Nationally Representative CDC Study Finds 1 in 4 Teenage Girls Has a Sexually Transmitted Disease
-- 3.2 Million Female Adolescents Estimated to Have at Least One of the Most Common STDs -- _
-- Other Studies Featured at 2008 National STD Prevention Conference Show Missed Opportunities for STD Screening and Innovative Solutions for STD Prevention and Treatment --
Chicago (March 11, 2008) - A CDC study released today estimates that one in four (26 percent) young women between the ages of 14 and 19 in the United States - or 3.2 million teenage girls - is infected with at least one of the most common sexually transmitted diseases (human papillomavirus (HPV), chlamydia, herpes simplex virus, and trichomoniasis). The study, presented today at the 2008 National STD Prevention Conference, is the first to examine the combined national prevalence of common STDs among adolescent women in the United States, and provides the clearest picture to date of the overall STD burden in adolescent women.
Led by CDC's Sara Forhan, M.D., M.P.H., the study also finds that African-American teenage girls were most severely affected. Nearly half of the young African-American women (48 percent) were infected with an STD, compared to 20 percent of young white women.
The two most common STDs overall were human papillomavirus, or HPV (18 percent), and chlamydia (4 percent). Data were based on an analysis of the 2003-2004 National Health and Nutrition Examination Survey.
"Today's data demonstrate the significant health risk STDs pose to millions of young women in this country every year," said Kevin Fenton, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. "Given that the health effects of STDs for women - from infertility to cervical cancer - are particularly severe, STD screening, vaccination and other prevention strategies for sexually active women are among our highest public health priorities."
"High STD infection rates among young women, particularly young African-American women, are clear signs that we must continue developing ways to reach those most at risk," said John M. Douglas, Jr., M.D., director of CDC's Division of STD Prevention. "STD screening and early treatment can prevent some of the most devastating effects of untreated STDs."
CDC recommends annual chlamydia screening for sexually active women under the age of 25. CDC also recommends that girls and women between the ages of 11 and 26 who have not been vaccinated or who have not completed the full series of shots be fully vaccinated against HPV.
The study of STDs among teenage girls is one of several presented today at the 2008 National STD Prevention Conference that highlights the significant burden of STDs among girls and women, and identifies creative prevention strategies for reducing the toll of STDs in the United States.
Contraceptive services represent missed opportunities for STD screening, prevention
Two other studies featured at the conference point to missed opportunities for STD testing, and underscore that it is critical for STD screening to be included in comprehensive reproductive health services for young women.
A study by CDC's Sherry L. Farr and colleagues found that while the majority of sexually active 15- to-24 year-old young women (82 percent) receive contraceptive or STD/HIV services, few receive both (39 percent). In addition, only 38 percent of a subset of young women who reported receiving contraceptive services associated with unprotected sex (e.g., pregnancy testing) also received STD/HIV counseling, testing or treatment, which indicates that many women at high risk are not receiving necessary prevention services.
A separate study, by CDC's Shoshanna Handel and the New York City Department of Health and Mental Hygiene, examined STD screening rates among young women seeking emergency contraception, which would suggest recent unprotected sex. The study found that just 27 percent were screened for chlamydia or gonorrhea. A significant proportion of those women (12 percent) had a positive test result, highlighting the need for routine chlamydia and gonorrhea screening at emergency contraception visits.
Innovative programs provide models for effective STD prevention
Other research from the conference highlighted creative programs that are effectively screening and treating people with STDs, and identifying those most at risk.
A CDC-funded confidential chlamydia screening program in high school-based health clinics in California resulted in high rates of screening among those seeking contraceptive or STD services (range: 85-94 percent). It also revealed significantly higher infection rates among African-American women than white women (9.6 percent versus 1.7 percent).
A study by New York City health officials assessed the effectiveness of an express visit option, allowing patients at city clinics to be tested for STDs without a doctor's exam. Comparing data before and after express visits were routinely offered, researchers found that the express visit option made it possible for an additional 4,588 tests to be performed, and increased STD diagnoses by 17 percent (2,617 versus 2,231).
# # #
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Sex Infections Found in Quarter of Teenage
By LAWRENCE K. ALTMAN
Published: March 12, 2008
The first national study of four common sexually transmitted diseases among girls and young women has found that one in four are infected with at least one of the diseases, federal health officials reported Tuesday.
Nearly half the African-Americans in the study of teenagers ages 14 to 19 were infected with at least one of the diseases monitored in the study - human papillomavirus (HPV), chlamydia, genital herpes and trichomoniasis, a common parasite.
The 50 percent figure compared with 20 percent of white teenagers, health officials and researchers said at a news conference at a scientific meeting in Chicago.
The two most common sexually transmitted diseases, or S.T.D.'s, among all the participants tested were HPV, at 18 percent, and chlamydia, at 4 percent, according to the analysis, part of the National Health and Nutrition Examination Survey.
Each disease can be serious in its own way. HPV, for example, can cause cancer and genital warts.
Among the infected women, 15 percent had more than one of the diseases.
Women may be unaware they are infected. But the diseases, which are infections caused by bacteria, viruses and parasites, can produce acute symptoms like irritating vaginal discharge, painful pelvic inflammatory disease and potentially fatal ectopic pregnancy. The infections can also lead to longterm ailments like infertility and cervical cancer.
The survey tested for specific HPV strains linked to genital warts and cervical cancer.
Officials of the Centers for Disease Control and Prevention said the findings underscored the need to strengthen screening, vaccination and other prevention measures for the diseases, which are among the highest public health priorities.
About 19 million new sexually transmitted infections occur each year among all age groups in the United States.
"High S.T.D. infection rates among young women, particularly young African-American women, are clear signs that we must continue developing ways to reach those most at risk," said Dr. John M. Douglas Jr., who directs the centers' division of S.T.D. prevention.
The president of the Planned Parenthood Federation of America, Cecile Richards, said the new findings "emphasize the need for real comprehensive sex education."
"The national policy of promoting abstinence-only programs is a $1.5 billion failure," Ms. Richards said, "and teenage girls are paying the real price."
Although earlier annual surveys have tested for a single sexually transmitted disease in a specified population, this is the first time the national study has collected data on all the most common sexual diseases in adolescent women at the same time. It is also the first time the study measured human papillomavirus.
Dr. Douglas said that because the new survey was based on direct testing, it was more reliable than analyses derived from data that doctors and clinics sent to the diseases center through state and local health departments.
"What we found is alarming," said Dr. Sara Forhan, a researcher at the centers and the lead author of the study.
Dr. Forhan added that the study showed "how fast the S.T.D. prevalence appears."
"Far too many young women are at risk for the serious health effects of untreated S.T.D.'s, " she said.
The centers conducts the annual study, which asks a representative sample of the household population a wide range of health questions. The analysis was based on information collected in the 2003-4 survey.
Extrapolating from the findings, Dr. Forhan said 3.2 million teenage women were infected with at least one of the four diseases.
The 838 participants in the study were chosen at random with standard statistical techniques. Of the women asked, 96 percent agreed to submit vaginal swabs for testing.
The findings and specific treatment recommendations were available to the participants calling a password-protected telephone line. Three reminders were sent to participants who did not call.
Health officials recommend treatment for all sex partners of individuals diagnosed with curable sexually transmitted diseases. One promising approach to reach that goal is for doctors who treat infected women to provide or prescribe the same treatment for their partners, Dr. Douglas said. The goal is to encourage men who may not have a physician or who have no symptoms and may be reluctant to seek care to be treated without a doctor's visit.
He also urged infected women to be retested three months after treatment to detect possible reinfection and to treat it.
Dr. Forhan said she did not know how many participants received their test results.
Federal health officials recommend annual screening tests to detect chlamydia for sexually active women younger than 25. The disease agency also recommends that women ages 11 to 26 be fully vaccinated against HPV.
The Food and Drug Administration has said in a report that latex condoms are "highly effective" at preventing infection by chlamydia, trichomoniasis, H.I.V., gonorrhea and hepatitis B.
The agency noted that condoms seemed less effective against genital herpes and syphilis. Protection against human papillomavirus "is partial at best," the report said.