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Incidence and consequences of STDs.

Every year, 3 million teenagers acquire an STD. Adolescents thus account for a quarter of the 12 million new sexually transmitted infections that occur annually in the United States (134) (Figure 28, page 38).

* About 25% of sexually experienced adolescents become infected each year. (135)

* Roughly 13% of young people between the ages of 13 and 19 contract an STD annually. (136)

The Variety of STDs

A wide variety of diseases can be transmitted through sexual intimacy. Chlamydia, trichomoniasis, gonorrhea, human papillomavirus (HPV), genital herpes, hepatitis B, syphilis and HTV are among the most common STDs. Some diseases, including chlamydia, gonorrhea, trichomoniasis and syphilis, can generally be cured quite easily if they are detected and treated early. On the other hand, viral infections--such as HPV, genital herpes, hepatitis B and HIV--cannot be cured and can be transmitted to sexual partners even years after initial infection. Some 56 million Americans--more than one in five--are estimated to be infected with a viral STD other than HIV; 1 million are believed to have the virus that causes AIDS. (137)

Data on STD incidence and prevalence among teenagers are often incomplete or extrapolated from small clinical samples. Available information, however, suggests that some STDs are extremely common among adolescents.

* Between 10% and 29% of sexually experienced adolescent women tested for STDs have been found to have chlamydia. (138)

* Up to 15% of sexually experienced teenage women are infected with HPV; in some studies, the majority have a strain of the virus linked to cervical cancer. (139)

* The rate of reported cases of infectious syphilis among adolescent women has more than doubled since the mid-1980s. (140)

* Sexually experienced women and men aged 15-19 have higher rates of gonorrhea than any five-year age-group between 20 and 44. (141)

* Although the number of reported AIDS cases among teenagers is very small, about 20% of AIDS cases are diagnosed in people in their 20s, most of whom probably contracted HIV during adolescence. (142)

The Consequences of STDs

Both men and women can suffer serious health problems--such as infertility, cancer or HIV infection--as a consequence of a sexually transmitted infection (Figure 29, page 39). STDs have a disproportionate impact on women, however, because these diseases are both more easily transmitted to and more difficult to detect in women; as a result, complications of undiagnosed infections are far more common and severe in women. In addition, women can transmit an STD to their offspring during pregnancy or childbirth, sometimes with devastating consequences. (143)

Infertility. Many of the most serious problems associated with STDs result from undetected chlamydial and gonorrheal infections. If untreated, these diseases can develop into pelvic inflammatory disease (PID) in women and epididymitis in men, which in turn can lead to infertility and, in women, to ectopic pregnancy. Because most sexually experienced teenage women postpone childbearing, untreated STDs are likely to have a greater impact on young women than on older women, many of whom have already begun or completed childbearing. (144)

A sexually experienced woman's risk of becoming infertile as a consequence of an upper genital tract infection (usually caused by untreated chlamydia or gonorrhea) or of having an ectopic pregnancy (a possible result of an upper genital tract infection) is almost nonexistent if her risk of contracting an STD is low--that is, if she is in a mutually monogamous relationship with an uninfected partner. The risk of infection is substantially higher if the relationship is not mutually monogamous. In fact, being in a mutually monogamous relationship has a greater impact on reducing the risk of becoming infertile than does the choice of a contraceptive method. (145)

Even those women at high risk of acquiring an STD, however, can avoid infection-induced infertility if they choose the right contraceptive method, especially if they use it consistently.

* On average, a woman who is in a relationship that is not mutually monogamous has a 5% risk of developing tubal infertility over a five-year period if she uses no method of contraception. (146)

* Barrier and spermicidal methods, especially latex condoms, offer the maximum protection. Even when used imperfectly, condoms will reduce a woman's risk of infertility to an estimated 2%; used consistently, they provide still greater protection. (147)

* The pill and other hormonal methods offer no protection against the risk of acquiring an STD. However, they probably lower a woman's risk of ultimately developing tubal infertility, because they reduce the chances that a lower genital tract infection will ascend into the upper genital tract, where it could develop into PID and its sequelae, and they help prevent ectopic pregnancies, which can lead to infertility. (148)

Cancer, HIV Infection. Early detection and treatment of STDs can reduce the chance that men and women will develop cancers associated with HPV and hepatitis B. In addition, a number of common infections, including syphilis, genital herpes, chiamydia, trichomoniasis and gonorrhea, increase an individual's risk of contracting HTV if exposed to that virus; (149) prompt treatment of these infections may eliminate or at least reduce that risk.

STDs are extremely common among sexually experienced teenagers and can have serious, even life-threatening consequences. The surest means of preventing these problems is to be in a mutually monogamous relationship. Use of contraceptives, particularly latex condoms, can significantly reduce the likelihood of experiencing serious consequences, usually by lowering the risk of acquiring an STD. When infection does occur, timely treatment can be crucial to protecting one's health. STDs, of course, are not the only negative consequence of unprotected sex. 134. CDC, 1993.

(134.) CDC, 1993.

Some individuals are infected with more than one STD at the same time, but there are no data en the overlap of infections. In fact, all figures on the incidence and prevalence of STDs are rough. The Centers for Disease Control and Prevention, and this report, assumes that the number of infections equals the number of infected people.

(135.) Calculated by AGI on the basis of data in CDC, 1993a; Forrest and Singh, 1990; Harlap, Kost and Forrest, 1991; Sonenstein, Pleck and Ku, 1989; U.S. Bureau of the Census, 1990.

(136.) CDC, 1993; U.S. Bureau of the Census, 1990.

(137.) CDC, 1993, p.29; Donovan, 1993.

(138.) Effler et al., 1992; Schachter, 1989, p.803.

(139.) Moscicki et al., 1990, p.507.

(140.) CDC, 1993, Figure 17.

(141.) CDC 1992, Figure 21; Forrest and Singh, 1990, Table 3, p.208; Billy et al., 1993 Table 1, p.54; Sonenstein, Pleck and Ku, 1989, Table 1, p. 153.

(142.) CDC, 1993, Table 19, p.207.

Screening of military recruits indicates that three teenagers in 10,000 entering the military are infected with HIV; the rate among black teenagers is one in 1,000. Screening of youth aged 16-21 entering the Job Corps, a program that provides education, job training and employment to disadvantaged teenagers, finds a higher level of HIV infection--about four per 1,000. Entrants who are black have the highest infection rate--five per 1,000, compared with three per 1,000 for Hispanics and one per 1,000 for white youth. On average, the incubation period between infection and onset of AIDS is 11 years.

(143.) Aral and Guinan, 1984; Donovan, 1993.

(144.) CDC, 1993; Donovan, 1993, pp. 24-25; Harlap, Kost and Forrest, 1991, pp. 42-44.

(145.) Forrest and Cates, 1993; Harlap, Kost and Forrest, 1991, pp.45-55.

(146.) Harlap, Kost and Forrest, 1991, pp. 53-55.

(147.) Harlap, Kost and Forrest, 1991, p.55; Kestelman and Trussell, 1991, pp. 226-227.

(148.) Harlap, Kost and Forrest, 1991, pp. 50-52.

(149.) Wasserheit, 1992, pp.61-77.

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FIGURE 29

EFFECTS OF STDS

STDs have similar effects on women and men, including teenagers,
although complications are more common in women. Chlamydia and
gonorrhea can cause infertility in both women and men if not
recognised and treated early.

Disease and Consequences for the infected
 person
annual incidence Woman

CURABLE, NONVIRAL DISEASES
Chlamydia Pelvic inflammatory disease
 4 million Ectopic pregnancy
 Chronic pelvic pain
 Infertility
 Increased risk of HIV if
 exposed

Trichomoniasis Increased risk of HIV if
 3 million exposed

Gonorrhea Pelvic inflammatory disease
 1.1 million Ectopic pregnancy
 Infertility
 Infection of joints, heart
 valves or brain
 Increased risk of HIV if
 exposed

Syphilis Serious damage to many
 120,000 body systems
 Mental illness
 Increased risk of HIV if
 exposed

Chancroid Increased risk of HIV if
 3,500 exposed

NONCURABLE, VIRAL DISEASES
HPV Cancer of cervix, vulva,
 500,000-1 million vagina or anus

Genital herpes Increased risk of HIV if
 200,000-500,000 exposed


Hepatitis B Cirrhosis
 100,000-200,000 Liver cancer
 Immune system disorders

HIV Immune system disorders
 40,000-50,000 Increased risk of other
 STDs

Disease and Consequences for theinfected
 person
annual incidence Man

CURABLE, NONVIRAL DISEASES
Chlamydia Epididymitis
 4 million Infertility
 Increased risk of HIV if
 exposed



Trichomoniasis Increased risk of HIV if
 3 million exposed

Gonorrhea Infertility
 1.1 million Infection of joints, heart
 valves or brain
 Increased risk of HIV if
 exposed



Syphilis Serious damage to many
 120,000 body systems
 Mental illness
 Increased risk of HIV if
 exposed

Chancroid Increased risk of HIV if
 3,500 exposed

NONCURABLE, VIRAL DISEASES
HPV Cancer of penis or anus
 500,000-1 million

Genital herpes Increased risk of HIV if
 200,000-500,000 exposed


Hepatitis B Cirrhosis
 100,000-200,000 Liver cancer
 Immune system disorders

HIV Immune system disorders
 40,000-50,000 Increased risk of other
 STDs

Disease and Consequences for theinfected
 person
annual incidence Fetus and newborn

CURABLE, NONVIRAL DISEASES
Chlamydia Premature delivery
 4 million Pneumonia
 Neonatal eye infections




Trichomoniasis Premature delivery
 3 million

Gonorrhea Blindness
 1.1 million Meningitis
 Septic arthritis





Syphilis Stillbirth or neonatal death
 120,000 Active syphilis
 Damage to heart, brain or eyes



Chancroid Unknown
 3,500

NONCURABLE, VIRAL DISEASES
HPV Warts in throat that can
 500,000-1 million obstruct air passages

Genital herpes Premature delivery
 200,000-500,000 Serious brain damage
 Death

Hepatitis B Liver disease
 100,000-200,000 Liver cancer


HIV Immune system disorders
 40,000-50,000 AIDS


Sources: HIV: Centers for Disease Control and Prevention, "Projections
of the Number of Persons Diagnosed with AIDS and the Number of
Immunosuppressed HIV-Infected Persons, United States, 1992-1994,
"Morbidity and Mortality Weekly Report, 41:18-19, 1992, Table 6.

All others: P. Donovan, Testing Positive: Sexually Transmitted Disease
and the Public Health Response, AGI, New York, 1993, pp. 10-17.
FIGURE 28

STD CASES, BY AGE

An estimated 3 million adolescent women and men get an STD each year,
accounting for 25% of all new STDs cases annually.

Estimated new cases of STDs, 1992: 12,000,000


Aged 19 and younger 25%
Aged 20-24 41%
Aged 25 and older 34%

Source: Centers for Disease Control and Prevention, Division of STD/HIV
Prevention, 1992 Annual Report, Atlanta, 1993.

Note: Table made from pie chart
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Title Annotation:sexually transmitted diseases
Publication:Sex and America's Teenagers
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Jan 1, 1994
Words:6033
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