Teenagers and sexual risk taking: The best of times and the worst of times

Abstract

Trends in sexually transmitted diseases (STD) among adolescents must be interpreted cautiously due to the variability of data quality among sources. Prevalence estimates vary with the source of data. The trends seem to indicate increasing risky sexual behaviors. Gonorrhea trends are the most stable. During 1975-89 the number of gonorrhea cases reported to the US Centers for Disease Control and Prevention declined from about 1 million to 750000 and from 200000 adolescents to 175000 adolescents. During the 1980s adolescent rates increased among males and females compared to other age groups. Gonorrhea cases and rates increased among Blacks during 1981-89 and were 10 times higher than for Whites. These differences are attributable to less successful media prevention messages in Black communities less attention in clinics due to work overload shifts to chlamydia and syphilis control and the influence of illicit drugs among a core population. When sexual activity is taken into account STD rates among adolescents are even higher. Syphilis cases declined among White males increased among Black heterosexual males and increased among minority teenaged women. Older age groups are at greater risk from syphilis but genital sores place women at greater risk of HIV infections and congenital syphilis. The incidence of chlamydia infections among adolescents is greater than gonorrhea infections. Trends are difficult to estimate due to the lack of a reporting requirement among all states. Visits due to viral STDs such as genital herpes and genital wart infections increased among adolescents from 50000 to 300000 during 1966-89. The long period of onset of HIV symptoms places 20% of all cases of AIDS within the ages of 20-29 years which means adolescent exposure. In a study in New York City about 1 in 140 adolescent women giving birth was HIV infected. Although condom use is reported to be more consistent over time recent use is under 50% of sexually active teenagers. Crack use among teenagers is associated with a high risk sexual behavior and a higher prevalence of STDs. Compliance with antibiotic medication and media influences are other factors affecting rates.