STDs in Adolescents and Young Adults

Public Health Impact

Compared to older adults, sexually-active adolescents 15 to 19 years of age and young adults 20 to 24 years of age 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 half of all new STDs.¹

Observations

Chlamydia

Chlamydia rates for persons 15 to 19 and 20 to 24 years of age continue to increase as they have for all age groups. Between 2006 and 2007, the increase for those 15 to 19 years of age was 7.7%, and for those 20 to 24 years of age was 6.6% (Table 10).

15- to 19-Year-Old Women – As in previous years, in 2007 15- to 19-year-old women had the highest rate of chlamydia (3,004.7  per 100,000 population) compared to any other age/sex group (Figure 5 and Table 10). Chlamydia rates for 15- to 19-year-old women increased 6.4% from 2,824 per 100,000 population in 2006 to 3,004.7 per 100,000 population in 2007.

20- to 24-Year-Old Women – In 2007, as in previous years, 20- to 24-year-old women had the second highest rate of chlamydia (2,948.8 per 100,000 population) compared to any other age/sex group. Chlamydia rates in women of this age group increased 5.6% from 2006 to 2007.

15- to 19-Year-Old Men – Chlamydia rates for 15- to 19-year-old men increased 14.3% from 537.9 per 100,000 population in 2006 to 615.0 per 100,000 population in 2007.

20- to 24-Year-Old Men – As in previous years, in 2007, 20- to 24-year old men had the highest rate of chlamydia among men (932.9 per 100,000 population). Chlamydia rates in men of this age group increased 9.4% from 2006 to 2007.

Gonorrhea

For the third consecutive year, gonorrhea rates for persons 15 to 19 and 20 to 24 years of age increased. Between 2006 and 2007, the increase for those 15 to 19 years of age was 2.1%, and for those 20 to 24 years of age was 0.7% (Table 20).

15- to 19-Year-Old Women – As in previous years, in 2007 15- to 19-year-old women had the highest rate of gonorrhea (647.9 per 100,000 population) compared to any other age/sex group (Figure 19 and Table 20). Gonorrhea rates in women of this age group have increased for the past three years.

20- to 24-Year-Old Women – In 2007, as in previous years, 20- to 24-year-old women had the second highest rate of gonorrhea (614.5 per 100,000 population) compared to any other age/sex group. Gonorrhea rates in women of this age group have also increased for the past three years.

15- to 19-Year-Old Men – Gonorrhea rates for 15- to 19-year-old men increased 3.8% from 275.4 per 100,000 population in 2006 to 286.0 per 100,000 population in 2007. Gonorrhea rates in men of this age group have increased for the past three years. (Figure 20, Table 20).

20- to 24-Year-Old Men – As in previous years, in 2007, 20- to 24-year old men had the highest rate of gonorrhea among men (450.1 per 100,000 population). Gonorrhea rates in men of this age group declined 0.4% from 2006 to 2007.

Primary and Secondary Syphilis

Syphilis rates among 15- to 19-year old women have increased annually since 2004 from 1.5 cases per 100,000 population to 2.4 per 100,000 population in 2007. Rates in women have been the highest each year in the 20 to 24 year age group. In this age group there were 3.5 cases per 100,000 population in 2007 (Figure 33, Table 32). Syphilis rates for women in these younger age groups are comparable to rates in older age groups.

In contrast, in men, rates among 15- to 19-years olds are much lower than those in men in older age groups. However, these rates have increased since 2002 from 1.3 cases per 100,000 population in 2002 to 3.0 in 2006 and 3.8 in 2007. During 2003 to 2006, rates in men had been the highest each year in the 35 to 39 year old age group. In 2007, rates in men were highest in the 25 to 29 year old age group, with 14.9 cases per 100,000 population, and 14.4 cases per 100,000 population in the 35 to 39 year old age group (Figure 33, Table 32).

Chlamydia Prevalence Monitoring Project

Chlamydia test positivity among 15- to 19-year-old women screened in family planning clinics fluctuated in all 10 HHS regions between 2003 and 2007 (Figure J). Positivity has remained fairly stable in four regions (I, III, V, X). From 2003 to 2006, slight decreases in positivity occurred in one region (II), followed by a small increase in 2007. In the remaining five regions (IV, VI, VII, VIII, IX), positivity rates increased slightly over the five-year time frame from 2003 to 2007. The positivity rates presented in Figure J are not adjusted for changes in laboratory test methods and associated increases in test sensitivity.

National Job Training Program

Since 1990, approximately 20,000 female National Job Training Program entrants have been screened each year for chlamydia. Since 2004, approximately 35,000 male entrants have been screened annually. This program, administered by the National Job Training Program at more than 100 sites throughout the country, is a job training program for socioeconomically-disadvantaged youth aged 16 to 24 years of age.

Chlamydial infection is widespread geographically and highly prevalent among socioeconomically-disadvantaged young women and men entering the National Job Training Program.^2-4 Specimens from at least 100 students from each state and outlying area were tested by a single national contract laboratory.^* Among women entering the program from 40 states, the District of Columbia, and Puerto Rico in 2007, based on their place of residence before program entry, the median state-specific chlamydia prevalence was 13.2% (range: 3.8% to 23.5%) (Figure K). Among men entering the program from 47 states, the District of Columbia, and Puerto Rico in 2007, the median state-specific chlamydia prevalence was 7.2% (range: 2.0% to 14.5%) (Figure L).

Data from National Job Training Program centers that submit gonorrhea specimens from female students aged 16 to 24 years to the national contract laboratory indicated a high prevalence of gonococcal infection in this population. Specimens from at least 100 students from each state and outlying area were tested by the contract laboratory. Among women entering the program from 36 states and Puerto Rico, the median state-specific gonorrhea prevalence was 3.0% (range: 0.0% to 7.2%) in 2007 (Figure M). Among men entering the program from 32 states and Puerto Rico in 2007, the median state-specific gonorrhea prevalence was 1.1% (range: 0.0% to 4.4%) (Figure N).

Juvenile Corrections Facilities

Among adolescent women entering juvenile corrections facilities, the Corrections STD Prevalence Monitoring Project identified a median facility-specific chlamydia positivity rate of 14.3% (range: 2.5% to 32.1%) (Table A) and a median gonorrhea positivity rate of 5.3% (range: 0.0% to 13.9%) (Table C). Among adolescent men entering juvenile corrections facilities, the median facility-specific chlamydia positivity rate was 5.7% (range: 0.0% to 14.2%) and the median gonorrhea positivity rate was 1.0% (range: 0.0% to 4.5%). See Special Focus Profiles (STDs in Persons Entering Corrections Facilities) for additional details.

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

 

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 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.

³ 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.

⁴ 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.