STDs increasing among young women; more prevention urged

The growing number of adolescent women diagnosed with sexually transmitted diseases reflects an increase in testing and a need for greater prevention efforts, said a Nov. 16 Centers for Disease Control and Prevention report.

The annual study, which tracked reported cases of chlamydia, gonorrhea and syphilis in the United States during 2008, showed that chlamydia and gonorrhea are most prevalent among young women age 15 to 19 -- 409,531 cases. Syphilis rates are rising in this group, the study found, increasing from 3.8 cases per 100,000 in 2007 to 5.3 in 2008.

"These three infections have tried and true prevention strategies. They're easily detected and cured. So having these infections occur means there are missed prevention opportunities," said John M. Douglas Jr., MD, director of the CDC's Division of STD Prevention.

The CDC recommends annual chlamydia screening for all sexually active women younger than 26, as well as for older women with risk factors such as multiple sexual partners. However, fewer than half of sexually active women younger than 26 get annual screenings, the CDC said.

Part of the problem, Dr. Douglas said, is that many physicians don't think their adolescent patients are at risk for STDs, so they don't raise the issue.

The CDC estimates there are about 19 million sexually transmitted infections each year -- almost half of them among people age 15 to 24.

Talking about sexual activity

Austin, Texas, family physician Jill Grimes, MD, suggests physicians incorporate questions about sexual activity into adolescent patients' annual physicals.

Because teens may have different definitions of "sex," she recommends asking patients if they have been physically intimate with anyone. When the answer is yes, Dr. Grimes encourages doctors to specifically ask if this intimacy includes oral, vaginal or anal contact.

Men who have sex with other men should be tested for gonorrhea and chlamydia, Dr. Douglas said. Most testing for men focuses on detecting urethral infections, which are more likely to be symptomatic than are pharyngeal or rectal infections, he said.

In addition to testing, physicians say it's important to educate patients on the serious health consequences of STDs, including infertility in women and an increased risk of HIV transmission among all populations. Dr. Grimes, for example, said sexually active adolescents can be warned about the risks through stories about unidentified peers.

She tells some of her patients about a seemingly healthy 19-year-old female college freshman who excelled academically and had slept with only three men. A standard STD test revealed the teen had chlamydia and HIV. "When I tell that story [my patients] are in absolute, utter shock. ... Their mouths drop open."

The CDC report also highlighted racial disparities in STD rates. Blacks represent approximately 12% of the U.S. population but accounted for about 71% of gonorrhea cases and almost half of all chlamydia and syphilis cases.

Dr. Grimes said such disparities need to be addressed. But she hopes doctors don't overlook testing patients who appear to be less at risk.

"We can't just treat who we think is high-risk."