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MONDAY, April 11, 2022
In all, just 20% of sexually active high school students said they were tested for an STD — now called sexually transmitted infections (STIs) — in the past year, according to researchers from the U.S. Centers for Disease Control and Prevention.
"The prevalence of sexually active high school students getting tested for an STI in the past year is relatively low, despite national guidelines," said study co-author Sanjana Pampati of the CDC's division of adolescent and school health.
The study data, from the nationwide Youth Risk Behavior Survey, were collected in 2019, before the COVID-19 pandemic, and Pampati said it's likely that the pandemic further disrupted access to and use of STI testing services.
Among the 20% who reported being tested, 26% were girls and 14% were boys.
"More sexually active girls reported testing, especially at older ages, and boys who reported greater sexual risk behaviors, like higher number of sex partners and using drugs or alcohol before sex, also reported having been tested for an STI in the previous year," Pampati said.
Her team estimated that 15- to 24-year-olds account for half of all new STIs annually in the United States, and one in four sexually active teen girls has an STI. But, Pampati said, many doctors don't ask patients about their sexual activity or reinforce the importance of annual STI screening.
"Addressing this public health issue will require concerted efforts from multiple levels to improve access to STI testing among adolescents," she said.
Pampati suggested that doctors, clinics and parents all have a role to play in ensuring that more teens receive annual STI screening. For example, doctors working with teens can do routine STI screening that aligns with national testing guidelines, including taking a sexual history of their patients.
"Clinics and parents can ensure adolescents get private time with their doctor during preventive care visits," she added.
And educating young people about the need for STI testing, where services can be obtained and their right to self-consent for confidential services may also help connect them to testing services, Pampati said.
"Schools can teach adolescents about the importance of STI testing and connect young people to testing and other health services," she suggested. "Additionally, addressing barriers that we know prevent adolescents from seeking STI testing services, such as cost, transportation and stigma, are important."
Dr. David Rosenthal, medical director of the Center for Young Adult, Adolescent and Pediatric HIV at Cohen Children's Medical Center in New York City, reviewed the findings.
"This report underlines what we've seen in practice for a long time," he said.
Rosenthal said many STIs, including HIV, are seen among adolescents, which is why screening is vital.
"I always tell the young people that knowledge is power and if you know your status, you can treat something — if you don't know what's going on you can't take care of your own health," he said.
But, he added, if you don't know you have an STI, you run the risk of significant illness and, in young women, pelvic inflammatory disease. And, of course, you can transmit these infections to others.
"The way I look at it is that by knowing your status, you're not only taking care of your health, you're also taking care of the health of people you love," Rosenthal said.
To protect against getting an STI, Rosenthal recommends using condoms.
"It's very effective in decreasing both pregnancy, transmission of HIV and STIs. But we realize that sometimes that doesn't happen," he said. "If that's the case, it's really important that you go see a provider and that you can get tested for STIs."
People have sex in different ways, Rosenthal added.
"So, it's really important that when you go to your doctor, you don't just pee into a cup to look for STIs," he said. "If you have anal or oral sex, you should also get swabs for gonorrhea and chlamydia and a blood test to look for HIV and syphilis."
He recommends screening at least once a year.
"If you have a risk situation or if a condom broke or if you aren't sure about someone's status," Rosenthal said, "it always is fine to get an extra test at any time."
Many teens are reluctant to get tested for STIs, he said. It's a combination of not wanting to talk about sex with their doctor, not seeing a doctor at all, or doctors not asking patients if they are sexually active, he said.
"There was a great quote from the Institute of Medicine saying, 'It's easier to be sexually active than to talk about sex,' and I think that's true," Rosenthal said.
Frank doctor-patient conversations are all part of making sure that people take ownership and responsibility for their sexual health, he said. He added that it is important for patients to know that their health care provider understands not only their sexual health and activity, but also their sexual orientation and gender identity.
The findings were published online April 11 in the journal Pediatrics.
SOURCES: Sanjana Pampati, MPH, health scientist, division of adolescent and school health, U.S. Centers for Disease Control and Prevention, Atlanta; David Rosenthal, DO, PhD, medical director, Center for Young Adult, Adolescent and Pediatric HIV, Cohen Children's Medical Center, Queens, N.Y.; Pediatrics, April 11, 2022, online
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