Adolesanlarda Genital Yol Enfeksiyonları/ Cybh, Hijyen Eğitimi ve Uygulamaları
Özet
Adolesan dönem, bireyin biyopsikososyal değişimler yaşadığı, cinsel olgunlaşmanın hızlandığı ve akran etkisinin arttığı kritik bir süreçtir. Limbik sistemin erken, prefrontal korteksin ise geç olgunlaşması, riskli cinsel davranışlara eğilimi artırır. Akran baskısı, bilgi eksikliği, aileyle iletişim sorunları ve cinselliğin tabu olarak görülmesi, güvensiz cinsel davranışları tetikleyen faktörlerdir. Bu durum, istenmeyen gebelikler, cinsel yolla bulaşan hastalıklar (CYBH) ve psikolojik sorunlar gibi ciddi sonuçlara yol açabilir. CYBH, özellikle klamidya, gonore, sifiliz ve trikomoniyazis gibi enfeksiyonlarla, adolesanların sağlığını tehdit etmektedir. Ergenlerde bu hastalıkların görülme sıklığı biyolojik yatkınlık, cinsel davranışlar ve bilgi eksikliği nedeniyle yüksektir. Enfeksiyonların çoğu tedavi edilebilir olsa da tedavi edilmediğinde uzun vadeli sağlık sorunlarına, infertiliteye ve doğum komplikasyonlarına neden olabilir. Dünya Sağlık Örgütü, bu hastalıkların önlenmesi ve tedavisi için stratejik planlar geliştirmiştir. Ergenlerin cinsel sağlığını korumak için eğitim, erken teşhis ve tedavi hizmetlerinin yaygınlaştırılması büyük önem taşımaktadır. Adolesanlarda genital hijyen konusunda doğru bilgi ve alışkanlıkların kazandırılması, sağlıklı bir yaşam sürdürebilmeleri için kritik öneme sahiptir. Bu eğitim, gençlerin sağlıklı cinsel yaşam alışkanlıkları geliştirmelerini, toplumda daha sağlıklı bireyler olmalarını sağlayacaktır. Adolesanlar için etkili genital hijyen eğitimi, sosyal, psikolojik ve fiziksel sağlığı destekleyen, toplum sağlığını iyileştiren önemli bir araçtır.
Adolescence is a critical period in which the individual experiences biopsychosocial changes, sexual maturation accelerates, and peer influence increases. Early maturation of the limbic system and late maturation of the prefrontal cortex increases the tendency towards risky sexual behaviors. Peer pressure, lack of information, communication problems with the family, and the perception of sexuality as a taboo are factors that trigger unsafe sexual behaviors. This situation can lead to serious consequences such as unwanted pregnancies, sexually transmitted diseases (STDs), and psychological problems. STDs threaten the health of adolescents, especially with infections such as chlamydia, gonorrhea, syphilis, and trichomoniasis. The incidence of these diseases in adolescents is high due to biological predisposition, sexual behaviors, and lack of information. Although most infections are treatable, they can cause long-term health problems, infertility, and birth complications if left untreated. The World Health Organization has developed strategic plans for the prevention and treatment of these diseases. Education, early diagnosis, and widespread use of treatment services are of great importance in protecting the sexual health of adolescents. Providing adolescents with correct information and habits regarding genital hygiene is of critical importance for them to live a healthy life. This education will enable young people to develop healthy sexual life habits and become healthier individuals in society. Effective genital hygiene education for adolescents is an important tool that supports social, psychological and physical health and improves public health.
Referanslar
Morris JL, Rushwan H. Adolescent sexual and reproductive health: The global challenges. Int J Gynecol Obstet. 2015;131(Suppl 1):S40-S42. doi:10.1016/j.ijgo.2015.02.006
Crone EA, Dahl RE. Understanding adolescence as a period of social-affective engagement and goal flexibility. Nat Rev Neurosci. 2012;13(9):636-650. doi:10.1038/nrn3313
Albert D, Chein J, Steinberg L. The teenage brain: Peer influences on adolescent decision-making. Curr Dir Psychol Sci. 2013;22(2):114-120. doi:10.1177/0963721412471347
Aylwin CF, Toro CA, Shirtcliff E, Lomniczi A. Emerging genetic and epigenetic mechanisms underlying pubertal maturation in adolescence. J Res Adolesc. 2019;29(1):54-79. doi:10.1111/jora.12457
Balogh KN, Mayes LC, Potenza MN. Risk-taking and decision-making in youth: Relationships to addiction vulnerability. J Behav Addict. 2013;2(1):1-9. doi:10.1556/JBA.2.2013.1.1
Adler LC, Turley RK. Cognitive development in the teen years. Published 2019. Accessed December 26, 2024. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P01594
Widman L, Choukas-Bradley S, Helms SW, Prinstein MJ. Adolescent susceptibility to peer influence in sexual situations. J Adolesc Health. 2016;58(3):323-329. doi:10.1016/j.jadohealth.2015.10.253
Bailey LD. Adolescent girls: A vulnerable population. Adv Neonatal Care. 2012;12(2):102-106.
Kansu Çelik H, Özel Ş, Engin Üstün Y. Adolesanlarda cinsel sağlık ve üreme sağlığı. Jinekoloji - Obstetrik ve Neonatoloji Tıp Dergisi. 2018;15(4):184-188.
Genz N, Meincke SMK, Carret M, Corrêa ACL. Sexually transmitted diseases: Knowledge and sexual behavior of adolescents. Texto Contexto Enferm. 2017;26(2):e5100015. doi:10.1590/0104-07072017005100015
Richardson D, Pakianathan M, Ewens M, et al. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023. Int J STD AIDS. 2023;34(9):588-602. doi:10.1177/09564624231168217
Diana P, Esposito S. Epidemiology, risk factors, and prevention strategies of HIV, HPV, and other sexually transmitted infections among cisgender and transgender youth: a narrative review. Front Public Health. 2024;12:1342532. doi:10.3389/fpubh.2024.1342532
World Health Organization. Sexually transmitted infections: Issues in adolescent health and development. Published 2017. Accessed December 26, 2024. https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)
Leichliter JS, Haderxhanaj LT, Obafemi OA. Increasing sexually transmitted infections among adolescents in the USA. Lancet Child Adolesc Health. 2021;5(9):609-611. doi:10.1016/S2352-4642(21)00191-7
Barrow RY, Berkel C, Brooks LC, et al. Traditional sexually transmitted disease prevention and control strategies: Tailoring for African American communities. Sex Transm Dis. 2008;35(12 Suppl):S30-S39. doi:10.1097/OLQ.0b013e31818eb923
Shannon CL, Klausner JD. The growing epidemic of sexually transmitted infections in adolescents: a neglected population. Curr Opin Pediatr. 2018;30(1):137-143. doi:10.1097/MOP.0000000000000578
Van Der Pol B, Williams JA, Orr DP, Batteiger BE, Fortenberry JD. Prevalence, incidence, natural history, and response to treatment of Trichomonas vaginalis infection among adolescent women. J Infect Dis. 2005;192(12):2039-2044. doi:10.1086/498217
Chesson HW, Meites E, Ekwueme DU, Saraiya M, Markowitz LE. Updated medical care cost estimates for HPV-associated cancers: implications for cost-effectiveness analyses of HPV vaccination in the United States. Hum Vaccin Immunother. 2019;15(7-8):1942-1948. doi:10.1080/21645515.2019.1603562
Galvin SR, Cohen MS. The role of sexually transmitted diseases in HIV transmission. Nat Rev Microbiol. 2004;2(1):33-42. doi:10.1038/nrmicro794
Rowley J, Vander Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019;97(8):548-562P. doi:10.2471/BLT.18.228486
World Health Organization. Global health sector strategy on sexually transmitted infections 2016–2021: Towards ending STIs. Published 2016. Accessed December 26, 2024. https://iris.who.int/bitstream/handle/10665/246296/WHO-RHR-16.09-eng.pdf?sequence=1
World Health Organization. Sexually transmitted infections among adolescents: The need for adequate health services. Published 2005. Accessed December 26, 2024. https://iris.who.int/bitstream/handle/10665/43221/9241562889.pdf?sequence=1
Brabin L, Kemp J, Obunge OK, et al. Reproductive tract infections and abortion among adolescent girls in rural Nigeria. Lancet. 1995;345(8945):300-304. doi:10.1016/s0140-6736(95)90281-3
World Health Organization. Global health sector strategy on sexually transmitted infections 2016–2021. Published 2016.
World Health Organization. WHO guidelines for the treatment of Chlamydia trachomatis. Geneva: WHO Guidelines Approved by the Guidelines Review Committee; 2016.
Behets FM, Williams Y, Brathwaite A, et al. Management of vaginal discharge in women treated at a Jamaican sexually transmitted disease clinic: use of diagnostic algorithms versus laboratory testing. Clin Infect Dis. 1995;21(6):1450-1455. doi:10.1093/clinids/21.6.1450
Smith PB, Phillips LE, Faro S, McGill L, Wait RB. Predominant sexually transmitted diseases among different age and ethnic groups of indigent sexually active adolescents attending a family planning clinic. J Adolesc Health Care. 1988;9(4):291-295. doi:10.1016/0197-0070(88)90252-5
Amin A. Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV. J Int AIDS Soc. 2015;18(Suppl 5):20302. doi:10.7448/IAS.18.6.20302
Taşkın L. Doğum ve Kadın Sağlığı Hemşireliği. Ankara: Akademisyen Tıp Kitabevi; 2016:395-439.
Kızılkaya Beji N, ed. Kadın Sağlığı ve Hastalıkları. İstanbul: Nobel Tıp Kitapevleri; 2015:500-533.
Acarken T. Vajinal flora bozukluğu ve vajinit. J Complement Med Regul Neural Ther. 2016;10(2):8-12.
Uslu YH, Cevrioğlu AS. Kadın üreme sistemi mikrobiyotası. J Biotechnol Strateg Health Res. 2017;1(Special Issue):95-103.
Yazıcı S, Çuvadar A. Genital sistem enfeksiyonlarının önlenmesi ve ebelik yaklaşımlar. Sağlık Profesyonelleri Araştırma Dergisi. 2019;1(1):33-37.
Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. AtlasPlus. Published 2017. Accessed December 26, 2024. https://www.cdc.gov/std/health-disparities/
Krasner A. National infertility prevention project (IPP). Published 2019. Accessed December 26, 2024. http://ipp.jsi.com/about2-ipp.htm
Mohseni M, Sung S, Takov V. Chlamydia. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020. Accessed December 26, 2024. https://www.ncbi.nlm.nih.gov/books/NBK537286/
Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance—United States, 2017. MMWR Surveill Summ. 2018;67(No. SS-8):1-114. doi:10.15585/mmwr.ss6708a1
Pickett ML, Goyal MK, Chernick LS. Time to address inequities in chlamydia screening among adolescents. Am J Public Health. 2022;112(1):7-8. doi:10.2105/AJPH.2021.306609
Centers for Disease Control and Prevention (CDC). Adolescent health. Published 2021. Accessed December 26, 2024. https://www.cdc.gov
World Health Organization (WHO). Gonorrhea. Published 2020. Accessed December 26, 2024. www.who.int
Gökçek A, Çolak M, Erdoğan M. Cinsel yolla bulaşan hastalıklar ve gençlerde gonore sıklığı. Türkiye Klinikleri J Infect Dis. 2022;8(1):45-53.
Hollier LM, et al. Gonorrhea: Prevention and management. Am J Obstet Gynecol. 2020;222(3):243-250.
O’Reilly M, et al. Diagnostic methods for gonorrhea in adolescents and young adults. J Clin Microbiol. 2019;57(5):1-10.
Wolf C, Clifton J, Sheng X. Screening for chlamydia and gonorrhea in youth correctional facilities, Utah, USA. Emerg Infect Dis. 2024;30(13):S62-S67. doi:10.3201/eid3013.230712
World Health Organization (WHO). Herpes simplex virus. Published 2020. Accessed December 26, 2024. https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus
Wald A, et al. Genital herpes: Epidemiology and management. Infect Dis Clin North Am. 2013;27(4):471-482.
Kibler KF, et al. Genital herpes and its epidemiology in adolescents. Clin Infect Dis. 2015;61(1):8-14.
Çakır DA, Baydar T, Erkekoğlu P. Herpes Simpleks Virüsleri ve aşı çalışmaları: Geleneksel derleme. Literatür Eczacılık Bilimleri Dergisi. 2022;11(3):201-212. doi:10.5336/pharmsci.2022-89865
Freeman EE, et al. The global burden of herpes simplex virus type 2 infection. Lancet Infect Dis. 2019;19(9):1044-1054.
Centers for Disease Control and Prevention (CDC). National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Sexually transmitted diseases: STD health equity. Published 2017. Accessed December 26, 2024. https://www.cdc.gov/std/health-disparities/default.htm
Markowitz LE, et al. Human papillomavirus vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2016;65(1):1-30.
American Cancer Society. HPV (Human Papillomavirus). Published 2024. Accessed December 26, 2024. https://www.cancer.org/content/dam/CRC/PDF/Public/7978.00.pdf
Benson PA. Patient education: Adolescent sexuality (Beyond the Basics). UpToDate. Published 2019. Accessed December 26, 2024. https://www.uptodate.com/contents/adolescent-sexuality-beyond-the-basics
Tulloch T, Kaufman M. Adolescent sexuality. Pediatr Rev. 2013;34:29-37; quiz 38.
Garland SM, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007;356(19):1928-1943.
Kreisel K, et al. Trichomoniasis: Current trends in prevalence and management. J Infect Dis. 2014;210(7):1015-1024.
Centers for Disease Control and Prevention (CDC). Trichomoniasis. Published 2019. Accessed December 26, 2024. https://www.cdc.gov
World Health Organization (WHO). Recommendations for the treatment of Trichomonas vaginalis, Mycoplasma genitalium, Candida albicans, bacterial vaginosis and human papillomavirus (anogenital warts). Published 2024. Accessed December 26, 2024. https://www.ncbi.nlm.nih.gov/books/NBK605758/
Wendel KA, et al. Epidemiology and diagnosis of Trichomonas vaginalis infection. Clin Infect Dis. 2019;68(3):355-358.
Crone EA, Dahl RE. Understanding adolescence as a period of social-affective engagement and goal flexibility. Nat Rev Neurosci. 2012;13(9):636-650.
World Health Organization (WHO). Syphilis (Treponema pallidum) and its global impact. Published 2022.
Rowley J, Vander Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019;97(8):548-562P. doi:10.2471/BLT.18.228486
Gilmour LS, Walls T. Congenital syphilis: A review of global epidemiology. Clin Microbiol Rev. 2023;36(2):e0012622.
Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Sifiliz enfeksiyonu istatistikleri. Accessed December 26, 2024. https://hsgm.saglik.gov.tr/depo/birimler/bulasici-hastaliklar-ve-erken-uyari-db/Dokumanlar/Istatistikler/Sifiliz_Istatistikleri.pdf
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(03):1-137.
Tudor ME, Al Aboud AM, Leslie SW, et al. Syphilis (Nursing) [Updated 2024 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568808/
Lopez P, Kwentoh I, Valdez Imbert M. A peculiar presentation of syphilis as a mysterious rash: A dermatological dilemma. Cureus. 2023;15(9):e45328.
Gupta M, Verma GK, Sharma R, Sankhyan M, Rattan R, Negi AK. The changing trend of syphilis: Is it a sign of an impending epidemic? Indian J Dermatol. 2023;68(1):15-24.
Chen T, Wan B, Wang M, Lin S, Wu Y, Huang J. Evaluating the global, regional, and national impact of syphilis: Results from the global burden of disease study 2019. Sci Rep. 2023;13(1):11386.
McKetin R, Lubman DI, Baker A, Dawe S, Ross J, Mattick RP, Degenhardt L. The relationship between methamphetamine use and heterosexual behaviour: Evidence from a prospective longitudinal study. Addiction. 2018;113(7):1276-1285.
Taylor MM, Peeling RW, Toskin I, Ghinidelli M. Role of dual HIV/syphilis test kits in expanding syphilis screening. Sex Transm Infect. 2017;93(7):458-459.
Apay ES, Özdemir F, Nazik E, Potur CD, Hadımlı A, Tanrıverdi D, et al. Yedi farklı ildeki kadınların genital hijyen davranışlarının belirlenmesi: Çok merkezli kesitsel bir çalışma. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2014;17(4):245-252.
Kasaro MP, Husnik MJ, Chi BH, Reid C, Magure T, Makanani B, et al. Impact of targeted counseling on reported vaginal hygiene practices and bacterial vaginosis: The HIV Prevention Trials Network 035 study. Int J STD AIDS. 2016;0(0):1-9. doi:10.1177/0956462416653001.
Ünsal A, Özyazıcıoğlu N, Sezgin S. Doğu Karadeniz’deki bir belde ve ona bağlı dokuz köyde yaşayan bireylerin genital hijyen davranışları. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2010;13(2):12-19.
Arslan Öİ, Kulakaç Ö. Kadın mahkumlarda genital hijyen davranışları. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2011;14(2):31-38.
