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STDs
in Adolescents and Young Adults
Public Health
Impact
Compared to older adults, adolescents (10- to 19-year-olds)
and young adults (20- to 24-year-olds) are at higher risk for
acquiring STDs for a number of reasons: they may be more likely
to have multiple (sequential or concurrent) sexual partners rather
than a single, long-term relationship; they may be more likely
to engage in unprotected intercourse; and they may select partners
at higher risk. In addition, for some STDs, for example Chlamydia
trachomatis, adolescent women may have a physiologically
increased susceptibility to infection due to increased cervical
ectopy.
In
addition, the higher prevalence of STDs among adolescents reflects
multiple barriers to quality STD prevention services, including
lack of insurance or other ability to pay, lack of transportation,
discomfort with facilities and services designed for adults, and
concerns about confidentiality.
Observations
- Numerous prevalence
studies in various clinic populations have shown that sexually
active adolescents have high rates of chlamydial infection.1-4 The
Regional Infertility Prevention Programs that perform large scale
screening for detecting chlamydial infections among women attending
family planning clinics demonstrate that younger women consistently
have higher positivity rates of chlamydia than older women, even
as prevalence declines. An example is the Region X Chlamydia
Project, which has screened women in family planning clinics
since 1988 (Figure
K).
- Among women,
15- to 19-year-olds had the highest rate of gonorrhea in 2000
compared to all other age categories (Figure
Q). In addition, 20- to 29-year-old women had the highest
rates of primary and secondary syphilis in 2000 (Figure
S). Among men, 20- to 24-year-olds had the highest rate of
gonorrhea and fourth highest rate of primary and secondary syphilis
(Figures
R and T).
- Rates of gonorrhea
among male adolescents generally decreased between the years
1996 and 2000 (Figure R). In the 10- to 14-year-old group,
the rate for young men remained stable at about 8 cases per 100,000
males between 1999 and 2000 (Table 20B).
In the 15- to 19-year-old group, the rate declined from 373.6
cases per 100,000 males in 1996 to 327.9 cases per 100,000 males
in 2000, a 12.2% decrease. Among young adult men in the 20- to
24-year-old group, the rate of gonorrhea increased between 1999
and 2000 (574.5 and 589.8 cases per 100,000 males respectively).
The rate in this age group in 2000 is 10.7% higher than the rate
of 532.7 cases per 100,000 males reported in 1996 (Table 20B).
- Gonorrhea among
female adolescents and young adults aged 10- to 19-years also
decreased between 1996 and 2000. In the 10- to 14-year-old group,
the rate for females decreased 9.0% during this period from 58.6
cases per 100,000 females in 1996 to 53.3 cases per 100,000 females
in 2000 (Table
20B). In the 15- to 19-year-old group, the rate declined
slightly by 1.3% from 724.7 to 715.6 cases per 100,000 females
between 1996 and 2000. In addition, the rates for female adolescents
in these age groups decreased between the years 1999 and 2000.
Among young adult women in the 20- to 24-year-old group, the
rate of gonorrhea increased by 3.7% from 633.4 to 656.6 cases
per 100,000 females between 1999 and 2000. The 2000 rate for
women in this age group was 21.0% greater than the age-group
specific rate of 542.7 cases per 100,000 females reported in
1996 (Table 20B).
- In 2000, the
highest age-specific gonorrhea rates among women and the third
highest rates among men were in the 15- to 19-year-old group
(Figure 14).
- Since 1990, approximately
20,000 female National Job Training Program entrants have been
screened each year for chlamydia. This program, administered
by the U.S. Department of Labor at more than 100 sites throughout
the country, is a job training program for economically disadvantaged
youth aged 16 through 24 years. Among women entering the program
from 30 states and Puerto Rico in 2000, based on their place
of residence before program entry, the median state-specific
chlamydia prevalence was 11.9% (range, 6.8% to 19.8%) (Figure
L). Chlamydial infection is widespread geographically and
highly prevalent among these economically disadvantaged young
women.3
- Since 1996, approximately
25,000 female recruits have been screened at entry in the U.S.
Army at basic training in Fort Jackson, South Carolina.4 All
tests are performed at the Johns Hopkins University Chlamydia
Research Laboratory on urine specimens. Among women aged 17 to
37 years entering the Army in 1999, based on their state of residence
before entry, the overall state-specific chlamydia prevalence
was 9.9%. State-specific prevalence ranged from 4.1% to 19.6%
(Figure
M). Data for female recruits in 2000 were unavailable.
- Among men aged
17 to 37 years entering the Army in 1999 and 2000, based on their
state of residence before entry, the overall chlamydia prevalence
was 4.7%. State-specific chlamydia prevalence ranged from 1.0%
to 11.1% (Figure
N).
- Data from National
Job Training Program centers submitting gonorrhea specimens to
the national contract laboratory from female students aged 16
to 24 years indicate a high prevalence of gonococcal infection
in this population. Specimens from at least 100 students from
each of 21 states and Puerto Rico, were tested by the contract
laboratory; the median state-specific gonorrhea prevalence was
3.5% (range, 0.9% to 8.5%) in 2000 (Figure O).
- Among men aged
17 to 37 years entering the Army in 1999 and 2000, based on their
state of residence before entry, the overall gonorrhea prevalence
was 0.4%. State-specific gonorrhea prevalence ranged from 0.0%
to 1.4% (Figure
P).
1Centers for Disease Control and Prevention. Recommendations for the prevention and management of Chlamydia
trachomatis infections,
1993. MMWR 1993;42(No. RR-12).
2Lossick J, Delisle S, Fine D, Mosure D, Lee
V, Smith C. Regional program for widespread screening for Chlamydia trachomatis in family planning clinics. In: Bowie WR, Caldwell
HD, Jones RP, et al., eds. Chlamydial Infections: Proceedings
of the Seventh International Symposium of Human Chlamydial Infections,
Cambridge, Cambridge University Press 1990, pp. 575-9.
3Mertz, KJ; Ransom RL; St. Louis ME, Groseclose
SL; Hadgu A; Levine WC; Hayman C. Decline in the Prevalence of
Genital Chlamydia Infection in Young Women Entering a National
Job Training Program, 1990-1997. Am
J Pub Health 2001;91(8):1287-1290.
4Gaydos CA, Howel MR, Pare B, et al. Chlamydia trachomatis infection in female military recruits. N Engl J Med 1998;339:739-44.
Figure
K. Chlamydia — Positivity among women tested in family
planning clinics by age group: Region X, 1988–2000
Note: Women who
met screening criteria were tested. Trends not adjusted for changes
in laboratory test method in 1994, 1999, and 2000 and associated
increases in test sensitivity.
SOURCE: Regional
Infertility Prevention Programs: Region X Chlamydia Project (Alaska,
Idaho, Oregon and Washington)
Figure
L. Chlamydia — Prevalence among 16-24 year-old women entering
the National Job Training Program by state of residence, 2000
*Fewer than 100
women residing in these states and entering the National Job Training
Program were screened for chlamydia in 2000.
Note: The overall
chlamydia prevalence among female students entering the National
Job Training Program in 2000 was 11.2%.
SOURCE: U.S. Department
of Labor
STDs in Adolescents
and Young Adults figures continued on STDs in Adolescents and
Young Adults - page 2
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