STDs in Adolescents and Young Adults

Public Health Impact

Estimates suggest that young people aged 15–24 years acquire nearly half of all new STDs.¹ 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 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 health insurance or ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality. Traditionally, intervention efforts have targeted individual-level factors associated with STD risk which do not address higher-level factors (e.g., peer norms and media influences) that may also influence behaviors.² Interventions for at-risk adolescents and young adults that address underlying aspects of the social and cultural conditions that affect sexual risk-taking behaviors are needed, as are strategies designed to improve the underlying social conditions themselves.^3,4

Observations

Chlamydia

Rates of reported chlamydial infection among persons aged 15–19 years and 20–24 years continue to increase. During 2010–2011, rates increased 4.0% for those aged 15–19 years and 11.0% for those aged 20–24 years (Table 10).

15- to 19-Year-Old Women—In 2011, the rate among women aged 15–19 years was 3,416.5 cases per 100,000 females, a 3.5% increase from the 2010 rate of 3,299.5 cases per 100,000 (Figure 5, Table 10).

20- to 24-Year-Old Women—In 2011, women aged 20–24 years had the highest rate of chlamydia (3,722.5 cases per 100,000 females) compared with any other age and sex group. Chlamydia rates for women in this age group increased 10.5% during 2010–2011.

15- to 19-Year-Old Men—Chlamydia rates for men aged 15–19 years increased 6.1% from 757.0 cases per 100,000 males in 2010 to 803.0 cases per 100,000 in 2011.

20- to 24-Year-Old Men—In 2011, as in previous years, men aged 20–24 years had the highest rate of chlamydia (1,343.3 cases per 100,000 males). Chlamydia rates for men in this age group increased 12.4% during 2010–2011.

Gonorrhea

During 2010–2011, gonorrhea rates remained essentially unchanged for persons aged 15–19 years (decreased 0.1%) and increased for persons aged 20–24 years (5.8%).

15- to 19-Year-Old Women—In 2011, women aged 15–19 years had the second highest rate of gonorrhea (556.5 cases per 100,000 females) compared with any other age or sex group (Figure 21, Table 21). During 2010–2011, the gonorrhea rate for women in this age group decreased 0.2%.

20- to 24-Year-Old Women—In 2011, women aged 20–24 years had the highest rate of gonorrhea (584.2 cases per 100,000 females) compared with any other age or sex group (Figure 21, Table 21). During 2010–2011, the gonorrhea rate for women in this age group increased 5.4%.

15- to 19-Year-Old Men—In 2011, the gonorrhea rate among men aged 15–19 years was 248.6 cases per 100,000 males (Figure 21, Table 21). During 2010–2011, the gonorrhea rate for men in this age group increased 0.4%.

20- to 24-Year-Old Men—In 2011, as in previous years, men aged 20–24 years had the highest rate of gonorrhea (450.6 cases per 100,000 males) compared with other males (Figure 21, Table 21). During 2010–2011, the gonorrhea rate for men in this age group increased 6.2%.

Primary and Secondary Syphilis

Syphilis rates among women aged 15–19 years increased annually during 2004–2009, from 1.5 cases per 100,000 females to 3.3 cases in 2009, but decreased to 2.9 cases in 2010 and 2.4 cases in 2011.

Rates in women have been highest each year among those aged 20–24 years with 3.8 cases per 100,000 females in 2011 (Figures 42 and 43, Table 34).

Rates among men aged 15–19 years are much lower than the rates among men in older age groups (Figures 42 and 44, Table 34). Rates in this group increased during 2002–2009 (from 1.3 cases per 100,000 males to 6.0 cases in 2009), but decreased to 5.5 cases in 2010 and 5.4 cases in 2011. However, rates among men aged 20–24 years have increased each consecutive year since 2002, from 5.2 cases per 100,000 males to 23.4 cases in 2011. Not only have men aged 20–24 years seen large increases in rates, they also have had the highest rate of P&S syphilis among men of any age group since 2008 (Table 34). These changes reflect a shift in the age distribution of P&S syphilis; rates were highest among men aged 35–39 years during 2002–2006.

Positivity in Selected Populations

In 2011, the median state-specific chlamydia test positivity among women aged 15–19 years who were tested during visits to selected family planning clinics in all 50 states, Puerto Rico, and the Virgin Islands was 9.8% (range: 3.4% to 19.1%). Chlamydia test positivity among women aged 15–19 years screened in selected family planning clinics increased in most HHS regions during 2007–2011 (Figure J). Test positivity data presented in Figure J are not adjusted for changes in laboratory test methods and associated increases in test sensitivity.

Among adolescent females entering selected juvenile corrections facilities, the median facility-specific chlamydia positivity was 13.5% (range: 3.7% to 27.7%); the median gonorrhea positivity was 3.4% (range: 0.0% to 9.6%). Among adolescent males entering selected juvenile corrections facilities, the median facility-specific chlamydia positivity was 6.3% (range: 0.4 to 19.1%); the median gonorrhea positivity was 0.7% (range: 0.0% to 6.0%) (Figures BB and DD). See the STDs in Persons Entering Corrections Facilities section for more details.

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 2011.

Chlamydial infection is widespread geographically and highly prevalent among socioeconomically disadvantaged young women and men entering the NJTP.⁵ Specimens from students in each state and outlying area were tested by a single national contract laboratory.*

Among women entering the program in 46 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 10.3% (range: 4.1% to 18.7%) (Figure K). Among men entering the program in 48 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 8.0% (range: 2.7% to 13.0%) (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 44 states and Puerto Rico, the median state-specific gonorrhea prevalence in 2011 was 1.0% (range: 0.0% to 4.9%) (Figure M). Among men entering the program in 38 states and Puerto Rico, the median state-specific gonorrhea prevalence was 0.9% (range: 0.0% to 2.6%) (Figure N).

* Laboratory data are provided by the Center for Disease Detection, LLC 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 DiClemente RJ, Salazar LF, Crosby RA. A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach. J. Pediatr. Psychol. 2007;32 (8): 888-906.

3 Sieving RE, Bernat DH, Resnick MD, Oliphant J, Pettingell S, Plowman S, et al. A clinic-based youth development program to reduce sexual risk behaviors among adolescent girls: prime time pilot study. Health Promot Pract (online). May 23, 2011.

4 Upchurch DM, Mason W, Kusunoki Y, Kriechbaum MJ. Social and behavioral determinants of self-reported STD among adolescents. Perspect Sex Reprod Health. 2004;36(6):276-287.

5 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.