David S. Reitman, MD

You sign his required college forms and give him his meningitis vaccine. As you prepare to say "good luck," you wonder what counsel you can offer to help him become a healthy and educated medical consumer and patient.

Oral contraceptive (OC) pills are frequently prescribed for a variety of clinical purposes. These medications--which contain varying amounts of estrogen- and progestin-based compounds--essentially "override" a woman's innate hypothalamic-pituitary-ovarian axis and frequently help ameliorate the effects of a maturing reproductive system while preventing pregnancy.

Anorexia nervosa (AN) affects as many as 1 in 200 white adolescent girls. Mean onset of this disorder, which is characterized by dramatic weight loss, a disturbed perception of body shape, and an intense fear of weight gain, is between 13 and 14 years.

Fourteen-year-old JT is worried. During health class last week, he learned about the different sexually transmitted infections as well as about testicular self-examination. While practicing his monthly testicular examination in the shower, he noticed that he had a number of small growths on his penis. On further questioning, JT insists that he has never been sexually active with another person.

Your doctor has just told you that you have an infection with human papillomavirus (HPV). Most teens have a lot of questions about warts and HPV. This guide will help answer some of those questions.

Adolescents are at high risk for HPV infection because they tend to become involved with multiple simultaneous sexual partners rather than forming monogamous relationships.

Most cases of HSV-2 infection are spread through sexual transmission. An infected person can have virus in his or her saliva, semen, or vaginal secretions. When a seronegative partner comes in sexual contact with these secretions, the virus can enter the body through mucosal surfaces (such as the vagina, anus, or mouth) or micro-abrasions on the skin (eg, the penile shaft, scrotum, thighs, or perineum).

How did I get herpes? Is there a cure? What causes an outbreak-- and what can I do to prevent another one? My friend got herpes and had to stay in the hospital; will that happen to me? Can I still have children?

Your doctor has just told you that you have a herpes simplex virus infection (herpes). Most teens have a lot of questions about herpes. This guide will help answer some of them for you.

Gonorrhea (aka "the clap," or "the drip") is caused by sexually transmitted Neisseria gonorrhoeae--a Gram-negative diplococcus. One of the most common reportable diseases in the United States, gonorrhea frequently affects sexually active adolescents. Approximately 30% of the 350,000 annual cases involve 15- to 19-year-olds. (That percentage is thought to be an underestimate!) Those most often infected are young women 15 to 24 years old. Recent data suggest that infection rates are higher among teens who are homeless or pregnant, and in those from a minority group or an economically disadvantaged background.

Your patient, Keith, is a 19-year-old college freshman who is currently on spring break following the successful completion of his midterm exams. You have known him since he was 9 years old and you are looking forward to hearing about his first few months away at school.

ASSESSMENT

It is 9:00 on Sunday morning when the first patient of the day registers during your weekend extended office hours. The triage nurse informs you that the patient is a 13-year-old boy with "chest pain."

"Jennifer is bleeding," confides Mrs Smith outside the door to her daughter's clinic room. "She's really embarrassed to discuss it with anyone but I'm really worried. Do you think that she is having sex?" You listen to her concerns and learn that Jennifer's last menstrual period has lasted approximately 3 to 4 weeks. Jennifer and her mother came to the pediatric clinic today after Mrs Smith found multiple menstrual pads in the bathroom wastebasket every day for several days.

Over the past 5 to 10 years, there has been an increasing incidence of synthetic "club" drug or "designer" drug use that has quietly permeated the adolescent and young adult culture. This review of MDMA, also known as "Ecstasy," ketamine, GHB, and methamphetamine, provides a basic introduction to help practitioners get "up to speed."

"Headaches" is the chief complaint. Acne was the problem last year for 17-year-old Michelle. Otherwise her history is unremarkable. What's causing these daily headaches?