STD Quarterly

Youth are at risk for sexually transmitted diseases: What can providers do to stem the tide?

Almost 50% of new cases are under 25 years old

Your next patient is 19, sexually active, and says her boyfriend infrequently uses condoms because she takes an oral contraceptive and is protected against pregnancy. What information should you share with her about protection against sexually transmitted diseases (STDs)?

The facts contained in just-published research may give her pause.1 The new findings indicate that of approximately 18.9 million new cases of STD that occurred in 2000, 9.1 million (48%) were among persons ages 15-24.1 Three STDs [human papillomavirus (HPV), trichomoniasis, and chlamydia] accounted for 88% of all new cases of STD among 15- to 24-year-olds.

"While 15- to 24-year-olds represent 25% of the sexually experienced population, in 2000 they accounted for almost half of the estimated new cases of STDs," says Hillard Weinstock, MD, an epidemiologist with the Atlanta-based Centers for Disease Control and Prevention (CDC) and lead author of the new research. "These data confirm what we’ve known for some time: that the burden of STDs is on younger people."

Better tests, routine screening programs, and new therapies have allowed more STDs to be detected and treated. However, STDs are taking a heavy toll on young adults; according to a second report, the total estimated burden of the 9.1 million new cases of STDs that occurred among 15- to 24-year-olds in 2000 add up to $6.5 billion.2

Providers need to be concerned when it comes to care of young adults: Those who are sexually active may have multiple sex partners, may be more likely to engage in unprotected intercourse; and younger individuals may be more vulnerable biologically to some STDs, says Weinstock.

"This study highlights the vulnerability of America’s youth to STDs and the need for greater emphasis on STD prevention efforts," states Weinstock.

Young adults need info

One reason the rates of STDs are so high in youth is that society does not do a very good job of communicating about the risks and where to get help, says Joan Cates, MPH, a doctoral student in the School of Journalism and Mass Communication at the University of North Carolina at Chapel Hill. Shame and fear make the situation worse, she maintains.

Cates is principal investigator for the "Our Voices, Our Lives, Our Futures: Youth and STDs," a project aimed at providing clarity and consensus about the scope and impact of STDs in U.S. adolescents and young adults. Funded by the William T. Grant Foundation in New York City, the project is using qualitative and quantitative research methods to raise public awareness about the problem.

To assess the magnitude, economic impact, and psychosocial burden of STDs in youth, the project convened two panels: one comprised of experts in public health, behavioral science, medicine, economics, and communication; and another formed of young people, all recruited through Advocates for Youth, a nonprofit public health organization based in Washington, DC. The two panels worked together to define challenges and recommend solutions for preventing STDs among young Americans. Their findings have just been published in report form.3 (Review the publication on-line. Go to www.jomc.unc.edu/youthandSTDs/ourvoices.html and click on the publication’s title, Our Voices, Our Lives, Our Futures: Youth and Sexually Transmitted Diseases.)

"Our research showed that parents need to be more open about sexual health with their children as they grow up, potentially romantic partners need to discuss risk and protection, and health care providers need to include routine and confidential sexual health assessments with their young patients," says Cates.

Several national prevention organizations support educating youth to reduce the risk of STDs by delaying sexual intercourse, using condoms if sexually active, and seeking diagnosis and treatment for infection. Education programs need to include messages about sexual health in addition to warnings about disease, the Our Voices report states).3

If young adults do decide to delay sexual intercourse, they still are in need of information when it comes to STD protection, according to new research.4

Teens who pledge to remain virgins until marriage have the same rates of sexually transmitted diseases as those who don’t pledge abstinence, according to a study that examined the sex lives of 12,000 adolescents.5 Pledgers are less likely to know that they have an STD than nonpledgers, even though they are not less likely to have one, researchers found. Just saying "no" without understanding STD risk or how to protect oneself from risk turned out to create greater risk and higher STD acquisition than should be the case, the researchers state.5

Check your approach

What can you do to help stem the rising STD tide in young adults? The Our Voices report offers the following suggestions for health care providers:

  • Make sure each patient understands that all conversations ideally are private. Explain under what conditions you cannot maintain confidentiality.
  • Screen youth for STDs regularly and consistently.
  • Screen men and women.
  • Don’t assume that youth are comfortable telling you the whole story immediately. Work to gain their trust.
  • Speak privately with youth. Explain to parents why this is important.
  • Work with parents to reinforce health education and strengthen your relationship with the patient.3

What is your advice when it comes to condom use? For people whose sexual behaviors place them at risk for STDs, correct and consistent use of a male latex condom can reduce the risk. When used correctly and consistently, latex condoms can aid in preventing sexual transmission of HIV and can reduce the risk of chlamydia, gonorrhea, genital herpes, syphilis, and trichomoniasis.

While the effectiveness of condoms in preventing HPV is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.6

For tips on correct condom use, a free handout, "The Do’s and Don’ts of Condom Use," is available from the Research Triangle Park, NC-based American Social Health Association (ASHA).

Explain to patients that the condom should be placed on an erect (hard) penis before there is any contact with a partner’s genitals, according to the ASHA information. Use plenty of water-based lubricant with latex condoms to reduce friction and help prevent the condom from tearing. Squeeze the air out of the tip of the condom when rolling it over the erect penis to provide room for the semen. When preparing to remove the penis after sex, hold the condom in place at the base of the penis.

Most youth do not use condoms every time they have sex, and most have not been taught the correct way to use a condom, according to the Our Voices report. Take time in demonstrating correct condom use when discussing condoms with young adult patients.

References

1. Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6-10.

2. Chesson HW, Blandford JM, Gift TL, Tao G, et al. The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspect Sex Reprod Health 2004; 36:11-19.

3. Cates JR, Herndon NL, Schulz SL, et al. Our Voices, Our Lives, Our Futures: Youth and Sexually Transmitted Diseases. Chapel Hill, NC: School of Journalism and Mass Communication, University of North Carolina at Chapel Hill; 2004.

4. Bearman P, Bruckner H. The relationship between virginity pledges in adolescence and STD acquisition in young adulthood. Presented at the 2004 National STD Prevention Conference. Philadelphia; March 2004.

5. Straziuso J. Study examines STD rates of teen virgins. Philadelphia Inquirer. Web site: www.philly.com/mld/philly/8142572.htm.

6. Cates W Jr. The condom forgiveness factor: the positive spin. Sex Trans Dis 2002; 29:350-353.