Studies document high rates of STDs among young people

Nearly half of all sexually transmitted diseases occur in people ages 15-24 even though this age group only accounts for a quarter of the sexually active population. The economic cost of these infections is significant, according to two studies published in the January/February Perspectives on Sexual and Reproductive Health.

Researchers at the Centers for Disease Control and Prevention and the nonprofit reproductive health organization, Family Health International, analyzed data from various sources to conclude that young people accounted for 48% of all STDs, including 74% of Chlamydia and 60% of gonorrhea cases. The lifetime medical costs for the infections acquired annually were set at $6.5 billion in direct medical expenses with $5.9 billion spent on care related to HIV and HPV.

"The numbers are pretty staggering," said John Douglas, MD, director of the CDC's division of sexually transmitted disease prevention.

Although much of the data used were at best rough estimates, those who treat adolescents say the numbers reflect their real-life experiences. They also say that the problem may be bigger than even the statistics reveal.

"I believe these numbers," said Wendi Ehrman, MD, assistant professor of pediatrics at the Medical College of Wisconsin in Madison. "But what really bothers me is that we don't know the prevalence of undiagnosed STDs that are going untreated."

Specialists say there are several social, economic and physical factors that make this situation so difficult to control. Adolescents' psychology leads young people to take chances that put them in situations in which they are likely to be at risk of being infected. Their bodies are also more susceptible to these bacteria and viruses.

In addition, this demographic is the least likely to access regular medical care. They may feel they've outgrown their pediatrician, but have yet to link with a family physician or internist. Most are at their healthiest and have little regular contact with the medical system. This is particularly true for males.

"Adolescent males and men in their 20s don't go in for anything," said Peter Leone, MD, associate professor of medicine at the University of North Carolina at Chapel Hill.

Even if they have contact with a physician, they may not feel comfortable discussing their sexual experience with an adult -- particularly one who may reveal the information to their parents. To address this concern, the youth panel that contributed to "Our Voices, Our Lives, Our Futures: Youth and STDs," a UNC report released in conjunction with these two papers, recommended that doctors explain to parents and to young people why these conversations are strictly confidential between the physician and the patient.

Feeling a lack of privacy

Still, even if the physician does not reveal information directly to the parents, the paper trail might. Most adolescents, if they are insured, are covered by their parents' plans, and it is they who may receive the billing statement for an STD test.

"There's a lot of concern that privacy isn't really private," said Diane Blake, MD, assistant professor of pediatrics at the University of Massachusetts Medical School in Worcester.

These hurdles are still not insurmountable to building trust. The UNC report recommended that physicians work to develop strong relationships and screen both men and women as a routine part of care. Experts said this is especially key for primary care physicians because most adolescents, if they present for medical care at all, are more likely to show up in the general practice setting than at an STD or other specialized clinic.

"Anybody who sees teenagers needs to ask about sex because if you don't ask you won't know," said Dr. Ehrman, who is also the interim director of the Milwaukee Adolescent Health Program. "Don't assume that somebody isn't sexually active."

Experts acknowledged that the call for physicians to take good sexual histories may result in conversations with which neither physician nor patient feels particularly comfortable.

"Sexuality and sex are so difficult for us to discuss in this country that physicians have not been particularly well-trained in taking a sexual history," said Dr. Leone. "And physicians sometimes confuse their parental role and being the physician who handles problems as they come up."