New data underscore importance of discussing sex, STIs sooner rather than later.
It can be difficult for pediatricians to discuss sexual activity with preadolescent patients, especially those who seem young and inexperienced. However, a recent study in Pediatrics by Forhan and colleagues1 suggests that there is a real need for early discussions of sexual activity and sexually transmitted infections (STIs). This study, as well as one in Archives of Pediatric and Adolescent Medicine by Tu and colleagues,2 indicates also that testing for STIs in sexually active adolescents should be done early and frequently-including in patients who are asymptomatic.
Forhan and colleagues analyzed data from 838 girls aged 14 to 19 years; the data were collected by the CDC in the National Health and Nutrition Examination Survey 2003-2004. Participants were interviewed, examined, and tested for chlamydial infection, gonorrhea, infection with herpes simplex virus type 2, trichomoniasis, and human papillomavirus (HPV) infection. Testing was conducted for 23 high-risk HPV strains as well as HPV types 6 and 11 (which cause most genital warts).
Sexual histories were obtained by computer-assisted audio self-interview. In the interview, "sex" was defined as oral, vaginal, or anal. The investigators considered as sexually experienced any participant who answered affirmatively when asked if she had ever had sex.
High STI prevalence demonstrated. Although results for all 5 of the STI tests were available for only 70% of the participants, at least 1 test result was available for 96%. Even with this incomplete data set, 24.1% of participants were found to have at least one STI. Of those who were sexually experienced, 37.7% had at least 1 STI. The infection identified most frequently was HPV infection, followed by chlamydial infection.
The prevalence of STIs increased with age, from 14.1% in 14- to 15-year-olds to 33.8% in 18- to 19-year-olds. The prevalence was higher among non-Hispanic black participants than among those who were non-Hispanic white or Mexican American. STI prevalence increased with time since first sexual experience and with lifetime number of partners. However, even those participants with less than 1 year of sexual experience or only 1 lifetime partner had significant infection rates (19.2% and 19.7%, respectively).
Forhan and colleagues1 state that their study was limited by the fact that sexual history data were self-reported, as well as by some gaps in their records. They did not investigate syphilis or HIV prevalence and did not test for all strains of HPV. In addition, laboratory data were missing for many participants, with more test results missing in those who were younger and sexually inexperienced.
Despite these limitations, the Forhan study revealed an impressive prevalence of STIs in adolescent girls, including in girls who had only recently become sexually active and in those with only 1 lifetime partner. Tu and colleagues2 found that among the adolescents in their study, the mean age at first intercourse was 14.2 years; they also found that 25% of urban adolescents have their first chlamydial infection within 1 year of having intercourse.
Early, frequent STI testing also important. These studies emphasize the importance of early discussions of sexual activity and STI prevention, as well as the importance of early and frequent STI testing, especially testing for Chlamydia trachomatis. The study findings should also bolster our support for HPV vaccination of girls while young enough that they are still likely to be sexually inexperienced. By opening our eyes to the realities of adolescent sexual activity, we can hopefully prevent, identify, and treat infections before permanent damage is done.
Forhan SE, Gottlieb SL, Sternberg MR, et al. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States.
Tu W, Batteiger BE, Wiehe S, et al. Time from first intercourse to first sexually transmitted infection diagnosis among adolescent women.
Arch Pediatr Adolesc Med