STDs in Adolescents and Young Adults

Public Health Impact

Incidence and prevalence estimates suggest that young people aged 15–24 years acquire half of all new STDs¹ and that 1 in 4 sexually active adolescent females have an STD, such as chlamydia or human papillomavirus (HPV).² 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 chlamydia, adolescent females may have increased susceptibility to infection because of increased cervical ectopy. Cervical ectopy refers to columnar cells, which are typically located within the cervical canal, being located on the outer surface of the cervix. Although this is a normal finding in adolescent and young women, these cells are more susceptible infection. The higher prevalence of STDs among adolescents may also reflect multiple barriers to accessing quality STD prevention and management services, including inability to pay, lack of transportation, long waiting times, conflicts between clinic hours and work and school schedules, embarrassment attached to seeking STD services, method of specimen collection, and concerns about confidentiality.³

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.⁴ 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.^5,6 In addition, in designing STD programs, consideration should be given to the needs of adolescent and young adult populations including extended hours, optimizing privacy in waiting rooms, and urine based specimen collection.³

Observations

Chlamydia

In 2014, there were 948,102 reported cases of chlamydial infection among persons aged 15–24 years of age, representing 66% of all reported chlamydia cases. Among those aged 15–19 years, the rate of reported cases of chlamydia decreased 3.5% during 2013–2014 (1,869.7 to 1,804.0 per 100,000) (Table 10). Among those aged 20–24 years, the rate increased 2.3% during 2013–2014 (2,428.8.8 to 2,484.6 per 100,000) (Table 10).

Among women aged 15–24 years of age, the population targeted for chlamydia screening, the overall rate of reported cases of chlamydia was 3,309.4 per 100,000 females. Rates varied by state, with highest reported case rates in the South (Figure H).

15- to 19-Year Old Women — In 2014, the chlamydia case rate among women aged 15–19 years was 2,941.0 cases per 100,000 females, a 4.2% decrease from the 2013 rate of 3,068.4 cases per 100,000 females (Table 10). Decreases in rates of reported cases were largest among 15-, 16-, and 17- year old females (Table 12).

20- to 24-Year Old Women — In 2014, women aged 20–24 years had the highest rate of chlamydia (3,651.1 cases per 100,000 females) compared with any other age and sex group (Figure 5). The overall chlamydia case rate among women in this age group increased 1.6% during 2013–2014 (Table 10). However, increases in rates of reported cases were largest among 23- and 24-year old females (Table 12).

15- to 19-Year Old Men — During 2013-2014, the chlamydia case rate for men aged 15–19 years decreased 0.6% (722.9 to 718.3 cases per 100,000 males) (Table 10).

20- to 24-Year Old Men — In 2014, as in previous years, men aged 20–24 years had the highest rate of chlamydia among men (1,368.3 cases per 100,000 males). The chlamydia rate for men in this age group increased 4.4% during 2013–2014 (Table 10).

Gonorrhea

During 2013–2014, the rate of reported gonorrhea cases decreased 5.0% for persons aged 15–19 years and increased 2.8% for persons aged 20–24 years (Table 21). Among women aged 15–24 years, the overall rate was 484.0 per 100,000 females. Rates varied by state, with highest reported case rates in the South (Figure I).

15- to 19-Year Old Women — In 2014, women aged 15–19 years had the second highest rate of gonorrhea (430.5 cases per 100,000 females) compared with other females (Figure 17, Table 21). During 2013–2014, the gonorrhea rate for women in this age group decreased 7.0%.

20- to 24-Year Old Women — In 2014, women aged 20–24 years had the highest rate of gonorrhea (533.7 cases per 100,000 females) compared with any other age or sex group (Figure 17, Table 21). During 2013–2014, the gonorrhea rate for women in this age group decreased 0.7%.

15- to 19-Year Old Men — In 2014, the gonorrhea rate among men aged 15–19 years was 221.1 cases per 100,000 males (Figure 17, Table 21). During 2013–2014, the gonorrhea rate for men in this age group decreased 0.9%.

20- to 24-Year Old Men — In 2014, as in previous years, men aged 20–24 years had the highest rate of gonorrhea (485.6 cases per 100,000 males) compared with other males (Figure 17, Table 21). During 2013–2014, the gonorrhea rate for men in this age group increased 6.9%.

Primary and Secondary Syphilis

During 2013–2014, the rate of reported primary and secondary (P&S) syphilis cases increased 11.6% among persons aged 15–19 years and 13.1% among persons aged 20–24 years (Table 35).

15- to 19-Year Old Women — The rate of reported P&S syphilis cases among women aged 15–19 years decreased each year during 2009–2013 (from 3.3 cases to 1.9 cases per 100,000 females) (Figure 38, Table 35). However, during 2013–2014, the rate increased 31.6%, to 2.5 cases per 100,000 females.

20- to 24-Year Old Women — In 2014, women aged 20–24 years had the highest rate of P&S syphilis (4.5 cases per 100,000 females) compared with other female age groups (Figure 37, Table 35). During 2013–2014, the P&S syphilis rate for women in this age group increased 15.4%.

15- to 19-Year Old Men — In 2014, the P&S syphilis rate among men aged 15–19 years was 7.0 cases per 100,000 males (Figure 37). During 2013–2014, the P&S syphilis rate for men in this age group increased 7.7% (Figure 39, Table 35).

20- to 24-Year Old Men — In 2014, men aged 20–24 years had the second highest rate of P&S syphilis compared with any other age group for either sex (Figure 37). During 2013–2014, the P&S syphilis rate for men in this age group increased 13.5% (Figure 39, Table 35).

National Job Training Program

The National Job Training Program (NJTP) is an educational program for socioeconomically disadvantaged youth aged 16–24 years and is administered at more than 100 sites throughout the country. The NJTP screens participants for chlamydia and gonorrhea within two days of entry to the program. All of NJTP’s chlamydia screening tests and the majority of gonorrhea screening tests are conducted by a single national contract laboratory*, which provides these data to CDC. To increase the stability of the estimates, chlamydia or gonorrhea prevalence data are presented when valid test results for 100 or more students per year are available for the population subgroup and state. The 2014 data were not available for inclusion in this report. Additional information about NJTP can be found in Section A2.1 in the Appendix.

Among women entering the program in 40 states, the District of Columbia, and Puerto Rico, the median state- specific chlamydia prevalence in 2013 was 11.7% (range: 4.1% to 19.0%) (Figure J). Among men entering the program in 47 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 7.4% (range: 1.8% to 14.6%) (Figure K).

Among women entering the program in 39 states and Puerto Rico, the median state-specific gonorrhea prevalence in 2013 was 2.1% (range: 0.0% to 5.6%) (Figure L). Among men entering the program in 36 states and Puerto Rico, the median state-specific gonorrhea prevalence was 0.7% (range: 0.0% to 2.6%) (Figure M).

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

     

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1 Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40(3):187-93.

2 Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Datta SD, McQuillan GM, et al. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics. 2009;124(6):1505-12 doi: 10.1542/peds.2009-0674. Epub 2009 Nov 23.

3 Tilson EC, Sanchez V, Ford CL, Smurzynski M, Leone PA, Fox KK et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions, 2004. BMC Public Health 2004, (4):21.

4 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.

5 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. 2012;13(4):462-71.

6 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.

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