STDs in Adolescents and Young Adults

Public Health Impact

Incidence and 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 has 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. Cervical ectopy refers to columnar cells, which are typically located within the cervical canal, being located on the outer surface of the cervix. Although this is a normal finding in adolescent and young women, these cells are more susceptible to infection. The higher prevalence of STDs among adolescents may also reflect multiple barriers to accessing quality STD prevention and management services, including inability to pay, lack of transportation, long waiting times, conflict between clinic hours and work and school schedules, embarrassment attached to seeking STD services, method of specimen collection, and concerns about confidentiality (e.g., Explanation of Benefits for services received mailed to parents or guardians).³

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.⁴ Interventions for at-risk adolescents and young adults that address underlying aspects of the social and cultural conditions affecting sexual risk-taking behaviors are needed, as are strategies designed to improve the underlying social conditions themselves.^5,6 In addition, in designing STD programs, consideration should be given to the needs of adolescent and young adult populations including extended hours, optimizing privacy in waiting rooms, and urine based specimen collection.³

Observations

Chlamydia

In 2015, there were 981,359 reported cases of chlamydial infection among persons aged 15–24 years, representing 64.3% of all reported chlamydia cases. Among those aged 15–19 years, the rate of reported cases of chlamydia increased 2.5% during 2014–2015 (1,811.9 to 1,857.8 cases per 100,000 population) (Table 10). Among those aged 20–24 years, the rate increased 4.2% during 2014–2015 (2,472.0 to 2,574.9 cases per 100,000 population) (Table 10).

Among women aged 15–24 years, the population targeted for chlamydia screening, the overall rate of reported cases of chlamydia was 3,377.6 cases per 100,000 females. Among men aged 15–24 years, the overall rate of reported cases of chlamydia was 1,132.5 cases per 100,000 males. Rates varied by state for both males and females, with the majority of states having the highest reported case rates in the South (Figures H and I).

15–19 Year Old Females — In 2015, the rate of reported chlamydia cases among women aged 15–19 years was 2,994.4 cases per 100,000 females, a 1.5% increase from the 2014 rate of 2949.3 cases per 100,000 females (Table 10). Increases in rates of reported cases of chlamydia were largest among 17–, 18–, and 19–year old women (2.1%, 2.8%, and 2.2% increases, respectively) (Table 12). However, during 2011–2015, the rate for women in this age group decreased 14.1% (Table 10).

20–24 Year Old Females — In 2015, women aged 20–24 years had the highest rate of reported chlamydia cases (3,730.3 cases per 100,000 females) compared with any other age group for either sex (Figure 5, Table 10). The overall rate of reported chlamydia cases among women in this age group increased 2.7% during 2014–2015 (Table 10). However, increases in rates of reported cases of chlamydia were largest among 23– and 24–year old women (3.0% and 5.9% increases, respectively) (Table 12). Similarly, during 2011–2015, the rate for women in this age group increased 2.8% (Table 10).

15–19 Year Old Males — In 2015, the rate of reported chlamydia cases among men aged 15–19 years was 767.6 cases per 100,000 males. During 2014–2015, the rate of reported chlamydia cases for men in this age group increased 6.3% (Table 10). However, during 2011–2015, the rate for men aged 15–19 years decreased 6.0% (Table 10).

20–24 Year Old Males — In 2015, as in previous years, men aged 20–24 years had the highest rate of reported chlamydia cases among all men (1,467.8 cases per 100,000 males). The rate for men in this age group increased 7.8% during 2014–2015 (Table 10). Similarly, during 2011–2015, the rate for men aged 20–24 years increased 12.2% (Table 10).

Gonorrhea

During 2014–2015, the rate of reported gonorrhea cases increased 5.2% for persons aged 15–19 years and 7.2% for persons aged 20–24 years (Table 21). Among women aged 15–24 years, the rate was 496.7 cases per 100,000 females. Rates varied by state, with the majority of states with the highest reported case rates in the South (Figure J). Among men aged 15–24 years, the overall rate was 398.2 cases per 100,000 males. Rates varied by state, with the majority of states having the highest reported case rates in the South (Figure K).

15–19 Year Old Females — In 2015, women aged 15–19 years had the second highest rate of reported gonorrhea cases (442.2 cases per 100,000 females) compared with other women (Figure 17, Table 21). During 2014–2015, the rate of reported gonorrhea for women in this age group increased 2.4%. However, during 2011–2015, the rate for women in this age group decreased 22.1% (Table 21).

20–24 Year Old Females — In 2015, women aged 20–24 years had the highest rate of reported gonorrhea cases (546.9 cases per 100,000 females) compared with any other age group for either sex (Figure 17, Table 21). During 2014–2015, the rate of reported gonorrhea for women in this age group increased 3.0%. However, during 2011–2015, the rate for women in this age group decreased 4.0% (Table 21).

15–19 Year Old Males — In 2015, the rate of reported gonorrhea cases among men aged 15–19 years was 244.8 cases per 100,000 males (Figure 17, Table 21). During 2014–2015, the rate of reported gonorrhea for men in this age group increased 10.1%. However, during 2011–2015, the rate for men in this age group decreased 3.1% (Table 21).

20–24 Year Old Males — In 2015, as in previous years, men aged 20–24 years had the highest rate of reported gonorrhea cases (539.1 cases per 100,000 males) compared with other men (Figure 17, Table 21). During 2014–2015, the rate of reported gonorrhea for men in this age group increased 11.6%. Similarly, during 2011–2015, the rate for men in this age group increased 22.9% (Table 21).

Primary and Secondary Syphilis

During 2014–2015, the rate of reported primary and secondary (P&S) syphilis cases increased 10.2% among persons aged 15–19 years and 14.9% among persons aged 20–24 years (Table 34).

15–19 Year Old Females — The rate of reported P&S syphilis cases among women aged 15–19 years decreased each year during 2009–2013 (from 3.3 to 1.9 cases per 100,000 females) (Figure 37, Table 34). However, the rate increased in 2014 and again in 2015. During 2014–2015, the rate increased 12.0%, from 2.5 to 2.8 cases per 100,000 females (Figure 37, Table 34).

20–24 Year Old Females — In 2015, women aged 20–24 years had the highest rate of P&S syphilis (5.1 cases per 100,000 females) compared with other women (Figure 36, Table 34). The P&S syphilis rate among women in this age group has increased each year since 2011 (Figure 37, Table 34). During 2014–2015, the rate increased 13.3%.

15–19 Year Old Males — In 2015, the rate of reported P&S syphilis among men aged 15–19 years was 8.0 cases per 100,000 males (Figure 36, Table 34). The P&S syphilis rate among men in this age group has increased each year since 2011 (Figure 38, Table 34). During 2014–2015, the rate increased 12.7%.

20–24 Year Old Males — In 2015, men aged 20–24 years had the second highest rate of reported P&S syphilis cases compared with any other age group for either sex (Figure 36). The P&S syphilis rate among men in this age group has increased each year since 2006 (Figure 38, Table 34). During 2014–2015, the rate increased 15.5%, from 30.9 to 35.7 cases per 100,000 males.

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*. 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. Additional information about NJTP can be found in Appendix A Section A2.1.

Among women entering the program in 43 states and Puerto Rico, the median state-specific chlamydia prevalence in 2015 was 12.7% (range: 5.4% to 20.5%) (Figure L). Among men entering the program in 48 states, the District of Columbia and Puerto Rico, the median state-specific chlamydia prevalence was 7.5% (range: 2.6% to 12.3%) (Figure M).

Among women entering the program in 43 states and Puerto Rico, the median state-specific gonorrhea prevalence in 2015 was 1.9% (range: 0.0% to 6.8%) (Figure N). Among men entering the program in 39 states and Puerto Rico, the median state-specific gonorrhea prevalence was 0.7% (range: 0.0% to 2.9%) (Figure O).

* Laboratory tests are conducted by the Center for Disease Detection, LLC San Antonio, Texas.

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

2 Forhan SE, Gottlieb SL, Sternberg MR, et al. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics. 2009;124(6):1505-12.

3 Tilson EC, Sanchez V, Ford CL, et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions. BMC Public Health. 2004;4:21.

4 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.

5 Sieving RE, Bernat DH, Resnick MD, 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.

6 Upchurch DM, Mason WM, Kusunoki Y, et al. Social and behavioral determinants of self-reported STD among adolescents. Perspect Sex Reprod Health. 2004;36(6):276-87.

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