CHICAGO More than 3 million teenage girls have at least one sexually transmitted disease, and 15% of those have multiple infections, according to the first large study of STDs in this population.
Overall, 26% of 14- to 19-year-olds were infected with at least one STD, according to the population-based study sponsored by the Centers for Disease Control and Prevention. Black teens had the highest prevalence of disease, with 48% testing positive for at least one of the four most common infections, compared with 20% of white teens, investigators reported during a CDC-sponsored conference on STD prevention.
"For any other disease, we would be calling this an epidemic," said Dr. John M. Douglas Jr., director of the CDC's Division of STD Prevention. "These high infection rates among young women, particularly African American women, are clear signs that we must continue developing ways to reach those at most risk. Screening and early treatment can prevent some of the most devastating effects of untreated STDs."
The study's lead author, Dr. Sara Forhan of the CDC, extracted her data from the 20032004 National Health and Nutrition Examination Survey, a continuous annual study that examines a nationally representative sample of U.S. households to assess a broad range of health issues. As part of the 20032004 survey, 838 girls aged 1419 years underwent STD testing for human papillomavirus (HPV), chlamydia, herpes simplex virus, and trichomoniasis. The teens underwent urine and blood testing and provided a self-collected vaginal swab to determine if an infection was present.
The analysis excluded the prevalence of gonorrhea, syphilis, and HIV infections, Dr. Forhan noted. The gonorrhea rates were not publicly available at the time of her analysis. Syphilis and HIV were excluded because they are not typically found in this age group. "We did test for syphilis and gonorrhea in women aged 1841, and in the 18- and 19-year-olds, who were also included in my analysis, there were no cases." The survey identified an overall STD rate of 26%, she said. "This means that one-quarter of our female adolescent population in the [United States]3.2 million girlshas at least one of the STDs that most commonly affect women. Far too many girls face the risk of serious effects from these diseases, including infertility and cancer." The most prevalent STD was cancer- and genital wart-associated HPV, affecting 18% of participants. Chlamydia was found in 4%, trichomoniasis in 2.5%, and herpes simplex virus type 2 in 2%. Among the teens who had an STD, 15% had more than one type of infection.
These infections occur quickly after sexual debut, Dr. Forhan noted. "Of particular importance is how fast these infections appear," she said. Among those who reported just 1 year of sexual activity, the prevalence already was 20%. Increased sexual activity leads to increased risk of infection: 50% of teens who reported three or more partners had at least one of the STDs.
The survey also showed sharp racial differences in STD prevalence, with black teens more than twice as likely as whites to have at least one STD (48% vs. 20%).
"While race itself is not a risk factor for an STD, the realities of life for many African American girlslimited access to health care, poverty, and a higher community prevalence of STDscan all contribute to an increased risk of infection," Dr. Forhan said.
The results underscore the importance of HPV vaccination for 11- and 12-year-olds, as well as chlamydia screening for all sexually active women under age 25, said Dr. Kevin Fenton, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention.
Of the adolescent girls studied, 4% were found to be infected with chlamydia. CDC/Dr. E. Arum/Dr. N. Jacobs