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At the 2008 National STD Prevention Conference held in March, CDC investigators released results of a national study that put into stark reality the public health burden of sexually transmitted infections (STIs) among female adolescents. As part of the 2003–2004 National Health and Nutrition Examination Survey, 838 female adolescents (age range, 14–19 years) completed a behavioral survey and underwent testing for human papillomavirus (HPV), Chlamydia trachomatis, herpes simplex virus type 2 (HSV-2), and Trichomonas vaginalis. Overall, 26% of the teens tested positive for any of the four STIs; 18% tested positive for HPV, 4% for chlamydia, 2% for trichomonas, and 2% for HSV-2. Among teens who reported ever having had sex (oral, vaginal, or anal sex), 40% tested positive for at least one STI, primarily HPV (30%) and chlamydia (7%). The prevalence of infection was highest among African Americans (48%) and was comparable among whites and Mexican Americans (about 20%). The prevalence of STIs was 20% among those who reported one lifetime partner and increased to 55% among those who reported three partners.
Department of Health and Human Services. 2008 National STD Prevention Conference, Chicago, Mar 10–13, 2008. (http://www.cdc.gov/stdconference/)
Forhan SE et al. Prevalence of sexually transmitted infections and bacterial vaginosis among female adolescents in the United States: Data from the National Health and Nutrition Examination Survey (NHANES) 2003–2004. Mar 13, 2008. (http://cdc.confex.com/cdc/std2008/techprogram/P14888.HTM)
Comment
These figures, weighted to national population estimates, indicate that 3.2 million female adolescents in the U.S. are infected with at least one STI. In view of the fact that STIs — especially recurrent infections — confer risk for cervical cancer, HIV infection, infertility, and ectopic pregnancy, these data lend a new urgency to public health efforts aimed at controlling what many refer to as a “hidden epidemic.” Previous research has shown that cellular changes in the maturing adolescent cervix render teenagers more susceptible than older women to infection with chlamydia and HPV after exposure to an infected partner. The higher rate among African Americans likely reflects disparities in healthcare access (both screening and treatment) that leads to a higher prevalence in the community.
What can we do as clinicians? First, ensure that all teenage girls receive the three-dose HPV vaccine, preferably at age 11 to 12 or before they become sexually active. Second, use every opportunity to screen all sexually active young women for chlamydia (using, if possible, urine-based nucleic acid amplification tests, self-collected vaginal swabs, or both), as recommended by the CDC. Widespread testing is critical, but it raises issues about confidentiality and payment. Hopefully, nationwide publicity from this report will help parents understand that testing for STIs is in their daughters’ best interests. Third, parents and clinicians must engage teenagers in “The Talk,” emphasizing abstinence, correct and consistent condom use, limited numbers of sexual partners, monogamous relationships, and partner testing.