Adolescents and Young Adults
Public Health Impact
Compared to older adults, sexually-active adolescents 10 to 19 years of age and young adults 20 to 24 years of age are at higher risk for acquiring STDs for a combination of behavioral, biological, and cultural reasons. For some STDs, for example, Chlamydia trachomatis, adolescent women may have a physiologically increased susceptibility to infection due to increased cervical ectopy. The higher prevalence of STDs among adolescents also reflects multiple barriers to accessing 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. Recent estimates suggest that while representing 25% of the ever sexually active population, 15 to 24 years of age acquire nearly half of all new STDs.1
After adjusting trends in chlamydia positivity to account for changes in laboratory test methods and associated increases in test sensitivity (see Appendix), chlamydia test positivity in 15- to 19-year-old women decreased in two of 10 HHS regions between 2005 and 2006, increased in seven regions, and remained the same in one region (Figure J).
Numerous prevalence studies in various clinic populations have shown that sexually-active adolescents have high rates of chlamydial infection.2,3 The Infertility Prevention Project (IPP) provides routine screening for detecting chlamydial infections among women attending family planning clinics. IPP prevalence data demonstrate that younger women consistently have higher positivity than older women, even when overall prevalence declines.
For the second consecutive year, gonorrhea rates for persons 15 to 19 and 20 to 24 years of age increased. Between 2005 and 2006, the increase for those 15 to 19 years of age was 6.3%, and for those 20 to 24 years of age was 4.4% (Table 20).
15- to 19-Year-Old Women - As in previous years, in 2006 15- to 19-year-old women had the highest rate of gonorrhea (647.9 per 100,000 population) compared to any other age/sex group (Figure 19 and Table 20).
20- to 24-Year-Old Women - In 2006, as in previous years, 20- to 24-year-old women had the second highest rate of gonorrhea (605.7 per 100,000 population) compared to any other age/sex group.
20- to 24-Year-Old Men - As in previous years in 2006, 20- to 24-year old men had the highest rate of gonorrhea (454.1 per 100,000 population).
Primary and Secondary Syphilis
Syphilis rates among 15- to 19- year old women have increased since 2004 from 1.5 cases per 100,000 population, to 1.9 in 2005 and to 2.3 in 2006. Rates in women have been the highest each year in the 20 to 24 year age group. In this age group there were 2.9 cases per 100,000 population in 2006 (Figure 34, Table 32).
In men, rates among those 15 to 19 years of age have increased since 2002 from 1.3 cases per 100,000 population in 2002 to 2.3 in 2005 and 3.1 in 2006. Rates in men have been the highest each year in the 35 to 39 year old age group. There were 13.5 cases per 100,000 population in 2006 (Figure 34, Table 32).
National Job Training Program
Since 1990, approximately 20,000 female National Job Training Program entrants have been screened each year for chlamydia. This program, administered by the National Job Training Program at more than 100 sites throughout the country, is a job training program for economically-disadvantaged youth aged 16 to 24 years of age.
Chlamydial infection is widespread geographically and highly prevalent among economically-disadvantaged young women and men in the National Job Training Program 4-6 Specimens from at least 100 students from each state and outlying area were tested by a national contract laboratory.* Among women entering the program from 40 states, the District of Columbia, and Puerto Rico in 2006, based on their place of residence before program entry, the median state-specific chlamydia prevalence was 13.1% (range 4.9% to 20.0%) (Figure K). This reflects a substantial increase from 2005 when the median state-specific chlamydia prevalence was 9.2%, and it appears due to the use of more sensitive tests. Among men entering the program from 48 states, the District of Columbia, and Puerto Rico in 2006, the median state-specific chlamydia prevalence was 7.9% (range 1.8% to 12.4%) (Figure L), which is little change from the chlamydia prevalence of 8.1% in 2005. There was no change in the test types used among men.
Data from National Job Training Program centers that submit gonorrhea specimens from female students aged 16 to 24 years to a national contract laboratory indicated a high prevalence of gonococcal infection in this population. Specimens from at least 100 students from each state and outlying areas were tested by the contract laboratory. Among women entering the program from 36 states, the District of Columbia, and Puerto Rico the median state-specific gonorrhea prevalence was 2.4% (range 0.0% to 7.1%) in 2006 (Figure M). Among men entering the program from 20 states in 2006, the median state-specific gonorrhea prevalence was 3.6% (range 0.0% to 6.2%) (Figure N).
Juvenile Corrections Facilities
Among adolescent women attending juvenile corrections facilities, data from the Corrections STD Prevalence Monitoring Project identified a median chlamydia positivity of 14.2% (range 2.8% to 29.4%) (Table AA) and a median gonorrhea positivity of 3.8% (range 0.0% to 12.2%) (Table CC). See Special Focus Profiles (STDs in Persons Entering Corrections Facilities).
2 Centers for Disease Control and Prevention. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR 1993;42(No. RR-12).
3 Lossick J, DeLisle S, Fine D, Mosure DJ, 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.
4 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.
5 Joesoef MR, Mosure DJ. Prevalence of chlamydia in young men in the United States from newly implemented universal screening in a National Job Training Program. Sexually Transmitted Diseases 2006;33(10):636-639.