Question:

A 17-year-old girl comes to the office for evaluation of worsening vaginal irritation and discharge. She has had multiple sexual partners in the past few months. The patient is adherent with oral contraceptives and inconsistently uses condoms. She has no prior medical conditions and takes no other medications. Urine pregnancy test is negative and urine gonorrhea test is positive. The patient does not want her parents to find out she is having sex and asks if the physician will tell her parents about today's visit. Which of the following is the most appropriate response to this patient?

"Because gonorrhea is a reportable illness, I am obligated to report it to the health authorities and to your parents."

"I don't need to inform your parents that you are sexually active, but I will need their consent to prescribe antibiotic treatment."

"I recommend that you tell your parents about today's visit in case your symptoms become more serious."

"I will not notify your parents because you can consent to testing and treatment for sexually transmitted infections on your own."

"You can consent to treatment of gonorrhea, but because you are a minor, I am obligated to notify your parents."

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Explanation:

Exceptions to informed consent by parent/guardian in minors
Emergency care	Condition in which treatment delay can cause serious impairment or death
Emancipated minor (adolescents)	Parent Married Military service Financially independent High school graduate Homeless
Specific medical care (adolescents)	Sexually transmitted infection Substance use disorder (most states) Pregnancy care (most states) Contraception

Minors (age <18) usually require parental consent for medical treatment; however, consent is generally not required in the following situations:

Legal or situational emancipation (eg, parent, married)
Emergency care in which delay of care could result in significant harm to life or limb
Specific conditions (eg, sexually transmitted infection [STI], pregnancy, substance abuse) that are potentially serious, sensitive, or stigmatizing

Allowing minors to consent for treatment of certain potentially serious medical conditions (eg, STI) encourages them to seek services without concern of parental involvement, as in this patient's situation. In most states, minors can also consent to substance abuse and mental health treatment as well as reproductive services, although there may be variations among states (eg, requiring minors to be a minimum age). Some, but not all states, also exclude information about sensitive services from insurance documentation that is sent to the parent (policyholder).

(Choice A) Notification of parents for STIs other than HIV is not mandated in any state.

(Choices B and E) The patient can obtain evaluation and treatment for STIs, including antibiotics, without parental notification or consent.

(Choice C) Although it is often preferable for parents to be involved in their child's care, it should not be automatically assumed that disclosing information would be in the patient's best interest. This response also dismisses the patient's concern about confidentiality and fails to answer her question.

Educational objective:
Minors do not require parental consent for medical treatment of conditions that may be sensitive or stigmatizing such as sexually transmitted infections, pregnancy, and substance abuse.