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Growing Stronger Together is a podcast for people who care about children.
Growing Stronger Together was developed by faculty at East Tennessee State University, including members of the ETSU Health Department of Pediatrics, the ETSU Center for Early Childhood Learning and Development, and the ETSU Child and Family Health Institute.
East Tennessee State University is located in the beautiful Appalachian Highlands. We appreciate the financial support provided through a Community Health Improvement Site Investment from Ballad Health’s Department of Population Health.
Dr. William Dodd (00:00)
Before we get started today, I would like to bring up the fact that there is recent legislation passed in the state in which I practice Tennessee that changes some of the confidentiality laws that we discuss in this podcast. It's very important to stay abreast of the legal situation which is always shifting for the care of these patients, and many of the points that we bring up are still useful to consider and I would
And pertinent to practice in many ways. So ⁓ without further delay, ⁓ here's the podcast. I'd like to welcome everybody to the Growing Stronger Together podcast. Today we have a familiar guest who is with us last week, ⁓ talking about ⁓ adolescent topics pertaining to confidentiality and mental and reproductive health. ⁓ as one of our pediatric residents here at
East Tennessee State University Health Pediatrics. like to welcome again ⁓ Doctor Vasileva. Dr. Vasileva, thank you for joining.
Dr. Alisa Vasileva (01:17)
Hey Dr. Dodd, thank you so much for introducing me again and for the opportunity to do this podcast with you.
Dr. William Dodd (01:27)
So ⁓ Dr. Vasileva, thank you so much for introducing this topic. ⁓ I'd like to kinda shift gears and maybe we could have another conversation about maybe the reproductive health aspects of confidentiality, how we approach that, maybe some of the risks. how does that sound?
Dr. Alisa Vasileva (01:49)
That sounds great. ⁓ yeah, I feel like next week we'll be discussing more about S T D prevention in more detail and about the pregnancy prevention as well. And we're gonna talk more about most common myths that teens and their parents do believe.
Dr. William Dodd (02:04)
Awesome. Sounds like a plan. ⁓ thank you so much for joining today and ⁓ we'll talk soon.
Dr. Alisa Vasileva (02:14)
So ⁓ so let's move to the sexual health conversations with our teenagers and ⁓ let's talk about why sexual transmitted diseases are matter in adolescents. So there are a few reasons. Basically because about 50% of new SDIs occur in adolescents and young adults from age like 15 to 25, and adolescents usually
Have higher rates of chlamydia and gonorrhea compared to older adults, according to the most articles and studies that I've gone through. ⁓ and many infections also sometimes could be asymptomatic, especially in female teenagers and young females. So that's why screening would be important and essential and not just a symptom based testing. So there are also some behavioral factors, ⁓
that put teenagers at the higher risks for STIs. And those would be multiple or new partners, inconsistent condom use, substance use disorder, early sexual ⁓ debut, limited access to confidential care, Bob that we already talked about. and
As you as you all may know, the most common STDs in adolescent would be chlamydia, that is the most common bacterial STI. ⁓ Often it could be asymptomatic, it can cause pelvic inflammatory disease and lead to infertility if left untreated. So the screen annually in sexually active females less than 25 years of age ⁓ would be great and is highly recommended. the second infection would be gunrhea that may cause urethritis.
And within the last years, it has increasing antibiotic resistance and the screeny for the gunnery, usually based on the risk and an anatomy. HBV, my favorite one. This one is the most common STI overall, and usually clear spontaneously, ⁓ may cause genital warts and cerebral cancer. So the HBV could be preventable.
Via H P vaccine and usually this conversation is one of my favorite conversations with ⁓ families and teenagers because I made lots of obstacles and barriers. ⁓ sometimes it's hard for me to understand why parents really don't want their teenagers to get this particular vaccine. yeah. They're not necessarily
Dr. William Dodd (04:49)
Yeah,
as a future oncologist, I mean, ⁓ you've seen how terrible of a disease cancer can be and
Dr. Alisa Vasileva (04:58)
Yes, and I feel like it's a sometimes this conversation could be a hard burden, but I still try to put my best effort on it because I just feel like at least this is my role as a ⁓ healthcare provider, to get the family the best education and knowledge that we know about this vaccine and how it can help to prevent the cervical cancer, the one of the most dangerous female cancer in the United States. So I think for all of us it's really important you understand and help the families to understand.
why we do this vaccine and to solve the most common myths that sometimes could be related with getting this vaccine and sometimes that could be the reason that stops families to get this vaccine for their child.
So the next few SDIs would be the herpus HSV, which can give you painful vesicular lesions. ⁓ usually it's lifelong infections. And often it could be very emotionally distressing for teens.
And I feel like this this particular infection would be the one that they will tell you for sure because because the symptoms could be very disturbing and painful. So that's usually har harder harder for them to hide that they're struggling with this particular infection. That's from my experience. But that could be different for every every healthcare provider I feel like. ⁓ what is what is your experience, Doctor Dodd?
Dr. William Dodd (06:26)
I mean, yeah, you're right. Herpes I think there's no patient that's gonna hide that from ya. Something like ⁓ chlamydia, you know, a lot of times you'll catch on incidental screening, but ⁓ but yeah, herpes it's so painful. The patient's gonna complain.
Dr. Alisa Vasileva (06:47)
Mm-hmm.
Yes, just simply because it's painful, it's really hard to hide even if they're struggling they want to hide it from their parents, but I feel like that will be the one that they will disclose. For sure. so the next one will be syphilis and unfortunately and we'll see this in the hospital and the clinic, but mainly for me, I I think like I see this in the hospital more, that rates rising, at least for the area where where we practice here in ⁓ Tennessee.
Dr. William Dodd (06:58)
Absolutely.
Dr. Alisa Vasileva (07:18)
around Johnson City area. Yeah. yes. And ⁓ we must always test with a any genital ulcer for syphil syphilis if we have any concerns. Because easily treated.
Dr. William Dodd (07:20)
It's really going around.
Yeah, pregnant people getting tested too. You know, this see so many patients who just for whatever reason end up not seeing a OB on time or maybe don't know they're pregnant or something like that and it just leads to bad situations for the baby.
Dr. Alisa Vasileva (07:52)
That is usually how we see it in the hospital. It's ⁓ most of the cases it's usually the woman who has had late prenatal care or had no prenatal care at all and then she yes, she did have some lesions but she never, you know, paid attention at this and then she came into labor and here we are with the syphilis. And we have to test the baby and we have to treat the baby and yeah. That could be
one hundred percent preventable, but unfortunately that's how it happens nowadays at least. And the very last one would be ⁓ HIV. HIV should be screened at least once in adolescence. ⁓ and obviously the higher risk would be in men who have sex with men and higher risk populations.
like with a pe with a populations with a d drug use disorder or a substance use disorder, or any other social economical struggles, obviously if we if we think that the patient needs to be tested, just go ahead and test.
Dr. William Dodd (09:05)
Yeah, it's always
a good thing to test for because it's so you know, it acts like a flu or something and then it goes away and then it causes really bad stuff. So don't wanna miss it. So so yeah, these patients have ⁓ it's kind of like a toxic social malou of
of engaging in behavior that may not be socially accepted, so they kinda have to sneak around a lot. They have very poor impulse control, may be clouded by substance use. ⁓ you know, I think everybody's been a teenager and ⁓ done things their parents may not approve of. ⁓ so ⁓
So how do we approach the patient, ⁓ you know, as an authority figure, you're a doctor, you're talking with them, you're trying to get a good sense of what's going on. ⁓ how how do we do that?
Dr. Alisa Vasileva (09:58)
So while we during the ⁓ obtaining obtaining the sexual history, we always should ask about the partners, the any pr type of practices, protection that they use, any history of past sexual transmitted infections, and of course about the pregnancy prevention. Those would be your five rules that you always have to be k keep in mind and always ask directly about those about the
those things so that way we can get a better idea of on what's going on and what what part can be missing. and always add the consent, normalize every question of course.
But yeah, those would be our pretty much five cornerstones of our sexual history that we're getting. And sometimes again it feels kinda awkward for for for us or for for a patient, you know, to talk about those things. So that's why I always emphasize it like try to normalize and it's just obviously it's just part of our life that we don't have to be ashamed of talking about. And especially when we see a doctor and again, just because ⁓ I always
tell my patients that, you know, your growing growing child and stepping into adulthood that could be just normal part of your doctor, patient doctor conversation at every visit. So just no shame, no judge. ⁓
Dr. William Dodd (11:33)
Yeah. And
and I also I mean, it is a difficult topic for teens to open up about, but it ⁓ something that sometimes helps as well as ⁓ you know, I just remind like, you know, you think this is bad, just think about if you got pregnant, you know, that it is indignity upon indignity. This is the time to, you know, be honest about risks and and talk about them.
Dr. Alisa Vasileva (12:01)
Yeah. Especially speaking of the female patients, I hardly can imagine any patient who would be like, yeah, I don't care if I'll get pregnant. Well you sh you should do care because it's your body. And there could be some of consequences if you don't make the right decisions about at least your own body and how to protect yourself from certain things.
Dr. William Dodd (12:13)
Absolutely.
difficult process that ends in a difficult situation no matter who you are.
Dr. Alisa Vasileva (12:29)
Absolutely. So moving towards the screening recommendations about some of our infections, so basically for any sexual active females less than twenty-five year old, annual chlamydia and annual gunorrhea would be recommended. ⁓ for men who have sex with men, at least annual screening for HIV, syphilis, gunner and chlamydia. and for those particularly who are at high risk, that will be recommended for every three to six months to test further.
those infections. and for HIV at least we should screen all adolescents at least once. and the screen usually based on anatomy exposed, not just identity.
Dr. William Dodd (13:13)
And and also I'd emphasize that the ⁓ like the mainstay of our STI screening for every sexually active adolescent would be that gonerry chlamydia for females. And that's a urine test. It's not like a there's no you know, no speculum exam or anything. The patient just gives a urine sample and you've put it in the machine. So it's quick, it's easy, it's ⁓ confidential, it's important.
So good test.
Dr. Alisa Vasileva (13:43)
Absolutely. And speaking of the confidentiality part in S D care, ⁓ even though SDIs are reportable, but I feel like it's it's important to emphasize that the report goes to the health department, not for the school or parents. public health may contact the team for partner services sometimes if there is a particular infection that needs to be treated. ⁓ and parents are usually not at a
automatically notified unless required for safety reasons. The other few very important ⁓ point key points is that most states allow minors to consent for ISTI testing and treatment. ⁓ And again, those are reportable to public health departments. But the only thing that could break the confidentiality sometimes that could be insurance explanation of benefits that can unintentionally breach the confidentiality if they if they are on their parents insurance, for example.
So the insurance company may lead to send EOB to policy holder, which usually the parent, and that EOB may list like chlamydia screening, contraceptive implant insertion, HIV tests, et cetera. So that could happen, unfortunately. ⁓ but again, we always have to explain that confidentiality part clearly to our patient. Yeah.
Dr. William Dodd (15:06)
And
the insurance side of things it's very difficult, you know. We don't as doctors we have basically zero control over that and it's not like you can't bill for screening or you shouldn't bill for screening, you know, that's not really an option. ⁓ so I I I th I think insurance is getting a little bit
better for that and kind of universal screening helps, but it's always a concern and always kind of an unknown.
Dr. Alisa Vasileva (15:39)
Yes, and I feel like this this is very unfortunate. That could be very unfortunate, especially for the patient if in some circumstances it will get disclosed to someone who they didn't really want to know. to
bridge this confidentiality part of it. few simple things about counseling and prevention when we talk to our patients about the ⁓ STI prevention. ⁓ obviously condom use. Still essential even with a hormonal contraception because hormonal contraception is a pregnancy prevention, so but it's not gonna help to prevent any sexual and transmitted diseases. So it's really important to explain and clarify that with a patient. ⁓ the next
the next key point would be again HPV vaccination is my favorite thing to talk about with the patients is for cancer prevention and make it very clear clear with the patient and with the parents. Because parents are the ones who may who give consent for this vaccine, fortunately, unfortunately, because sometimes that could be a barrier again. ⁓
The next thing would be the PRIP, which is HIV prevention, and it's considered for high risk adolescents if we have a strong concern that they might have they may have like a intercourse with a suspected HIV patient in the past, though we need to treat with a PRIP. ⁓ and then test them, make sure that they don't get HIV. and then
expeditive partner therapy, which basically means treat partner without visit when allowed. Again, with certain infections, we have to make sure that we treat the partner as well because those infections could be very contagious and the partner needs to be treated.
Dr. William Dodd (17:36)
Yeah, it just bounces back and forth like a ping pong ball. And ⁓ and yeah, that's one of the one times in medicine where I will treat a patient who's not my patient, with medicine, you know, I'll call something in for their their partner, 'cause if you don't, it's just gonna come back to your patient. So it's kind of the ethical thing to do and also culturally and medically accepted.
Dr. Alisa Vasileva (18:03)
Absolutely. And it's like you said, it's just gonna be like a ping pong ball. they're gonna share this infection between each other and it's never gonna get stopped. ⁓
Dr. William Dodd (18:15)
⁓ what
about are there any do do you ever hear anything ⁓ that teens you know, do teens have any common conceptions about sex that ⁓ may not be accurate?
Dr. Alisa Vasileva (18:29)
Yes, my favorite part of this is a common myth that teens may believe or sometimes their family members or their parents may believe. So, ⁓ for example, if I don't have symptoms, I don't have an STI. Well, maybe yes, maybe no, because some of them maybe are symptomatic. So still have to test, still have to go through the screening until we make sure that you're negative.
Because sometimes the test can be positive and the infection needs to be treated, otherwise you're just gonna share it with your partner, ⁓ and it it will give you consequences. So unfortunately many of the STI can be asymptomatic. So we don't really have to rely sometimes on just on the symptoms part of it. the next myth would be oral sex is safe.
Well, again, unfortunately no. Ganarrhea, syphilis, HSV, all these infections can transmit orally, unfortunately. And even HIV, if you have any small injuries ⁓ that can lead to the presence of a blood in your mouth, you can get HIV as well.
Dr. William Dodd (19:39)
Yeah.
And you know, all these all these bugs just love mucous membranes. They don't care what the mucous membrane is. It's like gonorrhea gets in little baby's eyes and causes blindness 'cause that's a mucous membrane. So
Dr. Alisa Vasileva (19:54)
Absolutely.
And sometimes I feel like people and patients are just underestimate. They think that all of these infections, they're ⁓ the sexual intercourses, they only weigh how they can get those infections and if they use other form of ⁓ sexual interactions, they will never get those infections. But unfortunately this is just not true. And we always have to make sure that we'll just provide them the better education as we can. To mo to make them basically aware that
Dr. William Dodd (20:16)
Absolutely.
Dr. Alisa Vasileva (20:20)
This is just a myth. It's not true. ⁓ you still can get these infections, unfortunately. ⁓ so the next myth would be birth control pills protect against STIs. Again, this is they do not this is just simply not true. and if you're getting any type of hormonal contraception, this is just gonna help you to prevent pregnancy. Again, depending on which type, they all have a different percentage of protection, but
it will never help to protect you from STI. So you will always have to use something additional on top of it. only premise curse people get STIs. Well the risk is behavioral, it's not moral. So you unfortunately, and this is one of the most common myths that I've heard from parents
⁓ when they say that, ⁓ my child will never have sex so we don't have this problem and unfortunately this is just not simply true. But again, sometimes it's just really hard to have this conversation with the family members and the parents and just normalize it with them, make them understand that this is part of every person personal life.
So that could be hard, but again, as a healthcare providers, we always have to bring it up and do not avoid this conversation with the parents.
Dr. William Dodd (21:52)
Yeah.
And also, you know, adolescents have terrible relationship skills and ability to judge behavior of partners and ⁓ you know, it it just seems like a lot of times kids just get themselves into risky situations and not thinking they're as risky.
Dr. Alisa Vasileva (22:13)
Absolutely. ⁓ so speaking of the a few more common myths ⁓ that teens or their parents could believe, ⁓ the other thing would be birth control causes infertility. There is simply no evidence that support this.
Dr. William Dodd (22:30)
Yeah, and this is a well studied thing too. It's you know, it's yeah it's the most common medicine that young women take and ⁓ if if there were a signal there that it causes infertility in young women, it w it would be present. You know, we would know about it.
Dr. Alisa Vasileva (22:48)
Yes. But th there is no like articles, no studies that support this, ⁓ this so we we can it's just w w again, we just have to educate the parents and explain them and clarify this matter with them. Yeah. ⁓ the other I feel like ⁓ most common myth that I personally face is that sometimes teens and their parents as well, they think that
IUD and things like reversible contraceptives like Nexplanon, there's ⁓ they want they w they just won't use it, like it's not for the teens. and that IUD may cause infertility or they could be like IUDs are only f intended only for use for women who have had babies in the past. So this is also very common
very common myths in basically all of these ⁓
Contraception methods like IUDs and Explanot, they're safe and they're effective. And again, there is no evidence that support that IUDs are only for women who had babies in the past. Like, no, it's it is safe to use for ⁓ any age, no matter if you had the child or not, no matter no matter if you're 25 or you're 17. ⁓ so just again, education will be your best support here.
And my other favorite would be I I heard that from many parents about HPV vaccine and just contraception itself that basically HP vaccine and pr contra any type of contraception will encourage the sex in the teenagers.
And there is no evidence that support that fear. So unfortunately it's just the most common myth that parents sometimes believe.
And again I feel like we just have to provide them the better care and education and just talk about that with them. Try to help them to understand that there is no evidence behind this idea and that it's just simply not true. And actually it's opposite. As more education you provide for the teenagers, as more they know about it, so there's more chances that they will have sex b because they will have sex anyway, so that
there's more chance that they will have it more safely.
Dr. William Dodd (25:31)
Yeah, absolutely. Teenagers fool around, it's a fact of life and ⁓ you really just don't want a unintended pregnancy to come out of it. ⁓ I don't think there's any teenager that worries about HPV as a factor when making that decision and ⁓ and yeah, the most important thing is to have clear communication with your kid and make sure they're safe and they don't have a major life event occur without planning.
Dr. Alisa Vasileva (26:00)
Yes, and maybe now they they may not even care that much about to get HP V, yes, but then when they're older and they obviously will not want to have a cervical cancer, right? So that could be also very good reason to have this conversation with your parents. If they're like really s it if that idea really stops them to get an HP vaccine for their kid is just because simply do you care about her or him whenever he's older or she's older. ⁓
because for a man it also very important to prepare for like animal.
Dr. William Dodd (26:34)
Yeah, I d I think anybody who's been through culposcopy or procedures like that knows they're very painful. You worry about cancer, like it's a very distressing type of thing. ⁓ you know, getting the HPV vaccine is very preventative. It's it's like going to the dentist and getting a fluoride varnish and then when you're in your twenties you don't get root canals as a result of it. You know, that's ⁓ good parenting to prevent badness for your kid later on in life.
Dr. Alisa Vasileva (27:04)
Absolutely. And it's very easy and it's not it's just like any other type of vaccine that your child is getting. And please don't hesitate ⁓ to talk to your doctor if you have any, you know, ⁓ superstitions about that. Just talk about it, ⁓ get more information. We can provide any ⁓ patient and a parents with the resources where you can read about this vaccine, ⁓ and why we do that and get a better sense of
what stands behind use of this vaccine basically.
Dr. William Dodd (27:40)
Yeah, absolutely.
Dr. Alisa Vasileva (27:42)
so again for us at ⁓ the major clinical pros for us to remember as a summary of that conversation would be like always offer confidential time with your teenager during the well child check visits ⁓ or any follow-up. ⁓ normalize STI screening for patient and for the parent ⁓ if they want to be part of that conversation.
Use urine NAT testing when it's possible. It's very easy, you know, it's not a blood draw, just a simple urine test. It doesn't need a lot from patient or you, ⁓ but it's very useful. Screen for sexual correction, and address mental health alongside sexual health because sometimes it even if
even most of the time it can come along together because our mental health is also very related to our sexual health and teenagers may have coexistence of this two issues in their life. So it's very important for us to address those two things during every visit. and again confidential access increases preventative care management.
Just to summarize for all of us as a doctors, as a healthcare providers, and as a parents as well, ⁓
Teens don't need perfect parents. They need safe adults. They need clear boundaries. They need honest information. And they need confidential and private spaces where they would feel safe to share any of the issues they they would like to share. And
when we explain confidentiality clearly, when we ask direct but not judgmental questions, when we normalize sexual health conversations, when we screen for mental health and self-harm, and when we use evidence based SDI prevention, I believe that we truly can make someone's life better. So that would be my point.
Dr. William Dodd (30:06)
Absolutely.
Dr. Alisa Vasileva (30:08)
If if you're a pediatric provider make confidentiality your routine, ⁓ if your parent make communication safe with your child, if you really love them, I think that should be your goal for long term. And if you're a teen listening, you deserve care that respects your voice and your privacy. Yeah.
Dr. William Dodd (30:32)
Amen. Thank you.
thank you so much for ⁓ for joining us and ⁓ kind of presenting on this important topic. I mean, I think it's a really interesting discussion and and also very important for adolescents and kind of their healthcare and ⁓ and getting good outcomes. So ⁓ Doctor Vassaleva, thank you so much.
Dr. Alisa Vasileva (31:01)
Thank you so much.