Question 4 - HIV in Adolescents and Young Adults Question Bank

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HIV in Adolescents and Young AdultsQuestion 4/10

A 14-year-old boy presents for follow-up HIV care. He has moderate enlargement of the testes (but not adult sized), a moderate amount of pubic and axillary hair (but not in a full adult distribution), and a moderate-sized penis.

Which of the following is the correct sexual maturity rating (SMR or Tanner Stage) for this individual?

III

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Question Last Updated
February 2nd, 2025

Table 1.
Sexual Maturity Rating (Tanner Staging) in Adolescents
			Female				Male
Stage	Age Range (years)	Breast Growth	Pubic Hair Changes	Other changes	Age Range (years)	Testes growth	Penis growth	Pubic hair growth	Other changes
I	0-15	Pre-adolescent	None	Pre-adolescent	0-15	Pre-adolescent testes (≤2.5 cm)	Pre-adolescent	None	Pre-adolescent
II	8-15	Breast budding (thelarche); areolar hyperplasia with small amount of breast tissue	Long downy pubic hair near the labia, often appearing with breast budding or several weeks or months later	Peak growth velocity often occurs soon after stage II	10-15	Enlargement of testes; pigmentation of scrotal sac	Minimal or no enlargement	Long downy hair, often appearing several months after testicular growth; variable pattern noted with pubarche	Not applicable
III	10-15	Further enlargement of breast tissue and areola, with no separation of their contours	Increase in amount and pigmentation of hair	Menarche occurs in 2% of girls late in stage III	1½–16.5	Further enlargement	Significant enlargement, especially in diameter	Increase in amount; curling	Not applicable
IV	10-17	Separation of contours; areola and nipple form secondary mound above breasts tissue	Adult in type but not in distribution	Menarche occurs in most girls in stage IV, 1–3 years after thelarche	Variable: 12–17	Further enlargement	Further enlargement, especially in diameter	Adult in type but not in distribution	Development of axillary hair and some facial hair
V	12.5-18	Large breast with single contour	Adult in distribution	Menarche occurs in 10% of girls in stage V.	13–18	Adult in size	Adult in size	Adult in distribution (medial aspects of thighs; linea alba)	Body hair continues to grow and muscles continue to increase in size for several months to years; 20% of boys reach peak growth velocity during this period

Source:

WHO Guidelines Approved by the Guidelines Review Committee. Annex H. Sexual Maturity Rating (Tanner Stage) in Adolescents. Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision. [WHO]

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Which of the following is the correct sexual maturity rating (SMR or Tanner Stage) for this individual?

Sexual Maturity Rating (Tanner Staging) in Adolescents

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