Transmission assessment survey (TAS) is done for which of the following purposes?

To determine when infections have been reduced below target transmission thresholds

To provide reliable estimates of birth rate, death rate and infant mortality rate

For assessing primary immunization coverage

A male with hyperpigmentation tanner stage 5 presents with hypertension & precocious puberty. The causative defect is:

17 alpha hydroxylase deficiency

A 25-year-old woman presents with vaginal discharge and vulvovaginal irritation. Wet mount shows motile trichomonads. She mentions having a similar infection 2 months ago treated with single-dose metronidazole. What is the most likely explanation for her current infection?

Reinfection from untreated partner

A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?

MTP can be carried out up to 24 weeks

MTP done in 2nd trimester only when mother's life is in danger

MTP cannot be more than 20 weeks

A sexually active 16-year-old presents for STI screening with recent assault history, multiple partners, inconsistent condom use. Which comprehensive prevention strategy is most appropriate?

HPV vaccination, counseling, PrEP evaluation, and regular screening

Single STI screen and treatment if needed

What is the preferred method of contraception for a female with a family history of ovarian cancer?

Combined oral contraceptive pills (OCP)

Copper intrauterine device (Cu IUCD)

Adolescent Sexuality for INI-CET: High-Yield Pediatrics Lessons

Sexual Maturation - Growing Up Guide

Tanner Staging (SMR): Classifies puberty (stages I-V).
- Girls: Breast (Thelarche), Pubic hair (Pubarche).
- Boys: Genital development, Pubic hair (Pubarche).
Female Puberty (onset avg. 10-11 yrs):
- Thelarche (breast): 8-13 yrs. First sign.
- Pubarche (pubic hair): Follows/coincides.
- Peak Height Velocity (PHV): Before menarche.
- Menarche: 10-16 yrs (avg. 12.5); 2-2.5 yrs post-thelarche.
Male Puberty (onset avg. 11-12 yrs):
- Testicular enlargement (≥4ml or >2.5cm): 9-14 yrs. First sign.
- Pubarche (pubic hair): Follows.
- Penile growth, voice deepening.
- PHV.
- Spermarche: Mid-puberty.

⭐ Sequence in girls: Thelarche → Pubarche → Peak Height Velocity → Menarche.

Adolescent Contraception - Plan Smart, Live Free

Key Principles: Confidential, patient-centered counseling. Emphasize dual protection (contraception + STI prevention).

Method	How it Works	Efficacy (Typical)	Adolescent Focus
LARC (IUD/Implant)	Prevents fertilization/implantation; inhibits ovulation (implant)	>99%	First-line; "fit & forget". Cu-IUD for EC.
OCPs	Suppress ovulation	93%	Daily adherence crucial. Screen for contraindications (e.g., VTE, migraine with aura).
Condoms	Barrier; STI protection	87%	Essential for dual protection. Counsel on consistent/correct use.
ECP	Delays ovulation; use ASAP (up to 72-120 hrs)	Variable	Backup, not primary. LNG or UPA (UPA more effective up to 120 hrs).

Adolescent STIs - Dodge The Dots

Adolescents: ↑ STI risk. Confidential screening, partner notification & comprehensive care vital. Early Dx/Tx prevents PID, infertility, ectopic pregnancy.

Screening: Sexual history-based (annual CT/GC for females ≤25y).
Counseling: Safe sex, contraception, HPV vaccine.
Partner Management: Expedited Partner Therapy (EPT).

Common STIs in Adolescents:

STI	Organism	Key Symptoms	Dx	First-Line Treatment (Adolescent)
Chlamydia	C. trachomatis	Often Asymptomatic; discharge, dysuria	NAAT	Azithromycin 1g PO / Doxycycline 100mg BID x7d
Gonorrhea	N. gonorrhoeae	Purulent discharge, dysuria	NAAT	Ceftriaxone 500mg IM
Syphilis	T. pallidum	Chancre (1°), Rash (2°)	Serology	Benzathine Penicillin G 2.4MU IM
HPV	Human Papillomavirus	Warts, Cervical changes	Clinical	Topical, Cryotherapy; Vaccination
Trichomoniasis	T. vaginalis	Frothy yellow-green discharge, pruritus	Wet Mount	Metronidazole 2g PO single dose

HPV vaccine protection

⭐ Asymptomatic Chlamydia infection is common in adolescents; annual screening for all sexually active females ≤25 years is crucial.

Consent (India):
- Age of consent: 18 years. Below 18, parental/guardian consent needed.
- Exceptions: Emergencies. Mature minor concept limited.
Confidentiality:
- Maintain unless risk of harm (self/others), abuse (POCSO), or legal order.
Key Laws:
- POCSO Act, 2012:
  - Sexual activity < 18 years = offense, consent irrelevant.
  - Mandatory reporting of abuse by doctors.
- MTP Act (amended):
  - < 18 years: Guardian consent for MTP.
  - ≥ 18 years: Self-consent. Gestational limits (20/24 weeks).

⭐ POCSO Act, 2012: Sexual activity < 18 years is an offense, regardless of consent; mandatory medical reporting.

High‑Yield Points - ⚡ Biggest Takeaways

Tanner staging: key for assessing pubertal milestones, sexual maturity.

Strict confidentiality & informed consent: crucial for adolescent sexual health services.

Screen for prevalent STIs (e.g., HPV, Chlamydia, Gonorrhea) based on risk factors.

Provide comprehensive contraception counseling, including emergency contraception.

Address psychosocial aspects: body image, peer influence, and SOGI awareness.

POCSO Act: know provisions on age of consent, mandatory reporting.

Investigate menstrual disorders (e.g., amenorrhea, menorrhagia) promptly.

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