Adult CHD: the ongoing need for physician counselling about heredity and contraceptive options.

Purpose Current guidelines recommend that patients with CHD receive age-appropriate counselling on reproduction, pregnancy, and risk of heredity. Our aim was to examine patient knowledge of reproductive health and explore the association between patient knowledge of CHD transmission risk and earlier physician counselling in adults with CHD. METHODS: We performed a cross-sectional survey of patients with CHD aged 18 years and older in a paediatric hospital. RESULTS: Of the 100 patients who completed the questionnaire, most did not report counselling on heredity (66%) or contraception (71%). Of the 54 women, 25 (46%) identified their contraceptive options correctly; 42 (78%) women were classified as being at significantly increased risk for an adverse outcome during pregnancy, and of these 20 (48%) identified this risk correctly. Of all patients surveyed, 72% did not know that having CHD placed them at increased risk for having a child with CHD. On multivariate analysis, factors associated with correct knowledge about risk of recurrence were correct identification of CHD diagnosis (p=0.04) and patient-reported counselling (p=0.001). CONCLUSIONS: Knowledge about heredity, pregnancy risk, and contraceptive options is inadequate among adults with CHD followed-up in a paediatric subspecialty clinic. The majority of patients did not report a history of counselling about reproductive health. There is a strong correlation between history of counselling by the patient's cardiologist and correct knowledge about recurrence risk, suggesting that effective reproductive counselling can positively impact this knowledge gap.

Views of treatment decision making from adolescents with chronic illnesses and their parents: a pilot study.

OBJECTIVE: Shared decision making may increase satisfaction with health care and improve outcomes, but little is known about adolescents' decision-making preferences. The primary purpose of this study is to describe the decision-making preferences of adolescents with chronic illnesses and their parents, and the extent to which they agree. DESIGN: Survey. SETTING AND PARTICIPANTS: Participants were 82 adolescents seen at one of four paediatric chronic illness subspecialty clinics and 62 of their parents. MAIN VARIABLES: Predictor variables include sociodemographics, health parameters, risk behaviour, and physical and cognitive development. The main outcome variable is preferences for decision-making style. RESULTS AND CONCLUSIONS: When collapsed into three response categories, nearly equal percentages of adolescents (37%) and parents (36%) preferred shared decision making. Overall, the largest proportion of adolescents (46%) and parents (53%) preferred passive decision making compared to active or shared decision making. Across five response choices, 33% of pairs agreed. Agreement was slight and not significant. Improved general health perceptions (OR=0.76, 95% CI=0.59-0.99) and improved behaviour (OR=0.75, 95% CI=0.56-0.99) were significantly associated with parents' preferences for less active decision making. Older age was significantly associated with agreement (OR 1.58, 95% CI=1.09-2.30) between parents and adolescents. The paucity of significant predictor variables may indicate physicians need to inquire directly about patient and parent preferences.

Do pediatric fellows recognize the importance and contribution of training to mastery of the general competencies?

BACKGROUND: Six general competencies form the framework for accreditation of postgraduate fellowship programs and maintenance of certification for physician specialists. Fellows' perceptions of these competencies, however, remain unexplored. AIMS: To examine fellows' perceptions of the importance of the competencies to medical education and the contribution of fellowship training to mastery of the competencies, and to explore the alignment of the competencies with critical learning experiences. METHODS: Semi-structured interviews were conducted with 20 pediatric fellows in five divisions at one institution. Fellows recounted critical learning experiences, rated each competency for importance and contribution of training, and explained their ratings. Interviews were analyzed using standard qualitative methods. RESULTS: Fellows assigned high ratings to medical knowledge and patient care for importance and contribution of training to mastery, referring to these competencies as 'staples of training'. They rated interpersonal and communication skills and professionalism higher for importance than contribution of training, viewing them as inherent traits or learned before fellowship. Fellows were unfamiliar with practice-based learning and improvement and systems-based practice and typically perceived them as secondary to training. Descriptions of critical learning experiences substantiated competency ratings for medical knowledge and patient care, but not practice-based learning and improvement. CONCLUSIONS: Fellows perceive traditional knowledge and skills of medical practice as fundamental to postgraduate training, but other competencies as less central.

Personal meaning of human papillomavirus and Pap test results in adolescent and young adult women.

OBJECTIVE: As new cervical cancer screening recommendations are adopted, more adolescents may learn they are infected with human papillomavirus (HPV). The objective of this study was to explore personal meaning of HPV and Pap test results in adolescent and young adult women. DESIGN: The authors recruited sexually active 14- to 21-year-old adolescent girls from an urban teen health center. Participants underwent HPV and Pap testing at baseline and returned 2 weeks later to receive test results and to be interviewed about their responses to test results. The authors analyzed interview transcripts using qualitative methods and developed a conceptual framework to explain participants' responses. MAIN OUTCOME MEASURES: Of the 100 participants, 51% were HPV positive and 23% had an abnormal Pap test. Personal meaning was comprised of four core dimensions: labeling of results, perceived risk of HPV-related disease, personal accountability, and anticipated shame or stigma. The association between test result and personal meaning was mediated through cognitive understanding of test results, which in turn was influenced by education about HPV and prior health experiences. CONCLUSION: Clinicians who communicate HPV and Pap test results to adolescent girls should provide accurate information in a nonjudgmental manner, take into account adolescents' personal experiences with sexually transmitted infections and cancer, and explore personal meaning of results such as anticipated risk and stigma. In this way, clinicians may be able to minimize adverse psychosocial outcomes while promoting positive reproductive health behaviors.

The Use and Out-of-Pocket Cost of Urgent Care Clinics and Retail-Based Clinics by Adolescents and Young Adults Compared With Children.

PURPOSE: We describe the use and out-of-pocket cost of urgent care clinics (UCCs) and retail-based clinics (RBCs) as ambulatory care alternatives to physician offices among children, adolescents, and young adults, and examine differences in use by age. METHODS: Cross-sectional analysis describing diagnoses and out-of-pocket costs for 8.9 million UCC, RBC, and physician office encounters by privately insured child (aged <11 years), adolescent (aged 11-18 years), and young adult (aged 19-30 years) beneficiaries in a U.S. national administrative data set from January to June 2013. We calculate relative odds (RO) of UCC and RBC utilization by adolescents and young adults, using physician office encounters and children as reference groups. RESULTS: UCC (n = 286,144) and RBC (n = 89,903) visits were <5% of encounters. Upper respiratory infections were the most common diagnosis at UCCs (children 25.2%, adolescents 27.3%, young adults 26.5%) and RBCs (38.1%, 44.1%, 42.0%). The mean out-of-pocket cost was higher for UCCs (children +$38, adolescents +$29, young adults +$25) and lower for RBCs (-$4, -$15, -$18) compared with physician office encounters. For adolescents, the adjusted relative probability of UCC or RBC versus physician office encounters was 9% higher (RO = 1.09, 95% confidence interval [CI] = 1.08-1.10) and 31% higher (RO = 1.31, 95% CI = 1.29-1.34), respectively, compared with children. For young adults, the adjusted relative probability of a UCC or RBC encounter was 54% (RO = 1.54, 95% CI = 1.52-1.55) and 68% (RO = 1.68, 95% CI = 1.65-1.71) higher, respectively. CONCLUSIONS: Adolescents and young adults were more likely to visit RBCs and UCCs than children. Understanding of UCC and RBC use, cost, and quality of care is needed to inform policies on their roles in health care.

Common and Costly Hospitalizations Among Insured Young Adults Since the Affordable Care Act.

PURPOSE: To describe the most prevalent and costly inpatient hospitalizations in a national cohort of privately insured young adults since the Affordable Care Act. METHODS: Cross-sectional study of a national administrative data set of privately insured young adult (18-30 years) beneficiaries hospitalized from January 2012 to June 2013. The most prevalent diagnosis categories for young adult hospitalizations are presented as percentages of all young adult hospitalizations by gender and age group (18-21, 22-25, and 26-30 years). Mean and median out-of-pocket costs by diagnosis category and gender are calculated based on deductible, copay and coinsurance payments. RESULTS: We analyzed 158,777 hospitalizations among 4.7 million young adult beneficiaries; young adults accounted for 18.3% of privately insured hospitalizations across all ages. Top diagnoses for young adult female hospitalizations were pregnancy related (71.9%) and mental illness (8.9%). Top diagnoses for young adult male hospitalizations were mental illness (39.3%) and injuries and poisoning (14.0%). Mean and median total out-of-pocket costs for any young adult hospitalization were $1,034 and $700, respectively (mean deductible payment = $411). The most expensive out-of-pocket hospitalizations were for dermatologic diseases (e.g., skin infections) with means of $1,306 for females and $1,287 for males. CONCLUSIONS: This study establishes a baseline for the ongoing assessment of the most common and costly hospitalizations among privately insured young adults in the United States under the Affordable Care Act. The substantial burden of potentially avoidable hospitalizations (e.g., mental health, injury, and poisonings) supports resource allocation to improve outpatient services, mental health access, and public health prevention strategies for young adults.

Sexually transmitted infection testing and screening in hospital-based primary care visits by women.

OBJECTIVE: To explore determinants of sexually transmitted infection screening of asymptomatic women and sexually transmitted infection testing of women with genitourinary symptoms, to investigate the effect of specific genitourinary symptoms on sexually transmitted infection testing, and to examine trends in screening. METHODS: We performed secondary data analysis of nationally representative data from the National Hospital Ambulatory Medical Care Surveys, using 17,458 visits by nonpregnant 15- to 44-year-old women seen in primary care clinics between 1997 and 2000. Point estimates, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are presented. RESULTS: Sexually transmitted infection screening was performed in 2.4% of visits by women without genitourinary symptoms and was more likely among visits for preventive care (OR 6.9, CI 3.8-12.5), by nonwhite women (OR 4.3, CI 2.3-7.9), and in gynecology clinic (OR 3.9, CI 2.5-6.1). Sexually transmitted infection testing occurred in 13.2% of visits by women with genitourinary symptoms and was associated with Medicaid (OR 2.3, CI 1.4-3.6), preventive care (OR 2.0, CI 1.2-3.2), patient age less than 25 years (OR 1.7, CI 1.0-2.6), and nonwhite race (OR 1.7, CI 1.0-2.6). Among symptomatic women, vaginal symptoms (OR 4.8, CI 2.6-8.9) and abdominal/pelvic pain (OR 2.5, CI 1.4-4.5) were associated with sexually transmitted infection testing. Between 1997 and 2000, sexually transmitted infection screening rates remained stable. CONCLUSION: Despite national guidelines, sexually transmitted infection testing outpaces screening. Few visits by asymptomatic women under age 25 result in screening. Strategies to improve screening in primary care should target nongynecology settings and non-preventive care visits. LEVEL OF EVIDENCE: III.

Psychological, behavioral, and interpersonal impact of human papillomavirus and Pap test results.

BACKGROUND: The purpose of this study was to explore the short-term psychological, behavioral, and interpersonal impact of human papillomavirus (HPV) and Pap results in adolescent and young adult women. METHODS: Sexually active young women 14-21 years of age were recruited using a purposeful sampling strategy from a hospital-based teen health center. Participants underwent HPV DNA and Pap testing at baseline. At a follow-up visit 2 weeks later, they received test results and participated in individual interviews designed to examine the impact of test results. Interview data were analyzed using framework analysis, a qualitative analytical method. RESULTS: The mean age of the 100 participants was 17.2 years, and 82% were black. Fifty-one percent were HPV positive, and 23% had abnormal Pap tests. Psychological responses consisted of affective reactions to abnormal results, empowerment through knowledge of results, and self-confidence to prevent future disease. Personal behavioral intentions encompassed safe sexual behaviors, partner monitoring, and return for screening. Anticipated interpersonal consequences focused on the impact of communication about test results on relationships. Psychosocial and behavioral responses were influenced by the personal meaning participants derived from HPV and Pap results (e.g., perceptions of personal risk and anticipated stigma), cognitive understanding of test results, and such factors as coping mechanisms, locus of control, and relationship quality. CONCLUSIONS: An understanding of young women's responses to HPV and Pap test results may help guide clinical interventions designed to prevent possibly harmful psychosocial and interpersonal responses to HPV and Pap testing but promote healthy sexual behaviors and regular screening.

Adolescent use of the monthly contraceptive injection.

STUDY OBJECTIVE: To compare weight and continuation among adolescents using monthly medroxyprogesterone acetate (MPA)/ethinyl estradiol cypionate (E2C), tri-monthly depot MPA (DMPA), and daily oral contraceptive pills (OCP). DESIGN: Medical records were reviewed for body mass index, demographics, and sexual history at baseline; and weight and continuation at 3, 6, 9, and 12 months. Bivariate analyses were performed by method, and continuation functions were compared by the log-rank and Wilcoxon tests. The effect of method on use duration was assessed by Cox regression. SETTING: Hospital adolescent clinic. PARTICIPANTS: 12- to 21-year-old patients who initiated MPA/E2C, DMPA, or OCPs in 2001. MAIN OUTCOME MEASURES: Weight gain and method continuation. RESULTS: MPA/E2C was initiated by 40 (18%) patients, DMPA by 63 (28%), and OCPs by 119 (54%, P < 0.001). OCP users were younger (P = 0.005) and more likely to be white, privately insured, and in school (P < 0.004) than MPA/E2C or DMPA users. Previous DMPA and OCP use, pregnancy, and sexually transmitted infections (STI) were more common among MPA/E2C than DMPA or OCP users (P < or = 0.001). Baseline BMI was lowest (P = 0.06) among DMPA users, and MPA/E2C users were most likely to be overweight (P = 0.03). There were non-significant differences in weight change. Continuation functions differed by the method only in the first three months of use (P = 0.03). Leading reasons for discontinuation were unavailability of MPA/E2C (20%), bleeding with DMPA (22%), and forgetting OCPs (17%). Duration of use was independently associated with white race (P < 0.005) and STI-never (P < 0.0001) but not with method type. CONCLUSIONS: Although MPA/E2C use was associated with overweight status and early discontinuation, it also was associated with previous use of other methods. For all methods, poor continuation at one year supports the ongoing search for effective contraceptive alternatives.

Identifying children with pneumonia in the emergency department.

Emergency physicians need to clinically differentiate children with and without radiographic evidence of pneumonia. In this prospective cohort study of 510 patients 2 to 59 months of age presenting with symptoms of lower respiratory tract infection, 100% were evaluated with chest radiography and 44 (8.6%) had pneumonia on chest radiography. With use of multivariate analysis, the adjusted odds ratio (AOR) and 95% confidence intervals (CI) of the clinical findings significantly associated with focal infiltrates were age older than 12 months (AOR 1.4, CI 1.1-1.9), RR 50 or greater (AOR 3.5, CI 1.6-7.5), oxygen saturation 96% or less (AOR 4.6, CI 2.3-9.2), and nasal flaring (AOR 2.2 CI 1.2-4.0) in patients 12 months of age or younger. The combination of age older than 12 months, RR 50 or greater, oxygen saturation 96% or less, and in children under age 12 months, nasal flaring, can be used in determining which young children with lower respiratory tract infection symptoms have radiographic pneumonia.

Earning trust and losing it: adolescents' views on trusting physicians.

OBJECTIVE: To explore how adolescents with and without chronic illness perceive patient-physician trust and to identify physician behaviors related to these perceptions that might be modified to promote adolescent health care. METHODS: Fifty-four adolescents recruited from the community (healthy subjects) and from hospital-based clinics (subjects with chronic illnesses) participated in 12 focus groups divided by age (11-14 or 15-19 years old), gender, and health status. Major themes related to preferred physician characteristics and trusting one's doctor were derived through a multistep, team-based qualitative analytic process. RESULTS: Adolescents hold varied perspectives of trust in their physicians. They describe elements of patient-physician trust similarly to the comprehensive model developed with adults, including fidelity, confidentiality, competency, honesty, and a global perspective intersecting several of the more specific domains. However, adolescents differ in the relative importance of these dimensions. Younger adolescents express more concern about confidentiality of their health information, and adolescents with chronic illnesses are more interested in involving parents in their care than are adolescents without chronic illnesses. Examples of specific behaviors to improve trust include asking for adolescent's opinion, keeping private information confidential, not withholding information, and engaging in small talk to show concern. CONCLUSION: Understanding the importance of trust and listening to recommendations about behaviors to improve it, in the words of the adolescents, may help physicians build positive relationships with their adolescent patients.

Adolescent presentations of inborn errors of metabolism.

Several studies have shown that a large percentage of inborn errors of metabolism is present in adolescent patients. Individually, each diagnosis in this category of diseases is rare; therefore, there is often a significant delay in determining the etiology of a patient's complaints. These disorders can have a wide variety of multisystemic presentations, several of which overlap with more common disorders of adolescence. This review highlights the red-flag findings on history and physical examination indicating a possible inborn error of metabolism. In addition, a systematic approach for evaluating and categorizing these disorders is introduced and demonstrated through case examples. Primary care physicians play a crucial role in the early detection and prompt treatment of patients with late-onset inborn errors of metabolism.

Predictors of Papanicolaou smear return in a hospital-based adolescent and young adult clinic.

OBJECTIVE: Sexually active young women have relatively high rates of abnormal cervical cytology, yet compliance with return for Papanicolaou smear screening and follow-up appointments is poor. The aim of this study was to determine whether a theory-based model could explain compliance with return visits. METHODS: Participants in this longitudinal cohort study were sexually active young women 12-24 years of age presenting to a hospital-based adolescent clinic. Participants completed self-administered surveys and were then followed for up to 15 months to assess for the outcome measure, return. Logistic regression modeling was used to determine variables independently associated with return. RESULTS: The outcome measure, return, was available for 439 of 490 participants (90%). Mean participant age (+/- standard deviation) was 18.3 (+/- 2.2) years, 49% were black, 23% were Hispanic, and 51% had Medicaid health insurance. Variables independently associated with return included belief that the Papanicolaou smear will not be painful (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.08, 2.83), belief that return for follow-up will prevent cervical cancer (OR 1.83, 95% CI 1.12, 3.07), likelihood that the doctor will be honest (OR 4.07, 95% CI 1.37, 17.5), and low self-reported impulsivity (OR 1.66, 95% CI 1.06, 2.63). Family history of cervical cancer was associated with decreased likelihood of return (OR 0.28, 95% CI 0.08, 0.78). CONCLUSION: Specific beliefs about Papanicolaou smears and providers, low self-reported impulsivity, and no family history of cervical cancer are associated with return for Papanicolaou smear screening and follow-up visits. These findings may guide the design of interventions to increase compliance with recommendations for Papanicolaou smear return.

Comparison of adolescent and young adult self-collected and clinician-collected samples for human papillomavirus.

OBJECTIVE: To examine the concordance between self-collected and clinician-collected samples for human papillomavirus (HPV) DNA. METHODS: Sexually active adolescent and young adult women aged 14-21 years (N = 101) were enrolled in a prospective cohort study of HPV testing. Participants self-collected vaginal samples for HPV DNA, and clinicians collected cervicovaginal samples for HPV DNA and a cervical cytology specimen. We determined concordance between the results of self- and clinician-collected specimens using a kappa statistic and McNemar's test. RESULTS: Of the 51% of participants who were HPV positive, 53% had 1 type, 25% had 2 types, and 22% had 3 types or more; 25 different HPV types were identified. Self-collected samples detected more participants with HPV than clinician-collected samples (45% versus 42%, P =.65). When results were categorized into presence or absence of high-risk HPV types, agreement between self- and clinician-collected specimens was high (kappa 0.72) and the difference between test results was not significant (McNemar's P =.41). However, when all HPV types detected were considered, agreement was perfect in only 51% of those with 1 or more types of high-risk HPV type. There was no association between agreement and age or HPV type. CONCLUSION: Self testing for HPV DNA may be sufficiently sensitive for the detection of high-risk HPV DNA among adolescent and young adult women in clinical settings.

Menstrual disorders in adolescence.

Problems associated with menstruation affect 75% of adolescent females and are a leading reason for visits to physicians. This chapter begins with a review of the timing and characteristics of normal menstruation during adolescence. It then discusses the evaluation and management of adolescents with amenorrhoea, dysmenorrhoea and abnormal uterine bleeding. An approach to adolescent amenorrhoea is presented that utilizes primary versus secondary amenorrhoea, delayed versus normal pubertal development, and the presence or absence of hyperandrogenism as nodal points for decision making. The differential diagnosis of dysmenorrhoea and the management of primary dysmenorrhoea and endometriosis are reviewed. The section on abnormal uterine bleeding contrasts anovulatory dysfunctional uterine bleeding (DUB) with bleeding secondary to problems of pregnancy, uterine pathology, exogenous hormone use and systemic bleeding disorders.

Adolescent beliefs about infertility.

PURPOSE: Explore adolescents' definition of fertility and range of beliefs regarding causes of infertility. METHODS: Qualitative study involving five focus groups that met between April 2001 and December 2001 at a hospital-based adolescent health center. All groups were led by one experienced moderator and observed by two investigators. Audiotapes of the group discussions were transcribed and reviewed independently by three investigators who met and reached consensus on underlying themes. RESULTS: Most adolescents generally understood fertility as the ability to become pregnant. Ten themes emerged as causes of infertility. Anatomic/gynecologic causes generated the most responses and most detailed discussion (e.g., "The coating on the egg is too hard and the sperm can't get in to fertilize the egg."). Other commonly mentioned causes were male factors (e.g., "He cannot produce sperm."), sexually transmitted infections (e.g., "like chlamydia caused scarring in the fallopian tubes"), genetics (e.g.,"a birth defect") and substance use (e.g., "if a man smoke weed all day, the egg may not develop because of problems with his sperm"). Less commonly mentioned themes were stress, contraception, environmental toxins, violence and injury. CONCLUSIONS: Most adolescents defined fertility as the ability to become pregnant and reported an extensive range of beliefs about the causes of infertility. Providers should consider eliciting adolescents' definitions of fertility and also exploring beliefs about causes of infertility with their patients when counseling about sexuality and contraception to determine if an adolescent has inaccurate beliefs about their fertility.

Adolescent and young adult mortality by cause: age, gender, and country, 1955 to 1994.

PURPOSE: To compare mortality rates from motor vehicle accidents (MVA), homicide, and suicide across countries, age groups, and time. METHODS: The World Health Organization Mortality Database was used to construct age- and gender-specific rates in 26 countries for individuals aged 15 to 34 years during the period 1955 to 1994. The rates were adjusted for differences among countries in the age-and-gender distributions of their populations. Cause-specific rates were compared by country, 4-year age groups, 8-year time blocks, and male/female ratios. RESULTS: The proportion of deaths in 15-34-year-olds owing to MVA, homicide, and suicide increased from 26% to 43% over the 40-year study period. Mortality rates differ by country more than time block, peak at ages 15-29 years, and are higher in males than females. Compared to the United States, 24 countries had lower homicide rates and 23 had lower MVA-death rates. CONCLUSIONS: Despite declining rates of death from other causes, the rates of adolescent and young adult death from MVA, homicide, and suicide remain high in countries throughout the world. The proportion of deaths attributable to these causes increased steadily during the latter half of the 20th century. Fatal risk behaviors begin to increase during adolescence but do not peak until age 30 years, suggesting that the target population for prevention extends well beyond the teenage years.

Important health provider characteristics: the perspective of urban ninth graders.

Clinicians caring for adolescents may be better positioned to provide health care when equipped with an understanding of adolescents' preferences regarding provider characteristics. The purpose of this study is to obtain a manageable framework of adolescents' concerns about health care providers. A series of qualitative and quantitative data-collection methods were used to elicit and organize ideas about health care providers from ninth-grade students in Philadelphia. A 5-point Likert survey, based on ideas generated and prioritized in earlier qualitative stages, was administered in school. Exploratory and confirmatory factor analysis was used to uncover latent factors. A total of 2602 students returned usable surveys. A confirmatory factor analysis model including four latent factors (patient's interpersonal relationship with provider, concern for physical safety, concern for emotional safety, and provider counseling ability) explained 51.6% of the model variability. Urban ninth graders want providers with whom they can develop strong relationships, feel emotionally and physically safe, and turn to for counseling. Communication with adolescent-aged patients should be a standard component of health care training and should promote provider sensitivity to adolescent fears and needs in the health care setting.

Urinary tract infection and Chlamydia infection in adolescent females.

STUDY OBJECTIVE: To examine whether clinical or laboratory findings could distinguish Chlamydia trachomatis (CT) from urinary tract infection (UTI) among adolescent females in whom providers tested for both. DESIGN, SETTING, PARTICIPANTS: A laboratory database at an urban teen health center was reviewed to identify females who had both urine culture and ligase chain reaction (LCR) test for CT ordered at the same visit. History and physical findings were abstracted from the medical record. There were 81 visits with retrievable laboratory results and chart documentation. MAIN OUTCOME MEASURES: UTI was defined as >1000 colony-forming units on culture, and CT was defined as positive LCR test. Pearson's Chi-squared test was used to assess strength of the hypothesized associations. RESULTS: UTI was diagnosed in 20 (24%) and CT in 18 (22%) of 82 visits. Concurrent CT was diagnosed in 6 of 20 subjects with UTI. Symptoms and physical signs did not differentiate UTI from CT. Positive urinary nitrites were associated with UTI, but did not exclude CT. Similarly, wet prep evidence of trichomonas or white blood cells was associated with CT, but did not exclude UTI. Clinical diagnosis of CT or UTI was 50% sensitive and 70% specific. CONCLUSIONS: Adolescent females who are screened for both CT and UTI have high rates of concurrent disease. Urinary or vaginal symptoms do not differentiate well between these infections. Clinical diagnosis is imprecise, suggesting that adolescent females with vaginal or urinary symptoms should be tested for both CT and UTI.