Compared to older adults, adolescents (10- to 19-year-olds) and
young adults (20- to 24-year-olds) are at higher risk for acquiring
STDs for a number of reasons. In addition, for some STDs, for example
Chlamydia trachomatis, adolescent women may have a physiologically
increased susceptibility to infection due to increased cervical
ectopy.
The higher prevalence of STDs among adolescents also reflects multiple
barriers to 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.
Observations
Numerous prevalence studies in various clinic populations
have shown that sexually active adolescents have high rates
of chlamydia infection.1-3 The Regional Infertility Prevention
Projects that routinely perform large scale screening for
detecting chlamydia infections among women attending family
planning clinics demonstrate that younger women consistently
have higher positivity than older women, even when prevalence
declines. An example is the Region X Chlamydia Project,
which has screened women in family planning clinics since
1988 (Figure L).
After adjusting trends in chlamydia positivity to account
for changes in laboratory test methods and associated increases
in test sensitivity (see Appendix),
for 15- to 19-year-old women chlamydia test positivity decreased
in 5 of 10 HHS
regions from 2002 through 2003, increased in 4 regions,
and remained the same in 1 region (Figure
K). Although chlamydia
positivity has declined in the past year in some regions
presumably due to the effectiveness of screening and treatment
of women, continued expansion of screening programs to populations
with higher prevalence of disease may have contributed to
increases in positivity in other regions.
As in previous years, 15- to 19-year-old women had the
highest rates of gonorrhea compared to women in all other
age categories (Figure S and Table 20). Women aged 20-29
had the highest rates of primary and secondary syphilis
in 2003 (Figure U and Table 33). Among men, 20- to 24-year-olds
had the highest rate of gonorrhea (Figure
T and Tables 20 and 33).
In 15- to 19-year-old women, the 2003 gonorrhea rate of
634.7 cases per 100,000 females was an 11.7% decrease from
the 1999 rate of 718.4. Among young women in the 20- to
24-year-old group, the rate of gonorrhea in 2003 decreased
only 3.3% from 615.6 in 1999 to 595.2 in 2003. Since 1999,
the rates in these two age groups have been converging (Figure
S, Table 20).
Rates of gonorrhea among male adolescents generally decreased
between the years 1991 and 2003 (Figure
T, Table
20). Among
15- to 19-year-old males, the gonorrhea rate declined by
21.0% from 332.2 in 1999 to 262.4 in 2003. Among 20- to
24-year-old males, the gonorrhea rate declined by 16.1%
from 555.5 in 1999 to 465.9 in 2003.
Since 1990, approximately 20,000 female National Job Training
Program entrants have been screened each year for chlamydia.
This program, administered by the U.S. Department of Labor
at more than 100 sites throughout the country, is a job
training program for economically-disadvantaged youth aged
16-24 years-old.
Chlamydia infection is widespread geographically and highly
prevalent among economically-disadvantaged young women in
the National Job Training Program.3Among women
entering the program from 39 states and Puerto Rico in 2003,
based on their place of residence before program entry,
the median state-specific chlamydia prevalence was 9.9%
(range 3.4% to 16.0%) (Figure M). Among men entering the
program from 38 states and Puerto Rico from July through
December 2003, the median state-specific chlamydia prevalence
was 7.8% (range 1.5% to 12.7%) (Figure
N).
Data from National Job Training Program centers that submit
gonorrhea specimens from female students aged 16-24 years
to a national contract laboratory indicates a high prevalence
of gonococcal infection in this population. Specimens from
at least 100 students from each of 34 states and Puerto
Rico were tested by the contract laboratory; the median
state-specific gonorrhea prevalence was 2.1% (range 0.0%
to 6.3%) in 2003 (Figure Q). Among men entering the program
from 10 states from July through December 2003, the median
state-specific gonorrhea prevalence was 2.8% (range 1.4%
to 6.3%) (Figure R).
The Adolescent Women Reproductive Health Monitoring Project
was established in 1999 to monitor STD prevalence and reproductive
health measures among adolescent women (less than 20 years
old) in non-traditional venues, including school-based clinics,
juvenile corrections facilities, drug treatment centers,
and organizations serving street youth. In 2003, urine-based
test results from this screening project identified a median
site-specific chlamydia positivity of 11.3% (range 6.7%
to 18.2%) (Figure O) and a median site-specific gonorrhea
positivity of 1.9% (range 0.6% to 3.7%) (Figure
P) at 25
school-based clinics.
Among adolescent women attending juvenile corrections
facilities, data from the Adolescent Women Reproductive
Health Monitoring Project and the Jail STD Prevalence Monitoring
Project identified a median chlamydia positivity of 15.9%
(range 2.7% to 33.5%) (Figure
JJ) and a median gonorrhea
positivity of 5.7% (range 0.5% to 15.9%) (Figure
LL). See
Special Focus Profiles (STDs
in Persons Entering Corrections Facilities).
Syphilis rates in women in all age groups are similar
and low (Figure U). In men rates in 15- to 19-year-olds
remain low but increases have been observed in 20- to 24-year-olds
(Figure V).
1 Centers for Disease Control and Prevention. Recommendations
for the prevention and management of Chlamydia trachomatis infections,
1993. MMWR 1993;42(No. RR-12).
2 Lossick J, DeLisle S, Fine D, Mosure DJ, Lee
V, Smith C. Regional program for widespread screening for Chlamydia
trachomatis in family planning clinics. In: Bowie WR, Caldwell HD,
Jones RP, et al., eds. Chlamydial Infections: Proceedings of the
Seventh International Symposium of Human Chlamydial Infections,
Cambridge, Cambridge University Press 1990, pp. 575-9.
3 Mertz, KJ, Ransom RL, St. Louis ME, Groseclose
SL, Hadgu A, Levine WC, Hayman C. Decline in the prevalence of genital
chlamydia infection in young women entering a National Job Training
Program, 1990-1997. Am J Pub Health 2001;91(8):1287-1290.