STDs in Adolescents and Young Adults

Public Health Impact

Compared to older adults, sexually-active adolescents 15 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, such as Chlamydia trachomatis, adolescent women may have a physiologically increased susceptibility to infection due to increased cervical ectopy. The higher prevalence of STDs among adolescents may also reflect 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. Estimates suggest that while representing 25% of the sexually experienced population, 15- to 24-year-olds acquire nearly half of all new STDs.¹

Observations

Chlamydia

Chlamydia rates for persons 15 to 19 and 20 to 24 years of age continue to increase, as they have for all age groups. Between 2007 and 2008, the increase for those 15 to 19 years of age was 10.7%, and for those 20 to 24 years of age was 8.9% (Table 10).

15- to 19-Year-Old Women—As in previous years, in 2008, 15- to 19-year-old women had the highest rate of chlamydia compared to any other age/sex group (Figure 5 and Table 10). Chlamydia rates for 15- to 19-year-old women increased 9.8% from 2,982.5 per 100,000 population in 2007 to 3,275.8 per 100,000 population in 2008.

20- to 24-Year-Old Women—In 2008, as in previous years, 20- to 24-year-old women had the second highest rate of chlamydia (3,179.9 per 100,000 population) compared to any other age/sex group. Chlamydia rates in women of this age group increased 7.6% from 2007 to 2008.

15- to 19-Year-Old Men—Chlamydia rates for 15- to 19-year-old men increased 14.8% from 611.0 per 100,000 population in 2007 to 701.6 per 100,000 population in 2008.

20- to 24-Year-Old Men—As in previous years, in 2008, 20- to 24-year old men had the highest rate of chlamydia among men (1,056.1 per 100,000 population). Chlamydia rates in men of this age group increased 12.6% from 2007 to 2008.

Gonorrhea

In 2008 gonorrhea rates for persons 15 to 19 and 20 to 24 years of age decreased for the first time in four years. Between 2007 and 2008, the decrease for those 15 to 19 years of age was 1.3%, and for those 20 to 24 years of age, it was 2.5% (Table 20).

15- to 19-Year-Old Women—In 2008, as in previous years, 15- to 19-year-old women had the highest rate of gonorrhea (636.8 per 100,000 population) compared to any other age/sex group (Figure 19 and Table 20). Gonorrhea rates in women of this age group decreased 1.0% from 2007 to 2008. This is the first decrease in this age group in the past four years.

20- to 24-Year-Old Women—In 2008, as in previous years, 20- to 24-year-old women had the second highest rate of gonorrhea (608.6 per 100,000 population) compared to any other age/sex group. Gonorrhea rates in women of this age group decreased 1.2% from 2007 to 2008. This is the first decrease in this age group in the past four years.

15- to 19-Year-Old Men—In 2008 gonorrhea rates for 15- to 19-year-old men decreased 2.0% from 284.1 per 100,000 population in 2007 to 278.3 per 100,000 population. This is the first decrease in this age group in the past four years. (Figure 20, Table 20).

20- to 24-Year-Old Men—In 2008, as in previous years, 20- to 24-year old men had the highest rate of gonorrhea among men (433.6 per 100,000 population). Gonorrhea rates in men of this age group declined 4.2% between 2007 and 2008.

Primary and Secondary Syphilis

Syphilis rates among 15- to 19-year old women have increased annually since 2004 from 1.5 cases per 100,000 population to 3.0 per 100,000 population in 2008. Rates in women have been highest each year in the 20 to 24 year age group with 5.1 cases per 100,000 population in 2008 (Figures 35 and 36 and Table 33).

Rates among 15- to 19-years olds are much lower than those in men in older age groups (Figure 35). However, rates in this group have increased since 2002 from 1.3 cases per 100,000 population to 3.8 in 2007 and 5.3 in 2008. Men in the 20 to 24 year old age group had the highest rate of syphilis, 17.3 cases per 100,000 population in 2008 (Figure 35, Table 33).

Prevalence Monitoring

Chlamydia test positivity among 15- to 19-year-old women screened in family planning clinics fluctuated in all 10 DHHS regions between 2004 and 2008 (Figure J). Positivity has remained fairly stable in four regions (II, III, V, X). In the remaining six regions, positivity rates increased slightly over this five-year time frame. The positivity rates presented in (Figure J) are not adjusted for changes in laboratory test methods and associated increases in test sensitivity.

National Job Training Program

Since 1990, approximately 20,000 female National Job Training Program entrants have been screened each year for chlamydia. Since 2004, approximately 35,000 male entrants have been screened annually. This program, administered at more than 100 sites throughout the country, is a job training program for socioeconomically-disadvantaged youth 16 to 24 years of age. The data presented are from locales where more than 100 persons were screened in 2008.

Chlamydial infection is widespread geographically and highly prevalent among socioeconomically-disadvantaged young women and men entering the National Job Training Program.^2-4 Specimens from students in each state and outlying area were tested by a single national contract laboratory.* Among women entering the program from 39 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 12.8% (range: 5.4% to 20.8%) (Figure K). Among men entering the program from 48 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 7.0% (range: 0.8% to 14.4%) (Figure L).

Data from National Job Training Program centers that submit gonorrhea specimens from female students aged 16 to 24 years to the national contract laboratory indicated a high prevalence of gonococcal infection in this population. Among women entering the program from 37 states, the District of Columbia, and Puerto Rico, the median state-specific gonorrhea prevalence was 2.7% (range: 0.0% to 5.0%) in 2008 (Figure M). Among men entering the program from 34 states, the District of Columbia, and Puerto Rico, the median state-specific gonorrhea prevalence was 0.8% (range: 0.0% to 2.8%) (Figure N).

Juvenile Corrections Facilities

Among adolescent women entering juvenile corrections facilities, the median facility-specific chlamydia positivity rate was 13.8% (range: 1.0% to 33.1%) and a median gonorrhea positivity rate of 3.6% (range: 0.0% to 19.0%). Among adolescent men entering juvenile corrections facilities, the median facility-specific chlamydia positivity rate was 6.1% (range: 0.6% to 13.6%) and the median gonorrhea positivity rate was 0.9% (range: 0.0% to 4.4%). See Special Focus Profiles (STDs in Persons Entering Corrections Facilities) for additional details.

* Laboratory data are provided by the Center for Disease Detection, San Antonio, Texas.

¹ Weinstock, H, Berman, S, Cates, W, Jr. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health, 2004:36(1):6–10.

² 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.

³ 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. Sex Transm Dis 2006;33(10):636–639.

⁴ Joesoef MR, Mosure DJ. Prevalence of chlamydia in young women entering the National Job Training Program 1998–2004. Sex Transm Dis 2006;33(9):571–575.