STDs in Adolescents and Young Adults

Public Health Impact

Compared with older adults, sexually active adolescents aged 15–19 years and young adults aged 20–24 years are at higher risk of acquiring STDs for a combination of behavioral, biological, and cultural reasons. For some STDs, such as C. trachomatis, adolescent females may have a physiologically increased susceptibility to infection because of increased cervical ectopy. The higher prevalence of STDs among adolescents also may 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 even though young people aged 15–24 years represent only 25% of the sexually experienced population, they acquire nearly half of all new STDs.¹

Observations

Chlamydia

Chlamydia rates for persons aged 15–19 years and 20–24 years continue to increase. During 2008–2009, the increase was 2.4% for those aged 15–19 years and 4.0% for those aged 20–24 years (Table 10).

15- to 19-Year-Old Women—In 2009, as in previous years, women aged 15–19 years had the highest rate of chlamydia compared with any other age or sex group (Figure 5, Table 10). Chlamydia rates for women in this age group increased 1.8%, from 3,269.5 cases per 100,000 population in 2008 to 3,329.3 cases in 2009.

20- to 24-Year-Old Women—In 2009, as in previous years, women aged 20–24 years had the second highest rate of chlamydia (3,273.9 cases per 100,000 population) compared with any other age or sex group. Chlamydia rates for women in this age group increased 3.3% during 2008–2009.

15- to 19-Year-Old Men—Chlamydia rates for men aged 15–19 years increased 5.0%, from 700.3 cases per 100,000 population in 2008 to 735.5 cases in 2009.

20- to 24-Year-Old Men—In 2009, as in previous years, men aged 20–24 years had the highest rate of chlamydia (1,120.6 cases per 100,000 population). Chlamydia rates for men in this age group increased 6.0% during 2008–2009.

Gonorrhea

In 2009, gonorrhea rates for persons aged 15–19 years and 20–24 years decreased for the second year in a row. During 2008–2009, the gonorrhea rate decreased 10.3% for those aged 15–19 years and decreased 7.4% for those aged 20–24 years (Table 20).

15- to 19-Year-Old Women—In 2009, as in previous years, women aged 15–19 years had the highest rate of gonorrhea (568.8 cases per 100,000 population) compared with any other age or sex group (Figure 20, Table 20). During 2008–2009, gonorrhea rates for women of this age group decreased 10.5%.

20- to 24-Year-Old Women—In 2009, as in previous years, women aged 20–24 years had the second highest rate of gonorrhea (555.3 cases per 100,000 population) compared with any other age or sex group. During 2008–2009, gonorrhea rates for women in this age group decreased 8.5%.

15- to 19-Year-Old Men—In 2009, as in previous years, men aged 15–19 years had the second highest rate of gonorrhea (250.0 cases per 100,000 population). During 2008–2009, gonorrhea rates for men in this age group decreased 10.0% (Figure 21, Table 20).

20- to 24-Year-Old Men—In 2009, as in previous years, men aged 20–24 years had the highest rate of gonorrhea (407.5 cases per 100,000 population). During 2008–2009, gonorrhea rates for men in this age group declined 6.1%.

Primary and Secondary Syphilis

Syphilis rates among women aged 15–19 years have increased annually since 2004, from 1.5 cases per 100,000 population to 3.3 in 2009. Rates in women have been highest each year among those aged 20–24 years, with 5.6 cases per 100,000 population in 2009 (Figures 38 and 39, Table 33).

Rates among men aged 15–19 years are much lower than the rates among men in older age groups (Figure 38). However, rates in this group have increased since 2002, from 1.3 cases per 100,000 population to 6.0 cases in 2009. Men aged 20–24 years had the highest rate of syphilis (20.7 cases per 100,000 population) in 2009 (Figure 38, Table 33).

Prevalence Monitoring

Chlamydia test positivity among women aged 15–19 years screened in family planning clinics fluctuated in all 10 HHS regions during 2005–2009 (Figure J). In 2009, positivity ranged from 5.8% in Region I to 13.2% in Region VI. Test positivity data 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 about 20,000 female NJTP entrants have been screened each year for chlamydia. Since 2004, about 35,000 male entrants have been screened annually. This educational program for socioeconomically disadvantaged youth aged 16–24 years is administered at more than 100 sites throughout the country. The data presented are from sites where more than 100 persons were screened in 2009.

Chlamydial infection is widespread geographically and highly prevalent among socioeconomically disadvantaged young women and men entering the NJTP.² Specimens from students in each state and outlying area were tested by a single national contract laboratory.*

Among women entering the program in 43 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 11.3% (range: 4.2% to 19.0%) (Figure K).

Among men entering the program in 48 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 7.0% (range: 2.4% to 11.7%) (Figure L).

The data from NJTP centers that submit gonorrhea specimens from female students aged 16–24 years to the national contract laboratory indicated a high prevalence of gonococcal infection in this population. Among women entering the program in 41 states, the District of Columbia, and Puerto Rico, the median state-specific gonorrhea prevalence in 2009 was 1.6% (range: 0.0% to 5.0%) (Figure M). Among men entering the program in 33 states, the District of Columbia, and Puerto Rico, the median state-specific gonorrhea prevalence was 0.6% (range: 0.0% to 3.4%) (Figure N).

Juvenile Corrections Facilities

Among adolescent females entering juvenile corrections facilities, the median facility-specific chlamydia positivity was 14.4% (range: 1.8% to 35.7%); the median gonorrhea positivity was 2.9% (range: 0.0% to 13.4%). Among adolescent males entering juvenile corrections facilities, the median facility-specific chlamydia positivity was 6.0% (range: 0.0% to 19.4%); the median gonorrhea positivity rate was 0.7% (range: 0.0% to 6.5%). See the STDs in Persons Entering Corrections Facilities section for more 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 Satterwhite CL, Tian LH, Braxton J, Weinstock H. Chlamydia prevalence among women and men entering the National Job Training Program: United States, 2003–2007. Sex Transm Dis. 2010;37(2):63-7.