STD Quarterly
New report: U.S. failing to stem spread of sexually transmitted diseases among adolescents
1 of 2 sexually active youth will contract an STD by age 25
Teens may be up to speed when it comes to movies, music, and sports, but when it comes to knowledge of prevention and treatment of sexually transmitted diseases (STDs), they are falling behind, a new national report reveals.1
The report, issued by the Research Triangle Park, NC-based American Social Health Association (ASHA), highlights the challenges in preventing the spread of sexual infections among young Americans. (Review the report at the ASHA web site, www.ashastd.org. Click on "Challenges Facing STD Prevention in Youth.")
One of every two sexually active youth in the United States will contract an STD by age 25,2 says James Allen, MD, MPH, ASHA president and chief executive officer. Most adolescents and young adults are not aware of this high risk, however, or they are not aware of the barriers to obtaining the information and services they need to make informed decisions to reduce or eliminate their risk, he states.
While the high prevalence of STDs among adolescents has been acknowledged in parts of the health care community, the public has a limited understanding of the growing epidemic as well as the challenges to mounting effective prevention programs, says Allen. The report is aimed at examining public health strategies that can aid in bringing the problem under control, he notes.
Public health approaches such as STD testing are not being used to their full potential, the new report states. Chlamydia is a case in point. While it has the highest prevalence among youth, and routine screening for chlamydial infection in young women has been demonstrated to work in reducing infection rates and lowering its cost to society, such screening is frequently overlooked, says Allen.
The need for routine screening for young women younger than age 25 is spelled out in recent guidelines issued by the American Medical Association, the American Academy of Pediatrics, the American College of Preventive Medicine, the Centers for Disease Control and Prevention (CDC), and the U.S. Preventive Services Task Force.
Chlamydia screening of sexually active women ages 15-25 is now one of the performance measures included in the National Committee for Quality Assurance’s Health Plan Employer Data and Information Set (HEDIS). The measure was added in 2000. Despite the implementation of the HEDIS screening measure, less than half of young sexually active females are screened annually for chlamydia.3
Sharpen your skill set
Are routine STD screenings part of your facility’s standard treatment for adolescents? If they are not, consider this fact: Results from a 2004 survey conducted on ASHA’s teen web site (www.iwannaknow.org) show that many teens believe that they are being tested for STDs when receiving routine medical checkups.1
Is your facility using the latest laboratory technology in detecting STD infections? Newer nucleic acid amplification tests (NAATs) are available commercially for chlamydia and gonorrhea and are the test of choice, says Charlotte Gaydos, DrPH, associate professor of infectious diseases at Johns Hopkins University in Baltimore. Older tests are much less sensitive and find only 60%-70% of infections, whereas the newer NAATs yield sensitivities of greater that 90%; thus, they detect many more infections accurately, she notes.
Check your facility’s guidelines on age-based STD screening. The CDC recommends screening all sexually active women younger than 25 for Chlamydia, because the infection is most often asymptomatic,4 says Gaydos. Although there are no official recommendations for males, the same recommendations seem prudent if males indicate they are sexually active, she states. Statistics point to "yes" the most recent Youth Risk Behavior Survey conducted by the CDC indicates that 37% of ninth graders are sexually active, with the number increasing to 60% by 12th grade,5 says Gaydos.
Be sure to include rescreening in your STD care, as adolescents change partners frequently, she urges. Adolescents who have had a chlamydia infection are at increased risk to have another infection.6 The CDC recommends rescreening women who have been found to be chlamydia-positive at three to four months after treatment to make sure they are not reinfected from an untreated partner or a new partner,4 says Gaydos.
"Use of urine and vaginal swab specimens make rescreening relatively easy, but they must be tested with the newer molecular amplification tests called NAATs," she states. "Additional care of adolescents include advocating use of condoms if the teens are sexually active and recommending limiting the number of partners."
Many barriers exist for adolescents and young adults who seek medical care for a concern about sexually transmitted infections, says Allen. When an adolescent comes into an exam room, it is critical that providers facilitate communication, including asking questions in a nonjudgmental and culturally appropriate way about sexual activity, states Allen. This includes questions about oral and anal sex, which many adolescents may not consider to be "sex."
It is also important for the provider to take the opportunity to recommend appropriate testing for sexually transmitted infections, even in the absence of signs or symptoms, and to provide counseling and prevention information, states Allen.
According to the ASHA report, political wrangling over school-based educational programs has overshadowed other key pieces of the teen STD prevention puzzle, such as removing barriers to health care for adolescents and ensuring compliance with current medical recommendations for testing and counseling. A multipronged approach may work best in addressing the problem, the report states.
"While national attention is focused on the debate over sex education, ASHA recognizes that controlling STDs in youth requires many answers — not one," states Allen.
References
- American Social Health Association (ASHA). State of the Nation 2005: Challenges Facing STD Prevention Among Youth — Research, Review, and Recommendations. Research Triangle Park, NC; 2005.
- Weinstock H, Berman S, Cates Jr. W. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6-10.
- Shih S, Scholle S, Irwin K, et al. 2004. Chlamydia screening among sexually active young female enrollees of health plans — United States, 1999-2001. MMWR 2004; 53:983-985.
- Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines — 2002. MMWR 2002; 51(RR06);1-80.
- Centers for Disease Control and Prevention. Youth risk behavior surveillance — United States, 2003. MMWR Surveillance Summaries 2004; 53(SS-2):1-96.
- Xu F, Schillinger JA, Markowitz LE, et al. Repeat Chlamydia trachomatis infection in women: Analysis through a surveillance case registry in Washington State, 1993-1998. Am J Epidemiol 2000; 152:1,164-1,170.
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