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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 one-third 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 incident STIs. Adolescents contract STIs at a higher rate than adults because of sexual risk taking, age-related biologic factors (eg, cervical ectropion, maturing immune system), and barriers to health care access. In every state and the District of Columbia, adolescents can consent for the diagnosis and treatment of STIs. In many states, adolescents can also 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.
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Providers should routinely screen adolescents for STIs and 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 certain behaviors.
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The trend in the past decade is that 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 (2021) reports that 30% of high school students have had sexual intercourse. Twenty-one percent of students had sex in the 3 months prior to the survey and 6% reported having had four or more lifetime sexual intercourse partners. Among youth currently sexually active, 52% reported that either they or their partner had used a condom during their last sexual intercourse. 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.
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Oral sex is common in adolescents, with approximately two-thirds of 15- to 24-year-olds reporting oral sexual activity. Adolescents may engage in oral sex instead of vaginal sex because they believe it to be less risky for sexually transmitted disease transmission and pregnancy. Approximately 11% of adolescents 15- to 19-year-olds have engaged in anal sex. Additionally, condom use is relatively uncommon during oral and anal sex, thus increasing the risk for acquisition of an STI. Sexual minority youth (SMY) are defined as those who identify as lesbian, gay, or bisexual; who are not sure of their sexual identity; or who have had sexual contact with people of the same sex. Adolescents struggling with ...