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 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 and Gonorrhea
Numerous prevalence studies in various clinic populations have shown that sexually active adolescents have high rates of chlamydia infection.2-4 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 overall prevalence declines. An example is the Region X Chlamydia Project, which has screened women in family planning clinics since 1988 (Figure
K).
After adjusting trends in chlamydia positivity to account for changes in laboratory test methods and associated increases in test sensitivity (see Appendix), in 15- to 19-year-old women chlamydia test positivity decreased in 2 of 10 HHS regions from 2003 through 2004, increased in 7 regions, and remained the same in 1 region (Figure
J).
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
17 and Table 20). Women aged 20-24 had the highest rates of primary and secondary syphilis in 2004, while among men, 35- to 39-year-olds had the highest rates of primary and secondary syphilis (Figure
34 and Table 33). Among men, 20- to 24-year-olds had the highest rate of gonorrhea (Figure
18 and Table 20).
In 15- to 19-year-old women, the 2004 gonorrhea rate of 610.9 cases per 100,000 females was a 12.7% decrease from the 2000 rate of 699.5. Among young women in the 20- to 24-year-old group, the rate of gonorrhea in 2004 decreased 8.4% from 621.0 in 2000 to 569.1 in 2004 (Figure
17, Table 20).
Rates of gonorrhea among male adolescents decreased between the years 2000 and
2004 (Figure 18, Table
20). Among 15- to 19-year-old males, the gonorrhea rate
declined by 21.1% from 320.6 in 2000 to 252.9 in 2004. Among 20- to 24-year-old
males, the gonorrhea rate declined by 22.3% from 554.1 in 2000 to 430.6 in
2004.
Primary and Secondary Syphilis
Syphilis rates in women are highest in the 20-24 year age group, 3.0 cases per 100,000 population. Rates among 15-19 year olds have decreased over time and remain low (Figure
34, Table 33).
In men, increases have been observed in 20- to 24-year-olds (Figure
35), but rates among 15-19 year olds are low and remain relatively unchanged (Figure
35, Table 33).
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.
Chlamydia infection is widespread geographically and highly prevalent among
economically-disadvantaged young women in the National Job Training Program.4 Among
women entering the program from 38 states and Puerto Rico in 2004, based on
their place of residence before program entry, the median state-specific chlamydia
prevalence was 9.7% (range 4.4% to 17.3%) (Figure
L). Among men entering the
program from 46 states, the District of Columbia, and Puerto Rico in 2004,
the median state-specific chlamydia prevalence was 7.3% (range 0.8% to 13%)
(Figure M).
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 33 states were tested by the contract laboratory; the median state-specific gonorrhea prevalence was 2.4% (range 0% to 6.4%) in 2004 (Figure
N). Among men entering the program from 8 states in 2004, the median state-specific gonorrhea prevalence was 3.7% (range 1% to 5.5%) (Figure
O).
Corrections Facilities
Among adolescent women attending juvenile corrections facilities, data from the Corrections STD Prevalence Monitoring Project identified a median chlamydia positivity of 14% (range 2.4% to 26.5%) (Table
AA) and a median gonorrhea positivity of 4.5% (range 0% to 16.6%) (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.
Adolescents
and Young Adults 1 
