Prevention of STIs

From AAUS

-Standardized slides in youth education for the prevention of sexually transmitted infections

Author

Soichi Arakawa (Division of Urology, Department of Surgery Related Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan)

Executive summary

The best strategy for preventing the spread of sexually transmitted infections (STIs) is by educating the young. It is considered effective to provide such education by the age of 15 to 16 years, ideally before teenagers become sexually active. This guideline describes the framework and discusses the educational points for standard educational slides created by the Japanese Society for Sexually Transmitted Infections and the Japan Society of Adolescentology. A discussion of sexuality is also a discussion of human life, and the prevention of STIs is an important part of sex education. The Japanese Society for Sexually Transmitted Infections has a certification system for doctors and experts, and considers prevention education to be one of its key programs.

Introduction

The prevention of sexually transmitted infections (STIs) in the young is an important mission, as these are the future leaders of the coming generations who will be responsible for bearing and raising healthy children. What should be done to protect young people from contracting STIs? The Japanese Society for Sexually Transmitted Infections collaborated with the Japan Society of Adolescentology to create standard slides for teaching STI prevention to primarily teenagers around the age of 15 to 16 years. The following is a discourse on a strategy for preventing STIs from the position of an educator who participated in the preparation of these slides and who teaches STI prevention classes annually to teenagers mostly between the ages of 14 and 16 years at local high schools.

How to cope with sexual awakening

The purpose of knowledge and virtue education is to promote the development of reason and intellect in individuals who will become fully-fledged adult members of society that must be capable of making unwavering judgments. However, it is also critical to nurture rich emotions and help young people develop the ability to both understand and control their emotions. That being said, humans are also part of the animal kingdom, and thus have “natural instincts” such as appetite that are difficult to control. It goes without saying that when sexual desire exceeds the limits of control, we catch a glimpse of the difficulties humans face in self-control. Schools are the primary setting for education, and therefore must teach young people objectively about sexual awakening with the hope that they do not blindly follow their impulses and instead transfer their energy into other activities, putting energy to good use. This is one clear challenge faced by boys and girls entering puberty (and especially boys, who are typically the active sexual agents), and an answer to the question of how far education can help resolve this universal challenge remains unclear. However, some factors, including the risk of pregnancy and STIs, are thought to be helpful in meeting this challenge. Educators and medical professionals alike must teach young people in the midst of puberty about the potential adverse events that may occur when sexual desire leads to sexual activity, and must actively strive to cool the passionate emotions that young people are developing to some extent. This is not intended to be a form of intimidation, but rather one fact that must be communicated as common sense in a scientific society. It should be seen as an element of education for STI prevention that is also a key part of sex education in general.

Detailed education for STI prevention (for high school students) (Slide 1)

Slide 1. Sex and Health During Puberty: Protecting Yourself From Sexually Transmitted Infections

1. Introduction (Slides 2, 3, and 4)

How would you describe your (the junior and senior high school students receiving the lesson) current stage of development? This is a detailed explanation of puberty and the other developmental stages, including physical changes in both boys and girls.

Slide 2. Stage of Human Development

Slide 3. What is Puberty?

Slide 4. Physical Develoment

2. Presentation of the risks of sexual activity and main topics of the class (Slides 5 and 6)

Point out the presence of undesired adverse events such as STIs and pregnancy. Do not use the term “adverse event” in the classes. Use the term “risk” instead.

Slide 5. Risks = Dangers

Slide 6. What you should learn from today's lesson

3. Detailed explanation about STIs (Slides 7, 8, and 9)

Describe the symptoms and route of infection for specific diseases such as chlamydial infection, how they may be present without symptoms, and problems they can lead to such as infertility, ectopic pregnancy, miscarriages or premature birth, or related infections in women, and swollen and painful epididymis in men.

Slide 7. What is a sexually transmitted infection (STI)?

Slide 8. Chlamydia

Slide 9. If chlamydia is left untreated...

4. Warning about the high prevalence of asymptomatic infections (Slides 10 and 11)

Use chlamydial infection or other types of infections as an example to explain the problem of disease spread, even when no symptoms are present.

Slide 10. Would you notice if you had an STI?

Slide 11. Chlamydia Infections Among High School Students

5. Information about the acquired immunodeficiency syndrome (AIDS) (Slides 12 and 13)

Provide information about the actual conditions and progression of this infectious disease, using data to explain that the incidence of human immunodeficiency virus (HIV) infections and AIDS is increasing annually in Japan, for example.

Slide 12. If you become infected with the AIDS virus (HIV)

Slide 13. Annual trend in number of reported HIV/AIDS cases

6. The relationship between human papillomavirus (HPV) infection and cervical cancer (Slides 14 and 15)

Show them that the incidence of cervical cancer among young women in their 20s is on the rise, and that one reason for this is the presence of high-risk HPV infection. In other words, explain that many cases of cervical cancer are a type of STI in the broad sense of the term.

Slide 14. Incidence of different types of cancers in Japan among 100,000 women aged 20 to 29 years Japan

Slide 15. Natural course of events from high-risk HPV infection to the development of cancer

7. Are you safe if you have had only one sexual partner? (Slides 16 and 17)

The answer is no. Even if you have only had one sexual partner, you are still at risk of infection due to the existence of a hidden sexual activity network.

Slide 16. Are you safe if you have had only one sexual partner?

Slide 17. Even if you have only had one sexual partner, you can be infected

8. How can we solve this problem? (Slides 18, 19, and 20)

The most important thing is prevention. Abstinence from sex is the best form of prevention. If young people are going to have sex, they should use condoms. Teach them the proper way to put on a condom as a common sense. Explain that they can have a free and anonymous HIV test at a public health center if they think they may be infected.

Slide 18. What should I do?

Slide 19. How to properly put on a (male) condom

Slide 20. Testing at Public Health Centers

9. Final message (Slide 21)

There is no need to rush into sexual activity. Start with heart-to-heart communication.

Slide 21. Protecting your future...

Education for STI prevention in pubescent students also applies to adults (Slide 22)

It is not necessarily true that most adults have accurate knowledge of STIs. “If you are going to have sex Always use a condom (consult a medical facility for the proper use of birth control pills or other contraceptive methods). You should only have sex without condoms or other forms of protection if both you and your partner are monogamous, have been tested, and are infection-free, and if both you and your partner are willing and able to raise a child.” This conclusion applies to adults as well.

Slide 22. If you are going to have sex

Conclusions

Providing junior and senior high school students with accurate knowledge about STIs against the background of a steadily increasing incidence of HIV and other types of infections is an absolutely essential mission from a societal perspective. The Japanese Society for Sexually Transmitted Infections launched a system for certifying doctors and experts in STI in 2009. Although about 370 doctors have been certified in four tests conducted up to 2012, only about 20 experts have been certified during that period. We plan on stepping up recruitment for certified experts with the goal of increasing their numbers and improving STI prevention education for junior and senior high school students. STIs are an increasing threat for young people around the world. Education in schools for young people in their mid-teens may represent the best strategy for STI prevention, and collaboration between medical and educational professionals is essential. It is important to link the study of infectious disease with epidemiology to conduct ongoing investigations, to inform the public and young people of the results, and to take effective measures. Societies for the prevention of STIs around the world should act as mediators to increase the number of expert certification systems, for example. The slides we developed show promise for use as standard educational materials.

Abbreviation

STIs: sexually transmitted infections, HPV: human papillomavirus, HIV: human immunodeficiency virus, AIDS: acquired immunodeficiency syndrome

References

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