The average young person in the U.S. and in Vermont initiates sexual activity for the first time at age 17. To help young people choose safe and healthy sexual relationships, we must provide education and support regarding prevention of sexually transmitted infections (STIs).
STIs are a common cause of disease in sexually active adolescents.
Bacteria, viruses, protozoa, parasites, or fungi cause STIs.
The most common viral STI is human papillomavirus (HPV). The most common bacterial STI is chlamydia. Other common infections in adolescents include gonorrhea, syphilis, trichomonas, and herpes simplex virus (HSV). Human immunodeficiency virus (HIV) is an STI, too. Some bacterial STIs, such as chlamydia, are curable with antibiotics. Others such as HSV persist in the body in dormant and active states, as there are no currently available cures.
Assorted complications of STIs include:
- Severe infections
- Chronic pain
- Ectopic pregnancy
- Harmful effects in fetuses
Every year, half of the 20 million new STIs reported in the US occur in youth between 15 and 24 years of age.
This percentage is remarkable because 15 to 24 year-olds represent just 25 percent of the sexually experienced population in the United States. Because of a variety of factors, many adolescents’ sexual practices and behaviors put them at risk for acquiring STIs. These risk factors include:
- Having increased biological susceptibility to infection
- Failing to use barrier protection consistently and correctly
- Having sequential sex partners of limited duration
- Having multiple sex partners concurrently
- Early age at sexual initiation
- Experiencing multiple obstacles to accessing health care
There are significant disparities in the STI rates for young people of different ages, gender, and sexual orientation.
While the highest rates of STIs are in young adults and adolescents, detection of these infections depends greatly on the different screening recommendations for each STI, as many infections are asymptomatic.
In terms of STI prevention a 2007 report by The National Campaign to Prevent Teen and Unplanned Pregnancy provided a detailed review of the important characteristics of effective curriculum-based sex education programs, and provided information about the primary factors that can reduce the probability of a young person contracting an STI:
- Increase the correct and consistent use of condoms
- Increase testing and treatment of STIs
- Vaccinate against STIs for which vaccines are available
- Increase abstinence (both delaying the initiation of sex and increasing the return to abstinence)
- Reduce the number of sexual partners
- Reduce the occurrence of concurrent partners
- Increase the period of time between sexual partners
- Decrease the frequency of sex
- Circumcision (boys)
Barrier protection is one of the key prevention factors in STI transmission and male condom use amongst young people has increased since 1991.
Unfortunately, in 2015 only about 57 percent of males and females age 15-19 years old reported male condom use at last intercourse. Other barrier methods, dental dams, and female condoms are infrequently used. Although condom use has increased overall, consistent condom use is still a challenge. Unfortunately, our culture presents mixed messages related to condom use: irresponsibility for wanting to have sex, but responsibility for using condoms. Influencing consistent condom use requires messaging that supports personal responsibility, safety and trust in relationships.
There are some additional key aspects to adolescent STI prevention:
- Health Education: Engaged adolescents in sexual health discussions appropriate for their developmental level. Make health education messages as specific as possible, aimed at specific risk behaviors. Make these discussions thorough, genuine, nonjudgmental, and confidential. In addition, offer print or electronic educational materials, as patients may not absorb educational information while in clinic and/or receiving bad news or treatment.
- Confidentiality: Confidentiality is an important element in providing quality care to adolescents. Discuss it with patients and parents/guardians. Most states have specific laws that guarantee minors’ rights to confidentiality for STI testing and treatment.
- Expedited Partner Therapy (EPT): When providers dispense medication for partners to the patient, it is as good as or better than standard partner referral options. EPT is supported by numerous professional medical organizations.
For more information on adolescent STIs:
- CDC Sexually Transmitted Infections, Adolescents and Young Adults
- Center for Young Women’s Health: Sexual Health
- Young Men’s Health: Sexual Health
- Vermont Department of Health: Adolescent Sexual Health
- Vermont Department of Health: Sexually Transmitted Diseases
Erica Gibson, MD, is a physician specializing in Adolescent Medicine at the University of Vermont Children’s Hospital.
This article is excerpted from: Commonly Sexually Transmitted Infections in Adolescents; Primary Care: Clinics in Office Practice. Vol 41, Issue 3, pages 631-650. Elsevier, Sept 2014. Erica J. Gibson, David L. Bell & Sherine A. Powerful.