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  • • The biology of the developing cervix may increase the risk for STDs in young women.
  • • Adolescents have delayed health care–seeking behavior and may not be forthcoming in reporting sexual risk behavior.
  • • In most states, patients 12 years and older can give consent for confidential reproductive health care services.

Nearly one quarter of all sexually transmitted diseases (STDs) occur in sexually active adolescents. A variety of biologic, cognitive, psychological, behavioral, and social factors contribute to the high rates of STDs observed in this population. To provide effective care for these patients, it is important that clinicians understand the issues that contribute to adolescents’ increased STD risk.

Not all adolescents are sexually active. According to the 2003 Youth Risk Behavior Surveillance System (YRBS), 46.7% of high school students reported having had sexual intercourse during their lifetime. Only 28–63% of those who were sexually active reported having used a condom during their last intercourse. STDs commonly go undiagnosed in adolescents because (1) infections are often asymptomatic, (2) routine screening relies on appropriate health care–seeking behavior, and (3) adolescents must identify themselves as sexually active. STDs in adolescents result in complications such as infertility, ectopic pregnancy, HIV infection, and cervical cancer.

Centers for Disease Control and Prevention. Tracking the hidden epidemics: Trends in STDs in the United States, 2000. Available at: http://www.cdc.gov/std/Trends2000. (Government report summarizing trends in STDs in 2000.)
Grunbaum JA, Kann L, Kinchen S, et al. Youth risk behavior surveillance—United States, 2003. MMWR Morb Mortal Wkly Rep 2004;53:1–96.  [PubMed: 15152182] (Survey of risk behaviors reported by high school students in the United States.)

Adolescents have the highest age-specific rates for chlamydia and gonorrhea. In 2003, the highest age-specific chlamydial rates were among female adolescents aged 15–19 years (2687.3 per 100,000 females vs 9.8 per 100,000 males, Figure 23–1). As with chlamydia, gonorrhea rates are highest in female adolescents aged 15–19 years, and in men aged 20–24 years (see Figure 23–2).

Figure 23–1.

Chlamydia rates by age: United States, 1984–2003. Rate is per 100,000 population. (Source: STD surveillance, Centers for Disease Control and Prevention, 2003.)

Figure 23–2.

Gonorrhea rates by age: United States, 1984–2003. Rate is per 100,000 population. (Source: STD surveillance, Centers for Disease Control and Prevention, 2003.)

Age-specific national prevalence estimates and case reporting data for genital herpesvirus infection, genital warts or other human papillomavirus (HPV) infections, and trichomoniasis are not available. The most common ulcerative disease among adolescents is herpes simplex virus type 2 (HSV-2). According to the National Health and Examination (NHANES) III data (1988–1994), seroprevalence rates among adolescents aged 12–19 years range from less than 10% to 17% in some reports. HPV is one of the most common STDs in ...

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