STDs in Adolescents and Young Adults

Public Health Impact

Prevalence estimates suggest that young people aged 15–24 years acquire half of all new STDs1 and that 1 in 4 sexually active adolescent females have an STD, such as chlamydia or human papillomavirus (HPV).2 Compared with older adults, sexually active adolescents aged 15–19 years and young adults aged 20–24 years are at higher risk of acquiring STDs for a combination of behavioral, biological, and cultural reasons. For some STDs, such as chlamydia, adolescent females may have increased susceptibility to infection because of increased cervical ectopy. The higher prevalence of STDs among adolescents also may reflect multiple barriers to accessing quality STD prevention services, including ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality. Traditionally, intervention efforts have targeted individual-level factors associated with STD risk which do not address higher-level factors (e.g., peer norms and media influences) that may also influence behaviors.3 Interventions for at-risk adolescents and young adults that address underlying aspects of the social and cultural conditions that affect sexual risk-taking behaviors are needed, as are strategies designed to improve the underlying social conditions themselves.4,5

Observations

Chlamydia

In 2013, 949,270 cases of chlamydial infection were reported among persons aged 15–24 years of age, representing 68% of all reported chlamydia cases. Among those aged 15–19 years, the rate of reported cases of chlamydia increased 6.4% during 2009–2011, decreased 4.4% during 2011–2012, and decreased 8.7% during 2012–2013 (Table 10). Among those aged 20–24 years, the rate increased 16.1% during 2009–2011 and remained stable during 2011–2013 (Table 10).

Among women aged 15–24 years of age, the population targeted for chlamydia screening, the overall rate of reported cases of chlamydia was 3,340.8 per 100,000 females. Rates varied by state, with highest reported case rates in the South (Figure H).

15- to 19-Year Old Women—In 2013, the chlamydia case rate among women aged 15–19 years was 3,043.3 cases per 100,000 females, a 8.7% decrease from the 2012 rate of 3,331.7 cases per 100,000 females (Table 10). Decreases in rates of reported cases were largest among 15-, 16-, and 17- year old females (Table 12).

20- to 24-Year Old Women—In 2013, women aged 20–24 years had the highest rate of chlamydia (3,621.1 cases per 100,000 females) compared with any other age and sex group (Figure 5). The overall chlamydia case rate among women in this age group remained stable during 2012–2013 (Table 10); however, rates of reported chlamydia increased among 23- and 24- year old females (Table 12).

15- to 19-Year Old Men—The chlamydia case rate for men aged 15–19 years decreased 9.0% from 785.8 cases per 100,000 males in 2011 to 715.2 cases per 100,000 males in 2013 (Table 10).

20- to 24-Year Old Men—In 2013, as in previous years, men aged 20–24 years had the highest rate of chlamydia among men (1,325.6 cases per 100,000 males). The chlamydia rate for men in this age group remained stable during 2012–2013 (Table 10).

Gonorrhea

During 2012–2013, the rate of reported gonorrhea cases decreased 11.6% for persons aged 15–19 years and decreased 1.9% for persons aged 20–24 years. Among women aged 15–24 years, the overall rate was 501.6 per 100,000 females. Rates varied by state, with highest reported case rates in the South (Figure I).

15- to 19-Year Old Women—In 2013, women aged 15–19 years had the second highest rate of gonorrhea (459.2 cases per 100,000 females) compared with other females (Figure 16, Table 21). During 2012–2013, the gonorrhea rate for women in this age group decreased 12.9%.

20- to 24-Year Old Women—In 2013, women aged 20–24 years had the highest rate of gonorrhea (541.6 cases per 100,000 females) compared with any other age or sex group (Figure 16, Table 21). During 2012–2013, the gonorrhea rate for women in this age group decreased 4.7%.

15- to 19-Year Old Men—In 2013, the gonorrhea rate among men aged 15–19 years was 220.9 cases per 100,000 males (Figure 16, Table 21). During 2012–2013, the gonorrhea rate for men in this age group decreased 8.9%.

20- to 24-Year Old Men—In 2013, as in previous years, men aged 20–24 years had the highest rate of gonorrhea (459.4 cases per 100,000 males) compared with other males (Figure 16, Table 21). During 2012–2013, the gonorrhea rate for men in this age group increased 1.3%.

Primary and Secondary Syphilis

15- to 19-Year Old Women—The rate of P&S syphilis among women aged 15–19 years increased annually during 2004–2009 (from 1.5 cases to 3.3 cases per 100,000 females), but decreased every year since 2010 to 1.9 cases in 2013 (Figures 36 and 37).

20- to 24-Year Old Women—The rate among women aged 20–24 years increased annually during 2006–2009 (from 2.9 to 5.5 cases per 100,000 females). The rate decreased from 5.5 to 3.7 cases during 2009–2011, then increased slightly (from 3.7 to 3.9 cases) during 2011–2013 (Figures 36 and37, Table 35).

15- to 19-Year Old Men—The rate among men aged 15–19 years increased annually during 2002–2009 (from 1.3 to 6.0 cases per 100,000 males). The rate decreased to 5.5 cases in 2010 and 2011, then increased to 5.8 cases (in 2012) and 6.4 cases (in 2013) (Figures 36 and 38, Table 35). In 2013, the rate among men aged 15–19 years was the highest reported since 1995.

20- to 24-Year Old Men—The rate among men aged 20–24 years increased annually during 2000–2013 (from 4.3 to 27.7 cases per 100,000 males) (Figures 36 and 38, Table 35). Men aged 20–24 years had the highest rate of P&S syphilis among men of any age group during 2008–2012, barely surpassed by men 25–29 years in 2013 (28.0 cases) (Figure 38, Table 35). In 2013, the rate among men aged 20–24 years was the highest reported since 1992.

Positivity in Selected Populations

During the mid-1990s to 2011, chlamydia and gonorrhea positivity among young women screened in clinics and juvenile correctional facilities participating in infertility prevention activities were reported to CDC to monitor chlamydia prevalence. As the national infertility prevention program expanded, these data became difficult to interpret as trends were influenced by changes in screening coverage, screening criteria, and test technologies, as well as demographic changes in patients attending clinics reporting data to CDC. Variables available at the national level limited the ability to address these issues. Positivity data continue to be useful locally to inform clinic-based screening recommendations and to identify at-risk populations in need of prevention interventions, but are no longer collected to monitor national trends in chlamydia and gonorrhea.

National Job Training Program

The National Job Training Program (NJTP) is an educational program for socioeconomically disadvantaged youth aged 16–24 years and is administered at more than 100 sites throughout the country. The NJTP screens participants for chlamydia and gonorrhea within two days of entry to the program. All of NJTP’s chlamydia screening tests and the majority of gonorrhea screening tests are conducted by a single national contract laboratory*, which provides these data to CDC. To increase the stability of the estimates, chlamydia or gonorrhea prevalence data are presented when valid test results for 100 or more students per year are available for the population subgroup and state.

Among women entering the program in 40 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence in 2013 was 11.7% (range: 4.1% to 19.0%) (Figure J). Among men entering the program in 47 states, the District of Columbia, and Puerto Rico, the median state-specific chlamydia prevalence was 7.4% (range: 1.8% to 14.6%) (Figure K).

Among women entering the program in 39 states and Puerto Rico, the median state-specific gonorrhea prevalence in 2013 was 2.1% (range: 0.0% to 5.6%) (Figure L). Among men entering the program in 36 states and Puerto Rico, the median state-specific gonorrhea prevalence was 0.7% (range: 0.0% to 2.6%) (Figure M).

* Laboratory data are provided by the Center for Disease Detection, LLC San Antonio, Texas.

1 Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40(3):187-93.

2 Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Datta SD, McQuillan GM, et al. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics. 2009;124(6):1505-12 doi: 10.1542/peds.2009-0674. Epub 2009 Nov 23.

3 DiClemente RJ, Salazar LF, Crosby RA. A review of STD/HIV preventive interventions for adolescents: sustaining effects using an ecological approach. J. Pediatr. Psychol. 2007;32 (8): 888-906.

4 Sieving RE, Bernat DH, Resnick MD, Oliphant J, Pettingell S, Plowman S, et al. A clinic-based youth development program to reduce sexual risk behaviors among adolescent girls: prime time pilot study. Health Promot Pract. 2012;13(4):462-71.

5 Upchurch DM, Mason W, Kusunoki Y, Kriechbaum MJ. Social and behavioral determinants of self-reported STD among adolescents. Perspect Sex Reprod Health. 2004;36(6):276-287.