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; 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.^1,2,3 The Regional Infertility Prevention Program that performs 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 2001 compared to all other age categories (Figure P and Table 21). In addition, 20- to 29-year-old women had the highest rates of primary and secondary syphilis in 2001 (Figure R and Table 34). Among men, 20- to 24-year-olds had the highest rate of gonorrhea and 30- to 39-year-olds had the highest rate of primary and secondary syphilis (Figures Q and S and Tables 21 and 34).
  
• Rates of gonorrhea among male adolescents generally decreased between the years 1991 and 2001 (Figure Q). In the 15- to 19-year-old group, the rate declined for a third year, going from 337.9 cases per 100,000 males in 1999, to 320.6 in 2000, to 307.5 in 2001, an overall 9.0% decrease. Among young men in the 20- to 24-year-old group, the rate of gonorrhea had generally been declining in the early 1990s but then increased slightly in the late 1990s and now has remained relatively unchanged in 2000 and 2001 (559.4 and 563.6 cases per 100,000 males, respectively).
  
• In 15- to 19-year-old women, the 2001 gonorrhea rate of 703.2 cases per 100,000 females was similar to the 2000 rate of 699.3. Among young women in the 20- to 24-year-old group, the rate of gonorrhea in 2001 was 664.1, a 6.0% increase from 626.5 in 2000 and a 22.4% increase from the rate in 1996 (542.7) ( Figure P, Table 21).
  

• In 2001, 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 and Table 21).
  
• 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 26 states and Puerto Rico in 2001, based on their place of residence before program entry, the median state-specific chlamydia prevalence was 10.6% (range 5.1% to 18.0%) (Figure L). Chlamydial infection is widespread geographically and highly prevalent among these economically-disadvantaged young women.³
  
• 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 17 states and Puerto Rico, were tested by the contract laboratory; the median state-specific gonorrhea prevalence was 3.7% (range 0.7% to 8.1%) in 2001 (Figure O).
  
• The Adolescent Women Reproductive Health Monitoring Project was established in 1999 to monitor STD prevalence and reproductive health measures among adolescent women (less than 20 years old) in non-traditional venues, including school-based clinics, juvenile detention centers, drug treatment centers, and organizations serving street youth. In 2001, results from this screening project, which uses urine-based tests, identified a median site- specific chlamydia positivity of 9.6% (range 7.2% to 17.7%) at 16 school-based clinics and 17.6% (range 14.3% to 19.0%) at 16 organizations serving street youth (Figure M). Median site-specific gonorrhea positivity was 1.6% (range 1.2% to 4.8%) at school-based clinics and 4.4% (range 2.7% to 6.4%) at organizations serving street youth (Figure N).
  
• Among adolescent women attending juvenile detention facilities, data from the Adolescent Women Reproductive Health Monitoring Project and the Jail STD Prevalence Monitoring Project identified a median chlamydia positivity of 14.8% (range 4.0% to 25.8%) (Figure GG) and a median gonorrhea positivity of 5.6% (range 0.0% to 13.6%) (Figure II) (see STDs in Persons Entering Corrections Facilities).
  

¹ Centers for Disease Control and Prevention. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR 1993;42(No. RR-12).

² Lossick 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.

³ Mertz, 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.