Talking to Adolescents About Sexually Transmitted Infections

Hello. I am Dr. Catherine Satterwhite, epidemiologist in the Division of STD Prevention at the Centers for Disease Control and Prevention (CDC). I am also the lead author of a new paper^[1] published in February of 2013 estimating the number of prevalent and incident sexually transmitted infections in the United States.

Every year in the United States, there are nearly 20 million new sexually transmitted infections (STIs). Nearly half of these new infections occur in young people, aged 15-24 years. The high number of incident STIs in the United States underscores the need for increased prevention efforts.

Most of these STIs will not cause harm; however, if left untreated, some of them can lead to serious health issues. Undiagnosed and untreated chlamydia or gonorrhea, for example, can increase a woman's chances of infertility. Increasing strains of drug-resistant gonorrhea have made successful treatment of the infection more difficult, and have prompted CDC to update recommendations for its treatment. In addition, some types of human papillomavirus (HPV) infections can lead to genital warts and cervical cancer.

For these reasons, it is important for clinicians to talk to their young patients about STI prevention and to conduct appropriate testing. Young people often face unique prevention challenges, including embarrassment and confidentiality concerns. Research shows that young patients may be afraid to initiate a conversation about STIs and will be looking to you, their healthcare provider, to begin the discussion.

During these conversations, it is important for you to create an environment that feels safe for your young patients to talk openly without judgment. It is also important that you make it clear that you understand that their health needs are different from the health needs of adults.

Asking about your young patient's sexual history is a good starting point for these discussions and will help you determine what tests and prevention counseling messages are necessary for your patient. For more information on how to take a sexual history, please visit www.cdc.gov/std.

The new CDC analysis also estimated that about 110 million STIs are currently prevalent in the United States. As with incident infections, HPV accounts for most prevalent infections.

Although the body's immune system clears most HPV on its own within 2 years, some infections persist and can cause genital warts, cervical cancers, and other cancers. Although there is no treatment for the virus itself, vaccines are available to prevent some of the most important types of HPV infection, including 2 of the most common types of HPV that can lead to cervical cancer. Given that most sexually active men and women will acquire HPV at some point in their lives, many can benefit from the protection that the HPV vaccine provides.

Currently, HPV vaccine is routinely recommended for 11- or 12-year-old boys and girls, as part of the adolescent vaccine schedule that also includes Tdap and the meningococcal vaccine. HPV vaccine is most effective when given before sexual debut. CDC also recommends HPV vaccination for teen girls and women through age 26 and teen boys and men through age 21 who have not been previously vaccinated. CDC recommends HPV vaccination for gay, bisexual, and other men who have sex with men through age 26, who have not been previously vaccinated.

CDC also recommends screening for the following STIs:

All adults and adolescents between the ages of 13 and 64 years should be tested at least once for HIV, regardless of recognized risk factors. Adolescents and adults at increased risk for HIV infection, such as those who have unprotected sex with multiple partners or exchange sex for money or drugs, should be tested annually. Clinicians should also screen all pregnant women for HIV.
All sexually active women aged 25 years and younger should be tested for chlamydia every year.
At-risk sexually active women should be tested for gonorrhea each year. This includes women with new or multiple sex partners or women who live in communities with a high burden of disease.
In addition, all sexually active gay, bisexual, and other men who have sex with men should be tested at least once a year for syphilis, chlamydia, gonorrhea, and HIV. Those who have multiple or anonymous partners should be screened more frequently.

For more detailed information about how to talk to your patients about STDs, or for printable fact sheets to pass along to them, please visit CDC's STD homepage at www.cdc.gov/std.

Web Resources

CDC Fact Sheet: Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States

CDC. A Guide to Taking a Sexual History

CDC Expert Commentary: Taking an Adolescent's Sexual History

CDC. HPV Vaccine Information for Clinicians: Fact Sheet

CDC. Teen-Friendly Office Tips

CDC. Focus on Adolescent Sexual Health: Webinar

Catherine Lindsey Satterwhite, PhD, MSPH, MPH, is an epidemiologist in the Health Services Research and Evaluation Branch of the Division of STD Prevention (DSTDP) at the Centers for Disease Control and Prevention (CDC) and Assistant Professor in the Departments of Preventive Medicine and Public Health and Obstetrics and Gynecology at the University of Kansas Medical Center. Dr. Satterwhite obtained her doctoral and master's degrees in epidemiology (PhD and MPH), as well as her degree in public health informatics (MSPH), from the Rollins School of Public Health at Emory University in Atlanta, Georgia.

Dr. Satterwhite is an expert in the epidemiology and surveillance of sexually transmitted infections, particularly Chlamydia trachomatis infections. Before her role in DSTDP, she worked in the Division of HIV/AIDS Prevention, conducting HIV prevention research and acting as a primary programming expert in the development of national HIV surveillance systems.

In 2006, Dr. Satterwhite joined DSTDP as the epidemiologist for the CDC-supported Infertility Prevention Project, a program that aimed to increase chlamydia and gonorrhea screening and treatment among young women to prevent the development of adverse outcomes of infection, including tubal factor infertility. Currently, she leads the evidence-based medicine curriculum for first- and second-year medical students at the University of Kansas Medical School while teaching epidemiology and serving as the resident expert in infectious disease epidemiology. Dr. Satterwhite is also working to address outstanding issues in STD prevention, including the development of STD screening recommendations among incarcerated individuals.