STDs in Adolescents and Young Adults

Public Health Impact

Prevalence estimates suggest that young people aged 15–24 years acquire half of all new STDs¹ and that 1 in 4 sexually active adolescent females have an STD, such as chlamydia or human papillomavirus (HPV).² Compared with older adults, sexually active adolescents aged 15–19 years and young adults aged 20–24 years are at higher risk of acquiring STDs for a combination of behavioral, biological, and cultural reasons. For some STDs, such as chlamydia, adolescent females may have increased susceptibility to infection because of increased cervical ectopy. The higher prevalence of STDs among adolescents also may reflect multiple barriers to accessing quality STD prevention services, including lack of health insurance or ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality. Traditionally, intervention efforts have targeted individual-level factors associated with STD risk which do not address higher-level factors (e.g., peer norms and media influences) that may also influence behaviors.³ Interventions for at-risk adolescents and young adults that address underlying aspects of the social and cultural conditions that affect sexual risk-taking behaviors are needed, as are strategies designed to improve the underlying social conditions themselves.^4,5

Observations

Chlamydia

In 2012, 1,002,692 cases of chlamydial infection were reported among persons under 25 years of age, representing 70% of all reported chlamydia cases. Rates of reported chlamydial infection are highest among persons aged 15–19 years and 20–24 years (Figure 5). From 2008–2011, rates increased steadily among those aged 15–19 years (1,947.7 to 2,120.8 cases per 100,000 population) and then decreased 5.6% during 2011–2012 (2,120.8 to 2,001.7 cases per 100,000 population) (Table 10). Among those aged 20–24 years, rates increased 18.1% during 2008–2011 (2,075.9 to 2,450.8 cases per 100,000) and increased slightly (2.1%) during 2011–2012 (2,450.8 to 2,501.5 cases per 100,000) (Table 10).

15- to 19-Year-Old Women—In 2012, the rate among women aged 15–19 years was 3,291.5 cases per 100,000 females, a 5.6% decrease from the 2011 rate of 3,485.2 cases per 100,000 females (Figure 5, Table 10). This is the first time that chlamydia rates among 15–19 year old females have decreased since 2000.

20- to 24-Year-Old Women—In 2012, women aged 20–24 years had the highest rate of chlamydia (3,695.5 cases per 100,000 females) compared with any other age and sex group (Figure 5). Chlamydia rates for women in this age group increased slightly (1.8%) during 2011–2012 (Figure 5, Table 10).

15- to 19-Year-Old Men—Chlamydia rates for men aged 15–19 years decreased 5.1% from 816.3 cases per 100,000 males in 2011 to 774.8 cases per 100,000 males in 2012 (Figure 5, Table 10). This is the first time that chlamydia rates among 15–19 year old males have decreased.

20- to 24-Year-Old Men—In 2012, as in previous years, men aged 20–24 years had the highest rate of chlamydia among men (1,350.4 cases per 100,000 males). Chlamydia rates for men in this age group increased 3.3% during 2011–2012 (Figure 5, Table 10).

Gonorrhea

During 2011–2012, gonorrhea rates decreased 7.5% for persons aged 15–19 years and increased 3.1% for persons aged 20–24 years.

15- to 19-Year-Old Women—In 2012, women aged 15–19 years had the second highest rate of gonorrhea (521.2 cases per 100,000 females) compared with any other age or sex group (Figure 16, Table 21). During 2011–2012, the gonorrhea rate for women in this age group decreased 8.2%.

20- to 24-Year-Old Women—In 2012, women aged 20–24 years had the highest rate of gonorrhea (578.5 cases per 100,000 females) compared with any other age or sex group (Figure 16, Table 21). During 2011– 2012, the gonorrhea rate for women in this age group increased 1.6%.

15- to 19-Year-Old Men—In 2012, the gonorrhea rate among men aged 15–19 years was 239.0 cases per 100,000 males (Figure 16, Table 21). During 2011– 2012, the gonorrhea rate for men in this age group decreased 5.4%.

20- to 24-Year-Old Men—In 2012, as in previous years, men aged 20–24 years had the highest rate of gonorrhea (462.8 cases per 100,000 males) compared with other males (Figure 16, Table 21). During 2011– 2012, the gonorrhea rate for men in this age group increased 5.5%.

Primary and Secondary Syphilis

Syphilis rates among women aged 15–19 years increased annually during 2004–2009, from 1.5 cases per 100,000 females to 3.3 cases in 2009, but decreased from 2.9 cases in 2010 to 2.3 cases in 2012. Rates among women aged 20–24 years remained stable during 2004–2006 (2.9–3.0 cases per 100,000 population), then increased during 2007–2009 (from 3.5 to 5.5 cases), before declining during 2010 and 2011 (to 4.5 and 3.7 cases, respectively); rates rose during 2012 (to 3.9 cases). Rates in women have been highest each year among those aged 20–24 years with 3.9 cases per 100,000 females in 2012 (Figures 35 and 36, Table 35).

Rates among men aged 15–19 years are much lower than the rates among men in older age groups (Figures 35 and 37, Table 35). Rates in this group increased during 2002–2009 (from 1.3 cases per 100,000 males to 6.0 cases in 2009), decreased to 5.5 cases in 2010 and 2011, and increased to 5.8 cases in 2012. However, rates among men aged 20–24 years have increased each consecutive year since 2002, from 5.2 cases per 100,000 males to 25.3 cases in 2012. Not only have men aged 20–24 years seen large increases in rates, they also have had the highest rate of P&S syphilis among men of any age group since 2008 (Table 35). These changes reflect a shift in the age distribution of P&S syphilis; rates were highest among men aged 35–39 years during 2002–2006.

Positivity in Selected Populations

During the mid-1990s to 2011, chlamydia and gonorrhea positivity among young women screened in clinics and juvenile correctional facilities participating in infertility prevention activities were reported to CDC to monitor chlamydia prevalence. As the national infertility prevention program expanded, these data became difficult to interpret as trends were influenced by changes in screening coverage, screening criteria, and test technologies, as well as demographic changes in patients attending clinics reporting data to CDC. Variables available at the national level limited the ability to address these issues. Positivity data continue to be useful locally to inform clinic-based screening recommendations and to identify at-risk populations in need of prevention interventions, but are no longer collected to monitor national trends in chlamydia and gonorrhea.

National Job Training Program

The NJTP is an educational program for socioeconomically disadvantaged youth aged 16–24 years and is administered at more than 100 sites throughout the country. The NJTP screens participants for chlamydia and gonorrhea within two days of entry to the program. All of NJTP’s chlamydia screening tests and the majority of gonorrhea screening tests are conducted by a single national contract laboratory*, which provides these data to CDC. To increase the stability of the estimates, chlamydia or gonorrhea prevalence data are presented when valid test results for 100 or more students per year are available for the population subgroup and state.

Among women entering the program in 47 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence in 2012 was 11.0% (range: 5.5% to 19.4%) (Figure H). Among men entering the program in 47 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 7.0% (range: 0.6% to 13.5%) (Figure I).

Among women entering the program in 45 states, the District of Columbia, and Puerto Rico, the median state-specific gonorrhea prevalence in 2012 was 1.3% (range: 0.0% to 4.8%) (Figure J). Among men entering the program in 41 states, the District of Columbia, and Puerto Rico, the median state-specific gonorrhea prevalence was 0.7% (range: 0.0% to 2.8%) (Figure K).

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

1 Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Su J, Xu F, Weinstock H. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013 Mar;40(3):187-93.

2 Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Datta SD, McQuillan GM, Berman SM, Markowitz LE. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics. 2009 Dec;124(6):1505-12 doi: 10.1542/peds.2009-0674. Epub 2009 Nov 23.

3 DiClemente RJ, Salazar LF, Crosby RA. A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach. J. Pediatr. Psychol. 2007;32 (8): 888-906.

4 Sieving RE, Bernat DH, Resnick MD, Oliphant J, Pettingell S, Plowman S, et al. A clinic-based youth development program to reduce sexual risk behaviors among adolescent girls: prime time pilot study. Health Promot Pract (online). May 23, 2011.

5 Upchurch DM, Mason W, Kusunoki Y, Kriechbaum MJ. Social and behavioral determinants of self-reported STD among adolescents. Perspect Sex Reprod Health. 2004;36(6):276-287.