Sexually Transmitted Disease Surveillance 1995

Division of STD Prevention

September 1996

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,
1995. U.S. Department of Health and Human Services, Public Health Service.
Atlanta: Centers for Disease Control and Prevention, September 1996.

Copies can be obtained from Information Technology and Services Office,
National Center for HIV, STD, and TB Prevention, Centers for Disease
Control and Prevention, 1600 Clifton Road, Mailstop E-06, Atlanta, Georgia
30333 or by telephone at (404) 639-1819.

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                  STDs in Adolescents and Young Adults

Public Health Impact

Compared with 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). Large-scale screening demonstration projects in federal
    Region X (Alaska, Idaho, Oregon, and Washington) (5) have demonstrated
    that younger women have consistently higher positivity rates of
    chlamydia than older women (Figure_F).

--  Rates of gonorrhea among male adolescents have steadily decreased
    during the four year period 1992-95 (Table_9B). In the 10- to
    14-year-old group, the rate for males decreased from 26.2 per 100,000
    in 1992 to 12.6 in 1995, a decrease of 52%. In the 15- to 19-year-old
    group, the rate declined from 770.3 in 1992 to 498.4 in 1995, a 35%
    decrease. Among young adult men in the 20- to 24-year-old group, the
    rate of gonorrhea fell from 896.1 in 1992 to 666.4 in 1995, a decrease
    of 26%.

--  Rates of gonorrhea among female adolescents also generally decreased
    over the four year period 1992-95 (Table_9B). However, both
    adolescent age groups exhibited an increase between 1993 and 1994,
    which was followed by a decrease in 1995. This pattern also occurred
    among young adult women. In the 10- to 14-year-old group, the rate for
    females decreased from 91.2 per 100,000 in 1992 to 72.8 in 1995, a
    decrease of 20%. In the 15- to 19-year-old group, the rate declined
    from 973.8 in 1992 to 839.7 in 1995, a 14% decrease. Among young adult
    women in the 20- to 24-year-old group, the rate of gonorrhea fell from
    766.5 in 1992 to 624.6 in 1995, a decrease of 19%.

--  In 1995, 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_12).

--  Increases in gonorrhea between 1994 and 1995 were noted among Hispanic
    adolescents and young adults (Table_9B).

--  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 1995, based on their place of residence just before program
    entry, state-specific chlamydia test positivity ranged from 4.2% to
    17.1% (Figure_I). Chlamydia infection is widespread geographically
    and highly prevalent among these economically disadvantaged young
    women.

Figure_F.  Chlamydia -- Percent positivity among women tested in family
               planning clinics by age group: Region X, 1988-1995
Figure_G.  Gonorrhea -- Age-specific rates among women 10-44 years of
               age: United States, 1981-1995
Figure_H.  Gonorrhea -- Age-specific rates among men 10-44 years of age:
               United States, 1981-1995
Figure_I.  Chlamydia -- Percent positivity among 16-24 year-old women
               entering the U.S. Job Corps by state of residence, 1995

---------------
(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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