Sexually Transmitted Disease Surveillance 1996

Division of STD Prevention September 1997

U.S. Department of Health and Human Services 
Public Health Service 
Centers for Disease Control and Prevention  
National Center for HIV, STD, and TB Prevention 
Division of STD Prevention 
Atlanta, Georgia 30333

Copyright Information 

All material contained in this report is in the public domain and may be
used and reprinted without special permission; citation to source, however,
is appreciated.

Suggested Citation

Division of STD Prevention. Sexually Transmitted Disease Surveillance,
1996. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1997.

Copies can be obtained from the Office of Communications, National Center
for HIV, STD, and TB Prevention, Centers for Disease Control and
Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia 30333.

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STDs in Adolescents and Young Adults

Public Health Impact

Compared to older adults, adolescents (10- to 19-year-olds) and young
adults (20- to 24-year-olds) are at higher risk for acquiring STDs for a
number of reasons: they may be more likely to have multiple (sequential or
concurrent) sexual partners rather than a single, long-term relationship;
they may be more likely to engage in unprotected intercourse; and they may
select partners at higher risk. In addition, for some STDs, e.g., Chlamydia
trachomatis, adolescent women may have a physiologically increased
susceptibility to infection due to increased cervical ectopy and lack of
immunity. During the past two decades, the age of initiation of sexual
activity has steadily decreased and age at first marriage has increased,
resulting in increases in premarital sexual experience among adolescent
women and in an enlarging pool of young women at risk (1,2,3). In addition,
the higher prevalence of STDs among adolescents reflects multiple barriers
to quality STD prevention services, including lack of insurance or other
ability to pay, lack of transportation, discomfort with facilities and
services designed for adults, and concerns about confidentiality.

Observations

--  Numerous prevalence studies in various clinic populations have shown
    that sexually active adolescents have high rates of chlamydial
    infection (4). The Chlamydia Regional Projects that perform large-scale
    screening among women attending family planning clinics demonstrate
    that younger women consistently have higher positivity rates of
    chlamydia than older women, even as prevalence declines. An example is
    the Region X Project, which has screened women since 1988 (5)
    (Figure_H). 

--  Among women, 15- to 19-year-olds had the highest rate of gonorrhea
    (Figure_J, Table_12B), and 20- to 24-year-olds had the highest
    rate of primary and secondary syphilis (Figure_L, Table_24B).
    Among men, 20- to 24-year-olds had the highest rate of gonorrhea and
    second highest rate of primary and secondary syphilis (Figure_K and
    Figure_M, Table_12B and Table_24B).

--  Rates of gonorrhea among male adolescents have steadily decreased
    during the 4 year period 1993-96 (Table_12B). In the 10- to
    14-year-old group, the rate for males decreased from 20.4 per 100,000
    in 1993 to 9.1 in 1996, a decrease of 55%. In the 15- to 19-year-old
    group, the rate declined from 611.4 in 1993 to 394.3 in 1996, a 36%
    decrease. Among young adult men in the 20- to 24-year-old group, the
    rate of gonorrhea fell from 729.9 in 1993 to 522.5 in 1996, a decrease
    of 28%.

--  Rates of gonorrhea among female adolescents also generally decreased
    over the 4 year period 1993-96 (Table_12B). However, both
    adolescent age groups exhibited an increase between 1993 and 1994,
    which was followed by decreases in 1995 and in 1996. This pattern also
    occurred among young adult women. In the 10- to 14-year-old group, the
    rate for females decreased from 78.0 per 100,000 in 1993 to 57.9 in
    1996, a decrease of 26%. In the 15- to 19-year-old group, the rate
    declined from 851.6 in 1993 to 756.8 in 1996, an 11% decrease. Among
    young adult women in the 20- to 24-year-old group, the rate of
    gonorrhea fell from 629.2 in 1993 to 522.9 in 1996, a decrease of 17%.

--  In 1996, the highest age-specific gonorrhea rates among women and the
    second highest rates among men were in the 15- to 19-year-old group
    (Figure_17).

--  From 1995 to 1996, gonorrhea rates increased among American
    Indian/Alaska Native adolescents and young adults (Table_12B).

--  Since 1990, approximately 20,000 female Job Corps entrants have been
    screened each year for chlamydia. The Job Corps, administered by the
    U.S. Department of Labor at 108 sites throughout the country, is a
    residential occupational training program for urban and rural
    disadvantaged youth aged 16-24 years. Among women entering the Job
    Corps in 1996, based on their place of residence just before program
    entry, state-specific chlamydia test positivity ranged from 1.7% to
    17.9% (Figure_I). Chlamydia infection is widespread geographically
    and highly prevalent among these economically disadvantaged young
    women.


Figure_H.   Chlamydia -- Percent positivity among women tested in 
                family planning clinics by age group: Region X, 1988-1996
Figure_I.   Chlamydia -- Percent positivity among 16-24 year-old women 
                entering the U.S. Job Corps by state of residence, 1996
Figure_J.   Gonorrhea -- Age-specific rates among women 10-44 years of 
                age: United States, 1981-1996
Figure_K.   Gonorrhea -- Age-specific rates among men 10-44 years of 
                age: United States, 1981-1996
Figure_L.   Primary and secondary syphilis -- Age-specific rates among 
                women 10-44 years of age: United States, 1981-1996
Figure_M.   Primary and secondary syphilis -- Age-specific rates among 
                men 10-44 years of age: United States, 1981-1996

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(1) CDC. Premarital sexual experience among adolescent women -- United
    States, 1970-1988. MMWR 1991;39:929-32.
(2) CDC. Pregnancy, Sexually Transmitted Diseases and Related Risk
    Behaviors Among U.S. Adolescents. Atlanta: Centers for Disease Control
    and Prevention, 1994. Adolescent Health: State of the Nation monograph
    series, No. 2. CDC Publication No. 099-4630.
(3) Forrest JD. Timing of reproductive life stages. Obstet Gynecol
    1993;82(1)105-11.
(4) CDC. Recommendations for the prevention and management of Chlamydia
    trachomatis infections, 1993. MMWR 1993;42(No. RR-12).
(5) Lossick J, Delisle S, Fine D, Mosure D, Lee V, Smith C. Regional
    program for widespread screening for Chlamydia trachomatis in family
    planning clinics. In: Bowie WR, Caldwell HD, Jones RP, et al., eds.
    Chlamydial Infections: Proceedings of the Seventh International
    Symposium of Human Chlamydial Infections, Cambridge, Cambridge,
    University Press, 1990, pp. 575-9.

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