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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.
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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.
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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.)
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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).
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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 adolescent and young adult ...