Sexually Transmitted Disease Surveillance 1993

Division of STD/HIV Prevention 

December 1994

U.S. Department of Health and Human Services 
Public Health Service 
Centers for Disease Control and Prevention 
National Center for Prevention Services 
Division of STD/HIV Prevention 
Surveillance and Information Systems Branch 
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/HIV Prevention. Sexually Transmitted Disease
Surveillance, 1993.  U.S. Department of Health and Human Services, Public
Health Service.  Atlanta: Centers for Disease Control and Prevention,
December 1994.

Copies can be obtained from Information Services, National Center for
Prevention Services, Centers for Disease Control and Prevention, 1600
Clifton Road, Mailstop E-06, Atlanta, Georgia 30333.

                   
                   STDs in Adolescents and Young Adults

Public Health Impact

Adolescents (<20-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, premarital sexual experience among adolescent women has steadily
increased resulting in an enlarging pool of young women at risk (1,2).
  
Observations

     --   Numerous prevalence studies in various clinic populations have
          shown sexually active adolescents have high rates of chlamydial
          infection (3).  Large-scale screening demonstrations projects in
          a variety of settings in federal Region X (Alaska, Idaho, Oregon,
          and Washington) (4), San Francisco, California, Columbus, Ohio,
          and Wisconsin (5) have demonstrated that younger women have
          consistently higher positivity rates of chlamydia than older
          women (Figure_E, Figure_F, Figure_G, and
          Figure_H).

     --   Rates of gonorrhea in 15- to 19-year-old adolescent men and women
          have declined in the past three years, but continue to be higher
          than for other age groups (Figure_12, Figure_I and
          Figure_J; Table_9B) (6).  In 1993, the overall rate of
          gonorrhea for 15- to 19-year-olds was 742.1 per 100,000
          population.  In this age group, rates for adolescents women
          (868.0) exceeded the rate in men (622.7).

(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) CDC. Recommendations for the prevention and management of Chlamydia
trachomatis infections, 1993. MMWR 1993;42(No. RR-12).

(4) 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.

(5) Addiss DG, Vaughn ML, Hillis SD, Ludka D, Amsterdam L, Davis JP. 
History and features of the Wisconsin Chlamydia trachomatis control
program.  Family Plan Perspec 1994;26:83-6.

(6) Webster LA, Berman SM, Greenspan JR.  Surveillance for gonorrhea and
primary and secondary syphilis among adolescents, United States--1981-1991. 
In: CDC Surveillance Summaries, August 13, 1993.  MMWR 1993;42:(No.
SS-3):1-11.

Figure_E. Chlamydia - Percent positivity among women tested in family
              planning clinics by age group: Region X, 1988-1993    
Figure_F. Chlamydia - Percent positivity among women tested in 16
              sentinel clinics by age group: San Francisco, California,
              1988-1993    
Figure_G. Chlamydia - Percent positivity among women tested in primary
              care settings by age group: Columbus, Ohio, 1988-1993    
Figure_H. Chlamydia - Percent positivity of chlamydia laboratory tests
              in women by age group: Wisconsin, 1985-1994    
Figure_I. Gonorrhea - Age-specific rates among women 15-44 years of
              age: United States, 1981-1993    
Figure_J. Gonorrhea - Age-specific rates among men 15-44 years of age:
              United States, 1981-1993    

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