STI infections in teens might boost HIV risk later
Results of a new study indicate individuals who contract sexually transmitted infections (STIs) during their teen years have a greater HIV risk into young adulthood.1 Data from the study indicate the greater the number of STIs contracted during teen years, the greater the risk of subsequent HIV.1
To conduct the retrospective cohort study, researchers with the Philadelphia (PA) Department of Public Health analyzed data from 75,273 Philadelphia high school students born between 1985 and 1993 who participated in the Philadelphia High School STD Screening Program. Students in the program, which includes education about STIs and HIV and STI screening, were studied between 2003 and 2010. To conduct the study, researchers matched the cohort to existing STI and HIV surveillance data sets and death certificates to estimate the connection between existing STIs and potential HIV risk.
Compared with individuals reporting no STIs during adolescence, adolescents with STIs had an increased risk for subsequent HIV infection (incidence rate ratio [IRR] for adolescent girls = 2.6; 95% confidence interval [CI] = 1.5, 4.7; IRR for adolescent boys = 2.3; 95% CI = 1.7, 3.1). Risk increased with number of STIs. The risk of subsequent HIV infection was more than three times as high among those with multiple gonococcal infections during adolescence as among those with none, researchers report.
How important is it that providers address STI/HIV risks with teens, given the current trend in adolescent STI rates across the United States? Because of the very high disease rates among adolescents, STI screening of this group has long been recognized as a priority in the United States, says Claire Newbern, PhD MPH, epidemiology unit manager with the Philadelphia Department of Public Health.
"Our study provides further evidence of the long-term HIV risk that can be associated with bacterial STIs acquired during adolescence and underscores the need for such screening," states Newbern, who served as lead author for the current analysis.
Burden is high
STIs are common in the United States, with a disproportionate burden among young adolescents and adults, according to a 2013 Centers for Disease Control and Prevention (CDC) analysis of national data.2 Americans ages 15-24 make up just 27% of the sexually active population, but account for 50% of the 20 million new STIs in the United States each year.3
With such high prevalence of STIs in young adults, it is important for clinicians to talk to their young patients about STI prevention and to conduct appropriate testing, says Catherine Satterwhite, PhD, MSPH, MPH. Satterwhite, a medical epidemiologist in the Division of STD Prevention at the CDC, served as lead author of the 2013 analysis. "Young people often face unique prevention challenges, including embarrassment and confidentiality concerns," says Satterwhite. "Research shows that young patients may be afraid to initiate a conversation about STIs and will be looking to you, their healthcare provider, to begin the discussion."
Create an environment that feels safe for your young patients to talk openly without judgment, Satterwhite suggests. Clinicians must communicate with young patients that they understand that teen and young adults' health needs are different from the health needs of older adults.
Asking about your young patient's sexual history is a good starting point for discussions and will help clinicians determine what tests and prevention counseling messages are necessary for the patient, Satterwhite observes. (The CDC offers a free downloadable guide on how to take a sexual history. Go to http://1.usa.gov/12qe7A2.)
When to screen?
To help adolescents and young adults stay sexually health, Satterwhite suggests clinicians look to the CDC's screening recommendations for the following STIs:
• HIV: All adults and adolescents between the ages of 13 and 64 should be tested at least once for HIV, regardless of recognized risk factors, states Satterwhite. Adolescents and adults at increased risk for HIV infection, such as those who have unprotected sex with multiple partners or exchange sex for money or drugs, should be tested annually. Clinicians also should screen all pregnant women for HIV.
• Chlamydia: All sexually active women ages 25 years and younger should be tested for chlamydia every year, says Satterwhite.
• Gonorrhea: At-risk sexually active women should be tested for gonorrhea each year. This includes women with new or multiple sex partners or women who live in communities with a high burden of disease, says Satterwhite.
All sexually active gay, bisexual, and other men who have sex with men should be tested at least once a year for syphilis, chlamydia, gonorrhea, and HIV, states Satterwhite. Those who have multiple or anonymous partners should be screened more frequently.
1. Newbern EC, Anschuetz GL, Eberhart MG, et al. Adolescent sexually transmitted infections and risk for subsequent HIV. Am J Public Health 2013; doi:10.2105/AJPH.2013.301463.
2. Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among U.S. women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 2013; 40:187-193.
3. Centers for Disease Control and Prevention. Sexually transmitted infections among young Americans. Infographic. Accessed at http://1.usa.gov/1d3VQNe.