The rate of sexually transmitted infections (STIs) acquired during adolescence remains high despite widespread educational programs and increased access to health care. By senior year in high school, up to half of youth will have had sexual intercourse. The highest age-specific rates for gonorrhea, chlamydia, and human papillomavirus (HPV) infection occur in adolescents and young adults (15–24 years of age). While this age group accounts for only 25% of the sexually active population, it accounts for almost half of the incident STIs. Adolescents contract STIs at a higher rate than adults because of sexual risk taking, age-related biologic factors (eg, cervical ectopy, maturing immune system), and barriers to health care access. In every state and the District of Columbia, adolescents can provide consent for the diagnosis and treatment of STIs without parental consent; 18 states allow, but do not require, disclosure to a parent. In many states, adolescents can also provide consent for human immunodeficiency virus (HIV) counseling and testing. Since individual state laws vary, health care providers should be knowledgeable about the legal definitions regarding age of consent and confidentiality requirements in their state.
Providers should screen sexually experienced adolescents for STIs and use this opportunity to discuss risk reduction. Since not all adolescents receive regular preventive care, providers should use acute care visits to offer screening and education. Health education counseling should be nonjudgmental and appropriate for the developmental level, yet sufficiently thorough to identify risk behaviors because many adolescents may not readily acknowledge engaging in these behaviors.
The spectrum of sexual behavior includes holding hands and kissing, touching, mutual masturbation, oral-genital contact, and vaginal and anal intercourse. Each has its associated risks. Over the last 10 years, high school students were less likely to have ever engaged in sexual activity, were less likely to have had four or more sexual partners, and were less likely to be currently sexually active. The most recent Youth Risk Behavior Survey (2019) reports that 38% of high school students have had sexual intercourse; 3% of teenagers initiated sex by age 13. Twenty-nine percent of students had sex in the 3 months prior to the survey—44% of 12th-graders and 13% of 9th-graders. Nine percent of students reported having had four or more lifetime sexual intercourse partners. Among those youths currently sexually active, 54% reported that either they or their partner had used a condom during their last sexual intercourse. Paradoxically, condom use decreases with age—61% of 9th-graders reported condom use at their last intercourse compared with 50% of 12th-graders. Substance use contributes to an increase in risky sexual activity; 21% of sexually active youth report that they used alcohol or drugs prior to their last intercourse.
Anal and oral sex are common sexual practices that become more prevalent with age. Oral sex is relatively common in adolescents with approximately two-thirds of 15- to 24-year-olds reporting oral sexual ...