More Than 25% of Teenage American
Has Sexually Transmitted Disease (STD)
LINDSEY TANNER / AP 11mar2008
At least one in four teenage American girls has a sexually transmitted disease, suggests a first-of-its-kind federal study that startled some adolescent-health experts.
First study shows high STD rates
Some doctors said the numbers might be a reflection of both abstinence-only sex education and teens' own sense of invulnerability. Because some sexually transmitted infections can cause infertility and cancer, U.S. health officials called for better screening, vaccination and prevention.
Only about half of the girls in the study acknowledged having sex. Some teens define sex as only intercourse, yet other types of intimate behavior including oral sex can spread some diseases.
Among those who admitted having sex, the rate was even more disturbing — 40 percent had an STD.
"This is pretty shocking," said Dr. Elizabeth Alderman, an adolescent medicine specialist at Montefiore Medical Center's Children's Hospital in New York.
"To talk about abstinence is not a bad thing," but teen girls — and boys too — need to be informed about how to protect themselves if they do have sex, Alderman said.
The overall STD rate among the 838 girls in the study was 26 percent, which translates to more than 3 million girls nationwide, researchers with the U.S. Centers for Disease Control and Prevention found. They released the results Tuesday at an STD prevention conference in Chicago.
"Those numbers are certainly alarming," said sex education expert Nora Gelperin, who works with a teen-written Web site called sexetc.org. She said they reflect "the sad state of sex education in our country."
"Sexuality is still a very taboo subject in our society," she said. "Teens tell us that they can't make decisions in the dark and that adults aren't properly preparing them to make responsible decisions."
Cecile Richards, president of Planned Parenthood Federation of America, said the study shows that "the national policy of promoting abstinence-only programs is a $1.5 billion failure, and teenage girls are paying the real price."
Similar claims were made last year when the government announced the teen birth rate rose between 2005 and 2006, the first increase in 15 years.
The new study by CDC researcher Dr. Sara Forhan relied on slightly older data. It is an analysis of nationally representative records on girls ages 14 to 19 who participated in a 2003-04 government health survey.
The teens were tested for four infections: human papillomavirus, or HPV, which can cause cervical cancer and affected 18 percent of girls studied; chlamydia, which affected 4 percent; trichomoniasis, 2.5 percent; and genital herpes, 2 percent.
Dr. John Douglas, director of the CDC's division of STD prevention, said the results are the first to examine the combined national prevalence of common sexually transmitted diseases among adolescent girls. He said the data, now a few years old, likely reflect current prevalence rates.
Disease rates were significantly higher among black girls — nearly half had at least one STD, versus 20 percent among both whites and Mexican-Americans.
HPV, the cancer-causing virus, can also cause genital warts but often has no symptoms. A vaccine targeting several HPV strains recently became available, but Douglas said it probably hasn't yet had much impact on HPV prevalence rates in teen girls.
The CDC recommends the three-dose HPV vaccine for girls ages 11-12 and catch-up shots for ages 13-26.
Chlamydia, which often has no symptoms but can lead to infertility, can be treated with antibiotics. The CDC recommends annual chlamydia screening for all sexually active women under age 25. Trichomoniasis, also treatable with antibiotics, can cause abnormal discharge and painful urination. Genital herpes can cause blisters but often has no symptoms. It's not curable but medicine can help.
The CDC's Dr. Kevin Fenton said given the dangers of some STDs, "screening, vaccination and other prevention strategies for sexually active women are among our highest public health priorities."
Douglas said screening tests are underused in part because many teens don't think they're at risk, but also, some doctors mistakenly think: "Sexually transmitted diseases don't happen to the kinds of patients I see."
Teens need to hear the dual message that STDs can be prevented by abstinence and condoms, said Dr. Ellen Kruger, an obstetrician-gynecologist at Ochsner Medical Center in New Orleans.
"You've got to hammer at them," with appropriate information at each stage of teen development to make sure it sinks in, she said.
She said there are a lot of myths out there, too — many sexually active teens think the withdrawal method will protect them, or that douching with Coca-Cola will kill STD germs.
Dr. Margaret Blythe, an adolescent medicine specialist at Indiana University School of Medicine, said some doctors hesitate to discuss STDs with teen patients or offer screening because of confidentiality concerns, knowing parents would have to be told of the results.
Blythe, who heads an American Academy of Pediatrics committee on adolescence, noted that the academy supports confidential teen screening.
Nationally Representative CDC Study Finds
1 in 4 Teenage Girls Has a Sexually Transmitted Disease
CDC Press Release 11mar2008
-- 3.2 Million Female Adolescents Estimated to Have at
Least One of the Most Common STDs --
-- Other Studies Featured at 2008 National STD Prevention Conference Show Missed Opportunities for STD Screening and Innovative Solutions for STD Prevention and Treatment --
Chicago – A CDC study released today estimates that one in four (26 percent) young women between the ages of 14 and 19 in the United States – or 3.2 million teenage girls – is infected with at least one of the most common sexually transmitted diseases (human papillomavirus (HPV), chlamydia, herpes simplex virus, and trichomoniasis). The study, presented today at the 2008 National STD Prevention Conference, is the first to examine the combined national prevalence of common STDs among adolescent women in the United States, and provides the clearest picture to date of the overall STD burden in adolescent women.
Led by CDC’s Sara Forhan, M.D., M.P.H., the study also finds that African-American teenage girls were most severely affected. Nearly half of the young African-American women (48 percent) were infected with an STD, compared to 20 percent of young white women.
The two most common STDs overall were human papillomavirus, or HPV (18 percent), and chlamydia (4 percent). Data were based on an analysis of the 2003-2004 National Health and Nutrition Examination Survey.
“Today’s data demonstrate the significant health risk STDs pose to millions of young women in this country every year,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “Given that the health effects of STDs for women – from infertility to cervical cancer – are particularly severe, STD screening, vaccination and other prevention strategies for sexually active women are among our highest public health priorities.”
“High STD infection rates among young women, particularly young African-American women, are clear signs that we must continue developing ways to reach those most at risk,” said John M. Douglas, Jr., M.D., director of CDC’s Division of STD Prevention. “STD screening and early treatment can prevent some of the most devastating effects of untreated STDs.”
CDC recommends annual chlamydia screening for sexually active women under the age of 25. CDC also recommends that girls and women between the ages of 11 and 26 who have not been vaccinated or who have not completed the full series of shots be fully vaccinated against HPV.
The study of STDs among teenage girls is one of several presented today at the 2008 National STD Prevention Conference that highlights the significant burden of STDs among girls and women, and identifies creative prevention strategies for reducing the toll of STDs in the United States.
Contraceptive services represent missed opportunities for STD screening, prevention
Two other studies featured at the conference point to missed opportunities for STD testing, and underscore that it is critical for STD screening to be included in comprehensive reproductive health services for young women.
A study by CDC’s Sherry L. Farr and colleagues found that while the majority of sexually active 15- to-24 year-old young women (82 percent) receive contraceptive or STD/HIV services, few receive both (39 percent). In addition, only 38 percent of a subset of young women who reported receiving contraceptive services associated with unprotected sex (e.g., pregnancy testing) also received STD/HIV counseling, testing or treatment, which indicates that many women at high risk are not receiving necessary prevention services.
A separate study, by CDC’s Shoshanna Handel and the New York City Department of Health and Mental Hygiene, examined STD screening rates among young women seeking emergency contraception, which would suggest recent unprotected sex. The study found that just 27 percent were screened for chlamydia or gonorrhea. A significant proportion of those women (12 percent) had a positive test result, highlighting the need for routine chlamydia and gonorrhea screening at emergency contraception visits.
Innovative programs provide models for effective STD prevention
Other research from the conference highlighted creative programs that are effectively screening and treating people with STDs, and identifying those most at risk.
A CDC-funded confidential chlamydia screening program in high school-based health clinics in California resulted in high rates of screening among those seeking contraceptive or STD services (range: 85-94 percent). It also revealed significantly higher infection rates among African-American women than white women (9.6 percent versus 1.7 percent).
A study by New York City health officials assessed the effectiveness of an express visit option, allowing patients at city clinics to be tested for STDs without a doctor’s exam. Comparing data before and after express visits were routinely offered, researchers found that the express visit option made it possible for an additional 4,588 tests to be performed, and increased STD diagnoses by 17 percent (2,617 versus 2,231).