This article waslast modified on
February 12, 2018.

Adolescents are often thought of as the healthiest age group. However, habits formed during the teen years will likely affect your teen's health well into adulthood. For example, helping an overweight or obese teen reduce his or her weight can prevent diabetes and heart disease in later years.

For teens, annual "well care" visits don't involve many laboratory screening tests. Rather, the emphasis is on preparing for teen health issues, such as accident and injury prevention, sexual health, and avoiding substance abuse. Preventive medicine for teens should emphasize healthy lifestyle choices that help protect against diseases that occur in adulthood. 

The sections below discuss the few conditions and diseases for which teens 13 to 18 years old may be screened. They summarize the recommendations from various authorities on screening tests for teens, and there is consensus in many areas, but not all. Therefore, when discussing screening with your teen's healthcare provider and making decisions about testing, it is important to consider your teen's individual health situation and risk factors.

For more information on preventive medicine and steps you can take to keep you and your family healthy, read Wellness and Prevention in an Era of Patient Responsibility.

Not everyone in this age group may need screening for every condition listed here. Read the sections below to learn more about each condition and to determine if screening may be appropriate for you or your family member. You should discuss screening options with your health care practitioner.

Screening Recommendations
  • Obesity

    Childhood obesity is a growing problem in the United States. About 17% of children and adolescents in the U.S. are obese, and at least three out of four obese teens grow up to become obese adults. There are many serious health consequences of being obese, including increased risk of developing type 2 diabetes, high blood pressure and high cholesterol, joint problems, sleep apnea, and social and psychological problems. Those who continue to be overweight into adulthood are at greater risk for serious health problems, including heart disease, stroke, and some cancers.

    Recommendations

    The American Academy of Pediatrics (AAP) recommends routine obesity screening of children. At least once a year, a healthcare practitioner should assess a child's weight status. This is the recommendation of a federally-convened expert committee, one that represents 15 national healthcare organizations, including AAP. The child's weight and height as well as age and sex are considered in determining their body mass index (BMI) percentile. BMI is a useful tool for estimating body fat.

    • Overweight: An overweight youth (one whose BMI is between the 85th percentile and the 94th percentile on standardized growth charts) faces additional health risks.
    • Obese: An obese youth (at or above the 95th percentile on standardized growth charts or a BMI of greater than or equal to 30 kg/m2, whichever is lower) faces even more serious health risks.

    For children aged 2 years and older, AAP says BMI changes should be monitored by calculating and plotting BMI on the Centers for Disease Control and Prevention (CDC) growth charts at every healthcare visit so that interventions can be implemented when a child starts to cross BMI percentiles upward, even before he or she approaches the 85th or the 95th percentile.

    The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen children, including adolescents, ages 6 and older for obesity and refer them to programs to promote improvements in weight status. The Task Force has found that the BMI is an acceptable measure for determining excess weight and defines "overweight" and "obese" as above. The American Academy of Family Physicians makes the same recommendation.

    At each well visit, the following should be discussed: the teen's dietary patterns, levels of physical activity, and sedentary behaviors. The family's history of obesity, type 2 diabetes, and high blood pressure are important considerations as are a number of other physical measurements the healthcare provider can take. The goal is to prevent and address the problems of overweight and obesity through identification and early interventions, namely, changes to diet and exercise, to achieve a healthy weight and BMI.

    Children's body mass calculations need to be related to their growth charts. A visit to a healthcare practitioner will provide you with the most reliable information, but the calculator on the CDC web site (in Links below) can help you determine if your teen is at risk of being overweight.


    Links
    HealthyChildren.org: Obesity  
    Centers for Disease Control and Prevention: BMI Percentile Calculator for Child and Teen 


    Sources Used in Current Review

    Centers for Disease Control and Prevention. Childhood Obesity Facts. Available online at https://www.cdc.gov/obesity/data/childhood.html. Accessed October 2016.

    U.S. Preventive Services Task Force. Obesity in Children and Adolescents: Screening. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryDraft/obesity-in-children-and-adolescents-screening1?ds=1&s=child%20obesity%20screening. Accessed October 2016.

    American Academy of Pediatrics. Press Room: AAP Updates Recommendations on Obesity Prevention. Available online through https://www.aap.org. Accessed October 2016.

    Daniels, Stephen R. and Hassink, Sandra G. and the Committee on Nutrition. The Role of the Pediatrician in Primary Prevention of Obesity. Pediatrics. July 2015, Vol 136 / Issue 1. Available online at http://pediatrics.aappublications.org/content/136/1/e275. Accessed October 2016.

    Herman, Amy Orciari. USPSTF Again Recommends Obesity Screening in Kids, Clarifies Age Group. NEJM Journal Watch. November 2, 2016. Available online at http://www.jwatch.org/fw112212/2016/11/02/uspstf-again-recommends-obesity-screening-kids-clarifies?query=pfwTOC&jwd=000020042086&jspc=. Accessed October 2016.

  • Chlamydia and Gonorrhea

    Chlamydia and gonorrhea are the most common bacterial sexually transmitted diseases (STDs) in the United States today, but many infected people have no symptoms. These infections usually affect the genitals but may also cause infections of other mucous membranes, eyes, or joints. Pregnant women may transmit the infections to their newborns. Often progressing silently, these diseases can cause infertility and other health complications if left untreated. However, both diseases can be cured with antibiotics.

    In the United States, reported rates of chlamydia and gonorrhea are highest among adolescent girls (15-19 years of age) and young women (20-24 years old). Many people have both chlamydia and gonorrhea infections at the same time.

    Recommendations for Adolescent Girls
    The U.S. Centers for Disease Control and Prevention (CDC), the U.S. Preventive Services Task Force (USPSTF), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) recommend that:

    The CDC and ACOG specifically recommend annual screening.

    For screening recommendations during pregnancy, see Pregnancy & Prenatal Testing.

    Recommendations for Adolescent Boys

    These organizations do not recommend routine screening for sexually active, heterosexual boys. Health care providers may, however, use their judgment and consider risks, such as prevalence of these STDs in the community. It is important to remember that an infected male can spread these diseases and even re-infect a partner if he does not complete treatment.

    • For sexually active males who have sex with other males, the CDC recommends chlamydia and gonorrhea screening at least annually.

    Risk

    Sexually active teens face more risk of chlamydia and gonorrhea infection, compared to adults age 25 and older. Your risk is even greater if you:

    • Are female
    • Have had one or both of these infections before
    • Have other STDs, especially HIV
    • Have new or multiple sex partners
    • Use condoms inconsistently
    • Exchange sex for money or drugs
    • Use illegal drugs
    • Start sexual relationships early in adolescence
    • Live in a detention facility
    • Are a male who has sex with other males

    Because reinfection rates are high, the CDC recommends that both teen girls and boys who are treated for chlamydia or gonorrhea infection be retested approximately 3 months after treatment or at their next health care visit, regardless of whether they believe that their sex partners were treated. It is important to continue annual screening for these diseases because reinfection is always possible.


    Links

    KidsHealth.org: Teens Sexual Health - Chlamydia 
    KidsHealth.org: Teens Sexual Health - Gonorrhea 


    Sources Used in Current Review

    United States Preventive Service Task Force. USPSTF Recommendations for STI Screening. Available online at http://www.uspreventiveservicestaskforce.org/uspstf08/methods/stinfections.htm through http://www.uspreventiveservicestaskforce.org. Last updated March 2008. Accessed May 24, 2012.

    Kimberly A. Workowski and Stuart Berman. Sexually Transmitted Diseases Guidelines, 2010. Morbidity and Mortality Weekly Report. PDF available for download at http://www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf through http://www.cdc.gov. Published December 27, 2010. Accessed March 24, 2012.

    U.S. Centers for Disease Control and Prevention. Chlamydia and Gonorrhea — Two Most Commonly Reported Infectious Diseases in the United States. Available online at http://www.cdc.gov/Features/dsSTDData/ through http://www.cdc.gov. Last reviewed April 22, 2011. Accessed May 23, 2011.

    U.S. Centers for Disease Control and Prevention. STD Prevention Conference 2012. Available online at http://www.cdc.gov/nchhstp/newsroom/stdconference2012summaries.html through http://www.cdc.gov. Last reviewed March 14, 2012. Accessed May 23, 2012.

    American College of Obstetricians and Gynecologists. Well-Woman Care: Assessments and Recommendations. Available online through http://www.acog.org/. Issued March 29, 2012. Accessed June 1, 2012.

    American College of Obstetricians and Gynecologists. Chlamydia Screening Rates Too Low, Reinfection Rates Too High. March 26, 2012. Available online through http://www.acog.org/. Accessed June 2012. 

    American Academy of Family Physicians. Gonorrhea. Available online at http://www.aafp.org/online/en/home/clinical/exam/gonorrhea.html through http://www.aafp.org. Accessed June 4, 2012.

    American Academy of Family Physicians. Chlamydia. Available online at http://www.aafp.org/online/en/home/clinical/exam/chlamydia.html through http://www.aafp.org. Accessed June 4, 2012.

    U.S. Centers for Disease Control and Prevention. 2010 Treatment Guidelines, Special Populations. Available online at http://www.cdc.gov/std/treatment/2010/specialpops.htm#msm through http://www.cdc.gov. Accessed June 2012. 

    American College of Obstetricians and Gynecologists. Spotlight on Chlamydia: Annual Screenings a Must for Young Women. May 8, 2007. Available online through http://www.acog.org/. Accessed June 2012.

    U.S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010 Dec 17; 59:1. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm through http://www.cdc.gov. Accessed January 2011.

  • Diabetes

    About 193,000 children and adolescents under 20 years of age in the United States had diabetes in 2015, according to the U.S. Centers for Disease Control and Prevention (CDC). While most cases of type 1 diabetes are diagnosed in those under the age of 18, the signs and symptoms often develop rapidly and the diagnosis is often made in an emergency room setting. Thirty percent of new-onset cases of type 1 diabetes in children present with diabetic ketoacidosis. Thus, blood glucose measurement as screening for type 1 diabetes in asymptomatic teens is presently not necessary. On the other hand, some youth with type 2 diabetes will have no obvious signs or symptoms of high blood glucose, especially early in the disease, and screening can be a useful tool. The incidence of type 2 diabetes has increased dramatically in the last decade, especially in minority populations, according to the American Diabetes Association (ADA).

    Developing the disease early in life means that the patient is at increased risk for the development of diabetic complications because of the potentially prolonged duration of exposure to high blood glucose (hyperglycemia). This increases the risk of serious health problems earlier in adulthood, such as heart disease, kidney failure, blindness, and foot amputations.

    Risk Factors
    Overweight, obesity, and physical inactivity are all contributing factors to development of type 2 diabetes, and they too have become national health problems. As public health experts work to educate Americans on how to avoid diabetes and its serious complications, parents and teens should be aware that healthy eating habits and activity choices can lower an individual's risk of developing type 2 diabetes and related complications later in life.

    A youth who is overweight—defined as [1] a body mass index (BMI) greater than the 85th percentile for age and sex, [2] weight for height greater than the 85th percentile, or [3] overweight more than 120% of ideal for height— plus 2 other known risk factors faces a substantial risk of having or developing type 2 diabetes, warns the ADA. These risk factors include:

    • Having a close relative with type 2 diabetes
    • Being Native American, African American, Latino, Asian American, or Pacific Islander
    • Having signs of or conditions associated with insulin resistance, including acanthosis nigricans, high blood pressure (hypertension), unhealthy lipid levels (dyslipidemia), polycystic ovary syndrome, or having a reduced birth weight (small-for-gestational age)
    • Having a birth mother who has diabetes or had gestational diabetes

    Recommendations
    The ADA makes the following screening recommendations:

    • Consider screening overweight adolescents who have 2 or more risk factors for diabetes every 3 years, starting at 10 years of age or at the onset of puberty
    • Screen using one of the following tests:
      • Fasting glucose (fasting blood glucose, FBG) – this test measures the level of glucose in the blood after an 8-12 hour fast.
      • Hemoglobin A1c (also called A1c or glycated hemoglobin) – this test evaluates the average amount of glucose in the blood over the last 2 to 3 months and has been recommended as another test to screen for diabetes.
      • 2-hour oral glucose tolerance test (OGTT) – this test involves drawing a fasting blood blood sample for glucose measurement, followed by having the person drink a solution containing 1.75 grams of glucose per kilogram body weight to a maximum of 75 grams and then drawing another sample two hours after the person begins to consume the glucose solutions.

    If any of these results is abnormal, the test is repeated on another day. If the repeat result is also abnormal, a diagnosis of diabetes is made.


    Links
    KidsHealth.org: Teens – Diabetes Center
    American Diabetes Association
    American Diabetes Association: Be Healthy Today; Be Healthy For Life, Information for Youth and their Families, Living with Type 2 Diabetes 


    Sources Used in Current Review (last reviewed 9/18/17)

    (2017). National diabetes Statistics Report, 2017. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed on 8/06/17.

    (2015 October). Abnormal Blood Glucose and Type 2 Diabetes Mellitis: Screening. U.S. Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes?ds=1&s=diabetes. Accessed on 8/06/17.

    (2017 July 27, Updated). What’s New in Diabetes. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/new/index.html. Accessed on 8/06/17.

    (2017 July 25, Updated). Who’s at Risk? Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/diabetes/basics/risk-factors.html. Accessed on 8/06/17.

    Genzen, J. et. al. (2017 July, Updated). Diabetes Mellitus. ARUP Consult. Available online at https://arupconsult.com/content/diabetes-mellitus. Accessed on 8/06/17.

    (2016 November). Diabetes Tests & Diagnosis. National Institute of Diabetes and Digestive and Kidney Diseases. Available online at https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis. Accessed on 8/06/17.

    (2015). Screening and Monitoring of Prediabetes. American Association of Clinical Endocrinologists. Available online at http://outpatient.aace.com/prediabetes/screening-and-monitoring-prediabetes. Accessed on 8/06/17.

    Diabetes Management Guidelines, American Diabetes Association (ADA) 2016 Guidelines. National Diabetes Education Initiative. Available online at http://www.ndei.org/ADA-2013-Guidelines-Criteria-Diabetes-Diagnosis.aspx.html#children. Accessed on 8/06/17.

  • High cholesterol

    Beginning in childhood, the waxy substance called cholesterol and other fatty substances known as lipids begin to build up in the arteries, hardening into plaques that narrow the arterial passageways. During adulthood, plaque buildup and resulting health problems occur not only in the arteries supplying blood to the heart muscle but in arteries throughout the body (a problem known as atherosclerosis). For both men and women in the United States, the number one cause of death is heart disease, and the amount of cholesterol in the blood greatly affects a person's chances of suffering from it.

    Growing evidence shows that the biological processes that precede heart attacks and cardiovascular disease begin in childhood, although they don't generally cause symptoms or lead to disease until middle age or later. Experts encourage physical activity and healthy eating in childhood and adolescence, limiting saturated fat and trans fat, to help protect against heart disease in adulthood.

    Monitoring and maintaining healthy levels of cholesterol are important in staying healthy. Screening for high cholesterol, typically with a lipid profile, is important because there are usually no symptoms. A lipid profile usually includes total cholesterolHDL-cholesterolLDL-cholesterol, and triglycerides. Non-HDL-cholesterol can also be calculated by subtracting the HDL-C value from the total cholesterol result. Typically, fasting for 9-12 hours before having the blood sample drawn is required; only water is permitted. However, some laboratories offer non-fasting lipid profiles. In particular, children and teens may have testing done without fasting.

    Since screening recommendations are not always consistent between healthcare organizations, it's important to work with your children's healthcare provider to develop a cholesterol-screening plan that is right for them.

    Recommendations

    • The American Academy of Pediatrics (AAP) recommends routine lipid testing in all youths once between the ages of 9 and 11 and again between 17 and 21. Testing at a younger age and more frequent screening with a lipid profile is recommended for youths who are at an increased risk of developing heart disease as adults. Children younger than 2 years old are too young to be tested.
    • The American Heart Association (AHA) does not recommend routine screening for children and adolescents with normal heart disease risk.
    • The U.S. Preventive Services Task Force (USPSTF) recommends screening for high cholesterol in youths 20 and younger only if they are at increased risk. Currently, there is not enough evidence to recommend for or against routine screening in all youths, according to the Task Force.

    Risk Factors

    • Family History: Youths are at increased risk if they have a parent, grandparent, aunt/uncle, or sibling who has high cholesterol or if they have a family history of cardiovascular disease (prior to age 55 in male relative and age 65 in female relative).
    • Personal Health: Youths are also at higher risk if they:
      • Are overweight or obese
      • Have a diet high in fats, especially saturated or trans fat
      • Get little or no exercise
      • Have diabetes or hypertension (high blood pressure)
      • Smoke cigarettes or use other tobacco products

    Links
    American Heart Association: Hey Kids, Learn About Cholesterol
    KidsHealth.org: Cholesterol 


    Sources Used in Current Review (last reviewed 7/12/17)

    (2016 August 9). Screening for lipid disorders in children and adolescents. U.S. Preventive Task Force recommendation statement. U.S. Preventive Services Task Force. Available online at http://jamanetwork.com/journals/jama/fullarticle/2542642. Accessed June 2017.

    Swift, D. (2017 February 17). AAP updates preventive care guidelines, targets HIV, depression screening. Medscape, News and Perspective. Available online at http://www.medscape.com/viewarticle/875950?pa=gzilco%2FMqWtheZwS%2BIv9ew%2F1apM1lJZswxmtf97%2BKCThPQZnAFNU5cYUCO0MrUVvVrJxKJt4DRD8mxYr6kYfOw%3D%3D. Accessed June 2017.

    (Reviewed 2017 April). Common misconceptions about cholesterol. American Heart Association. Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/Common-Misconceptions-about-Cholesterol_UCM_305638_Article.jsp#.WUsgzhPyvR0. Accessed June 2017.

    (Reviewed 2017 April). How to get your cholesterol tested. American Heart Association. Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/HowToGetYourCholesterolTested/How-To-Get-Your-Cholesterol-Tested_UCM_305595_Article.jsp#.WUrsWxPyvEY. Accessed June 2017.

    @2017. Periodicity schedule. American Academy of Pediatrics. Available online at https://www.aap.org/en-us/professional-resources/practice-transformation/managing-patients/Pages/Periodicity-Schedule.aspx. Accessed June 2017.

    Family History of Early Atherosclerotic Cardiovascular Disease. National Heart, Lung and Blood Institute. Available online at https://www.nhlbi.nih.gov/health-pro/guidelines/current/cardiovascular-health-pediatric-guidelines/full-report-chapter-4. Accessed June 2017.

  • Human Immunodeficiency Virus (HIV)

    HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease. Initially, an HIV infection may cause no symptoms or cause non-specific, flu-like symptoms that resolve after a short time period. The only way to determine whether a person has been infected is through HIV testing.

    If the infection is not detected and treated, eventually symptoms of AIDS emerge and begin to progressively worsen. Without treatment, HIV destroys the immune system over time and leaves a person's body vulnerable to debilitating infections.

    HIV is spread in the following ways:

    • By having sex with an infected partner
    • By sharing needles or syringes (such as with intravenous injection drug abuse)
    • During pregnancy or birth; if a pregnant woman is infected with HIV, the virus can be passed to and infect her developing baby.
    • Through contact with infected blood
    • In the U.S. today, because of screening blood for transfusion and heat-treating techniques and other treatments of blood derivatives, the risk of getting HIV from transfusions is extremely small. However, before donated blood was screened beginning in 1985 in the U.S. and before treatments were introduced to destroy HIV in some blood products, such as factor 8 and albumin, HIV was transmitted through transfusion of contaminated blood or blood components.

    Why Get Screening?
    Screening for HIV is now part of routine healthcare in the United States and is an important part of wellness and prevention. This is because diagnosis early in the course of infection leads to timely, effective treatment that decreases the risk of progression to AIDS. A major National Institutes of Health (NIH) clinical trial published in 2015 found that individuals with HIV have a lower risk of developing AIDS and other serious illnesses if they start antiretroviral therapy sooner rather than later.

    Early diagnosis also has important benefits for others and society at large. Thousands of people are diagnosed with HIV each year, and about 1 in 8 people in the United States with HIV are unaware that they have it. An individual can prevent further disease spread by learning their status, modifying behavior and not exposing others to infected blood or body fluids. Pregnant women who have HIV can start treatment to prevent spreading the disease to their children.

    If an HIV screening test shows a person is not infected, he or she can take steps to avoid infection. For individuals who are HIV-negative but at high risk for HIV, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommend that they consider taking pre-exposure prophylaxis (PrEP), a daily pill to help prevent infection. For people taking PrEP consistently, the risk of HIV infection is significantly lower compared to those who did not take it.

    Know Your Risk
    Several situations put you at high risk of contracting HIV:

    • You've had unprotected sex with more than one partner.
    • You have or have had a sexually transmitted disease (STD), which appears to make people more susceptible to and at higher risk for acquiring HIV infection during sex with infected partners.
    • You're a man who has had sexual contact with another man.
    • You have exchanged sex for money or drugs or had anonymous sex.
    • You use or used injection drugs and are likely to have shared unsterilized needles.
    • You have an HIV-positive sexual partner.
    • You have had sex with anyone who falls into one of the categories listed above or are uncertain about your sexual partner's risk behaviors.
    • You've been diagnosed with or treated for hepatitis or tuberculosis (TB).

    How often you are tested should depend on your risk, activities, and sexual contacts. For example, during a long-term, truly monogamous sexual relationship, you may want just one test. However, if you or your partner have had sexual contact with more than one person in recent months, your risk of infection is greater. If you or a person with whom you've had sexual contact (even unwanted sexual contact) engaged in some risky behavior, you have even more reason to be tested.

    Screening Tests
    Different types of tests are available for HIV screening:

    • Combination HIV antibody and HIV antigen test—this is the recommended screening test for HIV. It is available only as a blood test. It detects the HIV antigen called p24 plus antibodies to HIV-1 and HIV-2. (HIV-1 is the most common type found in the United States, while HIV-2 has a higher prevalence in parts of Africa.) By detecting both antibody and antigen, the combination test increases the likelihood that an infection is detected soon after exposure. These tests can detect HIV infections in most people by 2-6 weeks after exposure.
    • HIV antibody testing—all HIV antibody tests used in the U.S. detect HIV-1, and some tests have been developed that can also detect HIV-2. These tests are available as blood tests or tests of oral fluid. HIV antibody tests can detect infections in most people 3-12 weeks after exposure.

    Various options are available for getting tested:

    • A blood or oral sample can be collected in a healthcare provider's office or a local clinic and sent to a laboratory for testing. In these same settings, a rapid test may available in which results are generated in about 20 minutes.
    • A home collection kit approved by the U.S. Food and Drug Administration (FDA) is available for HIV antibody testing. This allows a person to take a sample at home and then mail it to a testing center. Results are available over the phone, along with appropriate counseling.
    • The FDA has approved an HIV test for home use. The testing kit is the same as that used in many healthcare providers' offices and clinics in which an oral sample is collected for testing and results are available in about 20 minutes. Though the home test is convenient, it has limitations. It is less sensitive than a blood test so the home test may miss some cases of HIV that a blood test would detect and it is not as accurate when it is performed at home by a lay person compared to when it is performed by a trained healthcare professional. Care must be taken to avoid errors when performing the test. (For more, see the article on Home Testing, Avoiding Errors.)

    Screening tests have limitations, so it is important to remember that:

    • A negative screening test means only that there is no evidence of disease at the time of the test. If you have increased risk of HIV infection but negative screening results, it is very important to get screening tests on a regular basis.
    • HIV tests will not detect the virus immediately after infection. Still, talk to your healthcare provider immediately if you think you’ve been infected. If exposure to the virus is recent, then antibody levels may be too low to detect. If an initial test is negative, it may be necessary to repeat testing at a later time with another antibody test or combination HIV antibody/antigen test. In the case of a negative result, the CDC recommends retesting three months after likely exposure.
    • A positive screening test is not a diagnosis. A positive result must be followed by a second antibody test that differentiates between HIV-1 and HIV-2 to establish a diagnosis.

    For more details on HIV screening, see the article on HIV Antibody and p24 Antigen.

    Screening Recommendations

    • The Centers for Disease Control and Prevention (CDC) recommends that everyone 13 to 64 years old have an HIV screening test at least once. The CDC recommends getting tested each year if you've engaged in an activity that can put you at increased risk of infection and spreading the disease. Additionally, men who have sexual contact with other men should be tested be tested every three to six months.
    • The United States Preventive Services Task Force (USPSTF) recommends that all teens and adults ages 15 to 65 be screened for HIV infection. It also recommends that younger adolescents and older adults at increased risk undergo screening for HIV. As for how often, the Task Force says a reasonable approach is one-time testing for all people ages 15 to 65 and at least annual screenings for those at very high risk of HIV, such as men who have sex with men, injection drug users, and those who live or receive medical care in areas where the rate of HIV infection is high. Individuals at increased but not very high risk may be screened less frequently than every year. The USPSTF recommends every three to five years as a guideline. The Task Force points out that risk is "on a continuum" and health professionals should use their own discretion in deciding how frequently to test people for HIV.
    • The American College of Physicians agrees with the CDC that everyone aged 13 to 64 be offered an HIV screening test in healthcare settings. It also recommends that healthcare practitioners should determine the frequency of repeat screening on an individual basis.
    • The American Academy of Pediatrics (AAP) recommends targeted HIV screening for all sexually active youth. In addition, the academy advises routine testing starting at age 16 for all teens who live in areas where prevalence is high; that is, where more than 1 in 1,000 individuals are infected.
    • For recommendations specific for pregnant women, see the article on Pregnancy.

    Aside from these recommendations, certain individuals should get tested and learn their status. These include:

    • People diagnosed with hepatitis, TB, or an STD
    • People who received a blood transfusion prior to 1985 or had a sexual partner who received a transfusion and later tested positive for HIV
    • A healthcare worker with direct exposure to blood on the job
    • Any individual who thinks he or she may have been exposed

    Talk to your healthcare provider
    Don't be surprised if a healthcare practitioner, in any care setting, offers you an HIV screening test, in keeping with CDC recommendations. If your healthcare provider does not bring up sexual health topics, you can simply ask for a test or a risk assessment. You can also use confidential services to obtain testing or counseling.


    Resources & Links

    For confidential information, you can call the STDs and HIV/AIDS hotline of the CDC: 800-CDC-INFO (232-4636).
    To find a testing site near you, visit National HIV and STD Testing Resources
    KidsHealth.org: HIV and AIDS
    MedlinePlus: Screening and diagnosis for HIV
    Mayo Clinic: HIV/AIDS - Preparing for your appointment
    AIDSinfo: HIV Testing


    Sources Used in Current Review

    Qaseem, A. et al. (2009 January 20). Screening for HIV in health care settings: A guidance statement from the American College of Physicians and HIV Medicine Association. Annals of Internal Medicine. Available online at http://annals.org/aim/article/744218/screening-hiv-health-care-settings-guidance-statement-from-american-college. Accessed 11/6/2016.

    (2011 October 31). The pediatrician's role in preventing HIV infection. American Academy of Pediatrics. Available online at https://healthychildren.org/English/news/Pages/The-Pediatricians-Role-in-Preventing-HIV-Infection.aspx. Accessed 11/6/2016.

    (2013 April). Human Immunodeficiency Virus (HIV) infection: Screening. U.S. Preventive Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening. Accessed 11/6/2016.

    (2015 May 27). Press release: Starting antiretroviral treatment early improves outcomes for HIV-infected individuals. National Institutes of Health. Available online at https://www.nih.gov/news-events/news-releases/starting-antiretroviral-treatment-early-improves-outcomes-hiv-infected-individuals. Accessed 11/6/2016.

    (Updated 2016 January 22). Working in healthcare and HIV. AVERT. Available online at http://www.avert.org/hiv-transmission-prevention/working-healthcare. Accessed 11/6/2016.

    (2016 May 23). Recommendations for HIV prevention with adults and adolescents with HIV. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/hiv/guidelines/personswithhiv.html. Accessed 11/6/2016.

    (2016 October 27). HIV and AIDS: Testing. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/hiv/basics/testing.html. Accessed 11/6/2016.

    (2016 June 20). HIV testing. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/hiv/testing. Accessed 11/6/2016.

  • Tuberculosis

    Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. TB primarily targets the lungs but may affect any area of the body. It can be spread through the air from person to person through droplets of respiratory secretions such as sputum or aerosols released by coughing, sneezing, laughing, or breathing.

    Most people who become infected with M. tuberculosis manage to confine the mycobacteria to a few cells in their lungs, where they stay alive but in an inactive form. This latent TB infection does not make the person sick or infectious and, in most cases, it does not progress to active tuberculosis. However, some people - especially those with compromised immune systems - may progress directly from initial TB infection to active tuberculosis. People who have HIV are much more likely to become sick if they contract TB. Another increasing concern is drug-resistant forms of TB that are resistant to the antibiotics typically prescribed to treat the disease.

    According to the U.S. Centers for Disease Control and Prevention (CDC), TB in children is a public health concern because it is a marker for recent transmission of the bacteria, and infants and young children are more likely than older children and adults to develop life-threatening forms of the disease. Among children, the most cases of TB are seen in those under 5 years of age and in adolescents older than 10 years of age.

    TB is one of the world's deadliest diseases, although it is relatively uncommon in the U.S. Still, it is a large health issue among at-risk groups. Current guidelines call for targeted screening among such groups.

    Recommendations

    The American Academy of Pediatrics (AAP) recommends that children and teens who are at risk of contracting TB have a tuberculin skin test, such as if:

    • They have been exposed to someone with active or suspected TB (e.g., a family member or other contact)
    • They are immigrants from a country where TB is endemic or have traveled to those countries for more than one week

    Links
    CDC: Tuberculosis (TB) in Children in the United States
    HealthyChildren.org (AAP): Tuberculosis in Children


    Sources Used in Current Review

    U.S. Centers for Disease Control and Prevention. Tuberculosis (TB) in Children in the United States. Available online at http://www.cdc.gov/tb/topic/populations/tbinchildren/default.htm. Accessed October 2016.

    HealthyChildren.org. Tuberculosis in Children. Available online at http://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Tuberculosis.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token. Accessed October 2016.

  • Hepatitis B

    According to the United States Preventive Services Task Force (USPSTF), approximately 700,000 to 2.2 million people in this country have chronic infection with hepatitis B virus (HBV). Many of these people are unaware that they are infected.

    HBV is one of five "hepatitis viruses" identified so far that are known to mainly infect the liver. It is spread through contact with blood or other body fluids from an infected person, such as during sex or by sharing needles, razors or toothbrushes, and can also be passed from an infected mother to her baby during or after birth.

    HBV infection can be acute or chronic, with the course of infection varying from a mild form that lasts only a few weeks to a more serious form lasting years that can lead to complications such as cirrhosis or liver cancer. According to the Centers for Disease Control and Prevention (CDC), approximately 2,000-4,000 people die every year in the U.S. from HBV-related liver disease.

    The vast majority of those with chronic infections will have no symptoms. A test for hepatitis B surface antigen (HBsAg) may be used for screening asymptomatic people who fall into one of the high-risk categories for chronic HBV. Effective vaccines against HBV are available; however, those who have not been vaccinated or who are at high risk and were vaccinated before being screened for HBV infection may want to consider getting tested.

    Risk
    According to the USPSTF, in the U.S., people considered at high risk for HBV infection include those from countries with a high prevalence of HBV infection, those who are HIV-positive, injection drug users, household contacts of those with HBV infection, and men who have sex with men. Since the prevalence of HBV infection is low in the general U.S. population and most of those infected do not develop complications, HBV screening is not recommended for those who are not at increased risk.

    Recommendations
    In 2008, the CDC revised its guidelines to recommend that the following groups be screened for HBV:

    • Healthcare and public safety workers
    • People born in areas of the world that have a greater than 2% prevalence of HBV (for example, much of Asia and Africa)
    • People born in the U.S. but who were not vaccinated and whose parents are from an area with greater than 8% prevalence of HBV
    • Men who have sex with men
    • People who have elevated liver enzymes (ALT and AST) with no known cause
    • People with certain medical conditions that require that their immune system be suppressed, such as organ transplant recipients
    • Pregnant women
    • People who are in close contact with someone infected with HBV
    • Those infected with HIV

    In 2014, the USPSTF updated its statement to recommend screening for HBV among asymptomatic, non-pregnant adolescents and adults in certain high-risk groups, bringing their recommendations into line with those of the CDC. The USPSTF had previously published the recommendation for HBV screening during pregnancy.

    Why get tested?
    People with chronic HBV can unwittingly spread the infection to others and remain at risk for serious complications of the infection.


    Link
    CDC: Hepatitis B Information for the Public 


    Sources Used in Current Review

    USPSTF Urges HBV Screening for High-Risk People. By Michael Smith. MedPage Today. Published May 27, 2014. Available online through http://www.medpagetoday.com. Accessed June 2014.

    USPSTF Recommends Hepatitis B Screening for High-Risk Groups. By Amy Orciari Herman. May 27, 2014. Journal Watch. Available online at http://www.jwatch.org/fw108870/2014/05/27/uspstf-recommends-hepatitis-b-screening-high-risk-groups?query=pfw through http://www.jwatch.org. Accessed June 2014.

    Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement. Michael L. LeFevre, MD, MSPH, on behalf of the U.S. Preventive Services Task Force. Annals of Internal Medicine. Article published online 27 May 2014. Available online at http://annals.org/article.aspx?articleid=1874740 through http://annals.org. Accessed June 2014.

    Centers for Disease Control and Prevention. Hepatitis B FAQs for the Public. Available online at http://www.cdc.gov/hepatitis/b/bFAQ.htm#statistics through http://www.cdc.gov. Accessed June 2014.

    Centers for Disease Control and Prevention. Hepatitis B Information for the Public. Available online at http://www.cdc.gov/hepatitis/B/index.htm through http://www.cdc.gov. Accessed June 2014.

    Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. Recommendations and Reports. September 19, 2008 / 57(RR08);1-20. Morbidity and Mortality Weekly Report. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm through http://www.cdc.gov. Accessed June 2014.

     

  • Iron deficiency anemia

    Teens grow and develop rapidly and need iron in their diet to develop normally. If a teen does not consume enough iron, there is a risk of developing iron deficiency. Iron deficiency can cause anemia, a condition that can delay a teen's mental, motor, and behavioral development and create problems that last long after the iron level is raised to a healthy level. Poor motor skills, behavior problems at home and school, and poor performance in school can be the long-term consequences of not receiving enough iron as a child.

    Iron deficiency may also be due to a severe blood loss, a genetic disorder, or something interfering with the body's ability to absorb iron, such as a medication the teen is taking or a chronic illness (e.g., celiac disease).

    Recommendations
    The American Academy of Pediatrics (AAP) recommends teens be screened with a hemoglobin and hematocrit test if they have risk factors for iron deficiency or iron deficiency anemia.

    Risk factors for iron deficiency anemia in teens may include:

    • Households with a low income or living in poverty
    • Poor or restricted diet that doesn't provide enough iron
    • Teen girls who begin menstruating can be at risk if they don't consume enough iron
    • History of:
      • Medications that interfere with iron absorption
      • Extensive blood loss
      • Exposure to lead

    Link
    Mayo Clinic: Iron deficiency in children - Prevention tips for parents 


    Sources Used in Current Review

    American Academy of Pediatrics. Policy Statement: 2014 Recommendations for Pediatric Preventive Health Care. Pediatrics. Available online at http://pediatrics.aappublications.org/content/pediatrics/133/3/568.full.pdf. Accessed October 2016.

View Sources

American Academy of Pediatrics. 2014 Recommendations for Pediatric Preventive Health Care. Pediatrics March 2014, VOLUME 133 / ISSUE 3. Available online at http://pediatrics.aappublications.org/content/133/3/568. Accessed October 2016.

2016 Pediatric Preventive Care Guidelines. Massachusetts Health Quality Partners. Available online through https://www.harvardpilgrim.org/. Accessed October 2016.