控制与预防中心（CDC）和巴特尔公共卫生研究与评估中心对提供青少年初级保健的临床医生进行了调查。该调查结果表明，大多数临床医生对其青少年患者进行了性传播疾病风险评估，开展了性传播疾病预防工作，并推荐了各种性传播疾病预防方法；然而，临床医生对预防HPV感染方法的有效性以及他们的患者是否会长期采用这些方法的看法各不相同。临床医生应定期评估其青少年患者的性传播疾病风险，并提供性传播疾病咨询和教育，以降低该高危年龄组中性传播疾病的发病率。
