ADVOCATES FOR YOUTH

The Facts

Adolescents—At Risk for Sexually Transmitted Infections

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In the United States, sexually active teens experience high rates of sexually transmitted infections (STIs), and some populations of youth face excessive risk—African American youth, young women, abused youth, homeless youth, young men who have sex with men (YMSM), and gay, lesbian, bisexual, and transgender (GLBT) youth. The STI epidemic is a global phenomenon, and wherever they live, youth in high risk situations also face a heightened risk of STIs.

Rates in the United States Are High among Teens and Young Adults.

• From 1987 through 2001, chlamydia rates rose from 51 to 278 per 100,000 population in the United States, an increase attributed, at least partly, to improved screening and reporting.¹
• The highest age-specific chlamydia rates occurred among women ages 15 to 19 and 20 to 24 (2,536 and 2,447 per 100,000 women, respectively).¹
• Chlamydia rates among U.S. males, while considerably lower than among young women, were also highest in 15- to 19-year-old and 20- to 24-year-old men (376 and 605 per 100,000 men, respectively).¹
• Gonorrhea rates were higher among women ages 15 to 19 and men ages 20 to 24 than among other age groups. The overall U.S. rate was 129 per 100,000 population; among 15- to 19-year-old women, the rate was 703; among 20- to 24-year-old men, it was 564.¹
• Experts estimate that one million new cases of genital herpes simplex virus type 2 (HSV-2) occur each year in the United States.2Although case report data for this incurable STI are not available, data from a national survey indicated that 22 percent of U.S. residents over age 11 are infected with HSV-2.¹
• Genital human papillomavirus (HPV), commonly known as genital warts, is the most common STI in the United States and, perhaps, the most common STI among sexually active youth. In a recent study, HPV seroprevalence was five percent among youth ages 12 to 19, and 15 percent among those ages 20 to 29.³

Rates of Curable STIs in the United States Are Higher than in Other Developed Nations.

• Experts estimate that more than 15 million sexually transmitted infections occur annually in the United States, nearly four million among teens and over six million among youth ages 20 to 24.^2,4 Moreover, rates of curable STIs in the United States are the highest in the developed world.⁵
• The gonorrhea rate among U.S. teens is 74 times higher than the rate among teens in either the Netherlands or France, 10 times higher than in Canada, and seven times higher than in England and Wales.⁶ The chlamydia rate among U.S. teens is 20 times higher than among teens in France, five times higher than in England and Wales, and twice as high as in Canada.⁶
• Prevalence of gonorrhea and syphilis is increasing among some populations in Europe, heightening fears that people are being less careful about risky sexual behaviors.⁷

In the United States, Some Populations Are at Disproportionate Risk of STIs.

• In 2001, the chlamydia rate among African American women ages 15 to 19 was nearly seven times higher than among white females (8,483 and 1,276 per 100,000 females, respectively); among African American males ages 15 to 19, the chlamydia rate was 12 times higher than among white males (1,550 and 128 per 100,000, respectively).¹
• In 2001, 75 percent of all reported cases of gonorrhea occurred among African Americans. Their gonorrhea rate was 782 per 100,000 population compared to 114 among Native Americans, 74 among Latinos, and 29 among non-Hispanic whites.¹
• HPV type 16, which accounts for about half of all cervical cancers worldwide, was over twice as prevalent in U.S. women as in men (18 and eight percent, respectively). Prevalence was highest among African American women (27 percent) compared to 17 percent among white women and 12 percent among Latinas.³
• In studies, chlamydia occurred among 18 percent of street youth and 15 percent of young women in juvenile detention facilities.¹ Fifty percent of 18- to 21-year-old youth living in an urban neighborhood known as a major area for drug sales and drug injection had HSV-2 (37 percent of young men and 64 percent of young women).⁸
• Recent data document rising rates of syphilis, gonorrhea, and chlamydia among YMSM.⁹
• In a nationwide survey of lesbians, 17 percent reported a history of STI.¹⁰

Factors beyond the Control of Youth May Place Them at Excess Risk for STI.

• Young women and female adolescents are more susceptible to STI, compared to their male counterparts, due to their anatomy. During adolescence and young adulthood, women's columnar epithelial cells—which are especially sensitive to invasion by sexually transmitted organisms, such as chlamydia and gonococcus—extend out over the vaginal surface of the cervix, where they are unprotected by cervical mucous, but recede to a more protected location as women age.⁵
• STIs are more likely to remain undetected in women than in men, resulting in delayed diagnosis and treatment, and untreated STIs are more likely to lead to complications in women, such as pelvic inflammatory disease and cervical cancer.⁵
• Lack of health care coverage directly affects people's ability to obtain professional assistance to prevent STIs, avoid transmitting infections, and receive treatment. One-fourth of adolescents and young adults lack health coverage.⁵
• Poverty and other socioeconomic facts contribute to STI risk. Youth living in poverty may not perceive the risk of STIs or may not practice preventive behaviors if other risks—such as hunger or homelessness—appear more imminent and threatening.⁵
• Cultural traditions that value women's passivity and subordination also diminish the ability of many women to adequately protect themselves, to refuse unwanted sex, and to negotiate condom use.⁵
• Sexual violence against women and sexual abuse of children put many women and young people at extreme risk. Up to 500,000 U.S. women suffer sexual violence each year, and one in three young girls and one in six young boys may experience sexual abuse or coercion at least once before reaching adulthood.⁵
• Estimates of the number of runaway and homeless adolescents in the United States vary from hundreds of thousands to millions. Adolescents living on the street—many of them lesbian, gay, bisexual, and transgender—are at risk for STIs, as they often engage in survival sex (trading sex for food, shelter, or money), use substances, and frequently suffer sexual and physical assault.⁵

References

1. CDC. Sexually Transmitted Disease Surveillance, 2001. Atlanta, GA: Author, 2002.
2. Cates W. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. Sex Transm Dis 1999; 26 (4 Suppl):S2-S7.
3. Stone KM et al. Seroprevalence of human papillomavirus type 16 infection in the United States. J Infectious Dis 2002; 186:1396-402.
4. Kaiser Family Foundation, American Social Health Association. Sexually Transmitted Diseases in America: How Many Cases and at What Cost? Menlo Park, CA: The Foundation, 1998.
5. Eng TR, Butler WT, ed. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press, 1997.
6. Panchaud C et al. Sexually transmitted diseases among adolescents in developed countries. Fam Plann Perspect 2000; 32:24-32+.
7. Nicoll A, Hamers FF. Are trends in HIV, gonorrhoea, and syphilis worsening in Western Europe? British Med J 2002; 324:1324-1327.
8. Friedman SR et al. Sex, drugs, and infections among youth: parenterally and sexually transmitted diseases in a high-risk neighborhood. Sex Transm Dis 1997; 24:322-26.
9. CDC. Taking Action to Combat Increases in STDs and HIV Risk among Men Who Have Sex with Men. Atlanta, GA: CDC, [2001].
10. Diamant AL et al. Lesbians' sexual history with men: implications for taking a sexual history. Arch Internal Med 1999; 159:2730-36.

Written by Sue Alford
January 2003 © Advocates for Youth

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