Sexually Transmitted Infections

Mary-Ann Shafer, Anna-Barbara Moscicki

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Sexually Transmitted Infections
Currently, more adolescents are engaging in sexual intercourse than 15 years ago: 50% have experienced their sexual debut by age 16 and 75% by 19 years of age. An increase in the prevalence of reported sexually transmitted infections (STIs) has accompanied a changing pattern of adolescent sexual activity.

The STDs are epidemic among teenagers, who represent 3 million STI cases reported annually in the United States. The STDs place our youth at risk for pelvic inflammatory disease and associated sequelae of ectopic pregnancy and infertility, genital cancers, and even death through complications of STIs, especially HIV infection. Therefore, pediatricians must be able to recognize symptomatic STIs; screen and treat STIs, both symptomatic and asymptomatic; and prevent STIs among youth.

Prevalence
Commonly reported prevalences of STIs among sexually active adolescent girls both with and without lower genital tract symptoms include Chlamydia trachomatis (10 to 25%), Neisseria gonorrhoeae (3 to 18%), syphilis (0 to 3%), Trichomonas vaginalis (8 to 16%), and herpes simplex virus (2 to 12%). Among adolescent boys with no symptoms of urethritis, isolation rates include C. trachomatis (9 to 11%) and N. gonorrhoeae (2 to 3%).

By use of molecular genetic techniques, human papillomavirus (HPV) DNA has been detected in 20 to 60% of female adolescents. The increasing rate of SIL among young women is an indicator of the impact of STIs on young women. The highest incidence of LSIL occurs in women aged 15 to 19 years.

Although adolescents currently represent fewer than 1% of reported cases of acquired immunodeficiency syndrome (AIDS) in the United States, the number of cases among ages 20 to 24 is tenfold greater. Because of the long latency period of the disease (2 to 7 years or more), it is probable that many young adults with AIDS acquired their HIV infections during adolescence. The HIV seropositivity data available from screening programs show a rate of < 1/1000 for military recruits, 3.6/1000 for Job Corps applicants, and 50/1000 for runaway youth. The greatest increase in new AIDS cases is among heterosexuals, including adolescents.

Age, Gender, Ethnicity
Gonorrhea rates, used as a measurable indicator of STD risk, continue to show that adolescents have the highest rate of reportable STIs relative to sexual activity. From individual studies and sentinel centers, it is obvious that adolescents have the highest rate of chlamydial infections, with females having the associated morbidities of pelvic inflammatory disease (PID) and ectopic pregnancy. Gender is an important factor in the epidemiology of STIs because both the rates of infection and sequelae are disproportionately higher among females compared to males. In 1997, among 15- to 19- year-olds, the female:male ratio for chlamydia was 7.7, for gonorrhea 2.0, and for primary and secondary syphilis 2.2. During the same year the ratios of gonorrhea for African-American, Native American, Hispanic and white youth were 25:3:2:1. The ratios for primary and secondary syphilis among these same groups were 40:10:4:1, and for chlamydia the ratios were 7:4:2:1.

Trends in rates of gonorrhea among youth show a decrease over the past 10 years. Between 1990 and 1997, the gonorrhea rate has decreased about 46% among youth. However, rates from 1994 to 1997 show little to no change among 15- to 19-year-old Native Americans and Hispanic males and small increases in Native American and Hispanic females. It is important to note that the relationships between the ethnicity and STIs including AIDS have been confounded by socioeconomic factors. In addition to age, gender, and ethnicity, a number of important biological and behavioral factors may help to explain these epidemic rates of STIs among adolescents.

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Provided by ArmMed Media
Revision date: July 3, 2011
Last revised: by Janet A. Staessen, MD, PhD