Public Health Impact

Compared to older adults, sexually active adolescents (10- to 19-year-olds) and young adults (20- to 24-year-olds) are at higher risk for acquiring STDs for a combination of behavioral, biological, and cultural reasons. 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 accessing 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. Recent estimates suggest that while representing 25% of the ever sexually active population, 15- to 24-year olds acquire nearly one-half of all new STDs.¹

Observations

Chlamydia

Numerous prevalence studies in various clinic populations have shown that sexually active adolescents have high rates of chlamydia infection.^2,3 The Regional Infertility Prevention Projects (IPP) provide routine screening for detecting chlamydia infections among women attending family planning clinics. IPP prevalence data demonstrate that younger women consistently have higher positivity than older women, even when overall prevalence declines.

After adjusting trends in chlamydia positivity to account for changes in laboratory test methods and associated increases in test sensitivity (see Appendix), chlamydia test positivity in 15- to 19-year-old women decreased in 5 of 10 HHS regions between 2004 and 2005, increased in four regions, and remained the same in one region (Figure J).

Gonorrhea

As in previous years, 15- to 19-year-old women had the highest rate of gonorrhea (624.7 per 100,000 population) compared to women in all other age categories (Figure 18 and Table 19). Among men, 20-to 24-year-olds had the highest rate of gonorrhea (436.8 per 100,000 population, Figure 18 and Table 19).

Gonorrhea rates among 15- to 19-year-old women and 15- to 19-year-old men had been decreasing in recent years, but in 2005 gonorrhea rates showed slight increases in both groups (Figures 19 and 20, Table 19).

Similarly, gonorrhea rates among 20- to 24-year-old women and 20- to 24-year-old men had been decreasing in recent years, but in 2005 the gonorrhea rates in both groups increased slightly (Figures 19 and 20, Table 19).

Primary and Secondary Syphilis

Syphilis rates in women are highest in the 20-24 year age group, 3.0 cases per 100,000 population in 2005. Rates among 15-19 year olds have decreased each year from 2.5 cases per 100,000 population in 2001 to 1.5 in 2004, but increased to 1.9 in 2005 (Figure 34, Table 31).

In men, rates among 20- to 24-year-olds increased each year from 4.8 cases per 100,000 population in 2001 to 8.1 in 2005 (Table 31). Rates among 15-19 year olds had been low but increased to 2.4 in 2005 (Table 31).

National Job Training Program

Since 1990, approximately 20,000 female National Job Training Program entrants have been screened each year for chlamydia. This program, administered by the National Job Training Program at more than 100 sites throughout the country, is a job training program for economically-disadvantaged youth aged 16-24 years-old.

Chlamydial infection is widespread geographically and highly prevalent among economically-disadvantaged young women and men in the National Job Training Program.4-6 Specimens from at least 100 students from each state and outlying area were tested by a national contract laboratory. Among women entering the program from 39 states, District of Columbia, and Puerto Rico in 2005, based on their place of residence before program entry, the median state-specific chlamydia prevalence was 9.2% (range 3.1% to 14.5%) (Figure K). Among men entering the program from 48 states, the District of Columbia, and Puerto Rico in 2005, the median state-specific chlamydia prevalence was 8.1% (range 0.0% to 14.8%) (Figure L).

Data from National Job Training Program centers that submit gonorrhea specimens from female students aged 16-24 years to a national contract laboratory indicated a high prevalence of gonococcal infection in this population. Specimens from at least 100 students from each state and outlying areas were tested by the contract laboratory. Among women entering the program from 32 states and District of Columbia the median state-specific gonorrhea prevalence was 2.4% (range 0.0% to 6.6%) in 2005 (Figure M). Among men entering the program from 14 states in 2005, the median state-specific gonorrhea prevalence was 2.2% (range 0.0% to 6.1%) (Figure N).

Juvenile Corrections Facilities

Among adolescent women attending juvenile corrections facilities, data from the Corrections STD Prevalence Monitoring Project identified a median chlamydia positivity of 14.2% (range 3.7% to 33.7%) (Table AA) and a median gonorrhea positivity of 4.7% (range 0.9% to 14.2%) (Table CC). See Special Focus Profiles (STDs in Persons Entering Corrections Facilities).

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 Centers for Disease Control and Prevention. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR 1993;42(No. RR-12).

³ 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.

⁴ 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.

⁵ Joesoef MR, Mosure DJ. Prevalence of chlamydia in young men in the United States from newly implemented universal screening in a National Job Training Program. Sexually Transmitted Diseases 2006;33(10):636-639.

⁶ Joesoef MR, Mosure DJ. Prevalence of chlamydia in young women entering the National Job Training Program 1998–2004. Sexually Transmitted Diseases 2006;33(9):571-575.