According to research by The Medical Institute the impact of teen pregnancies is wreaking havoc on the health of our youth. Below are FAQ & statistics co
Frequently Asked Questions
- What is the impact of nonmarital teenage pregnancy?
- Generally speaking, how old are males who father nonmarital births?
- How serious is the sexually transmitted infection epidemic?
- What is the difference between “reported” and “estimated” STI cases?
- How many STIs are there and what are their names?
- How many people in America are infected with an STI? Are many of those who are infected adolescents?
- What makes adolescent females so susceptible to STIs?
- What is meant by “consistent” condom use?
- I heard that there are 6 steps to correct condom use. What are they?
- How effective are condoms in preventing STIs?
- What can be done about the epidemics of STIs and nonmarital pregnancy facing our country?
- What is abstinence?
- What is secondary virginity?
- Should parents discuss sex with their teens?
- Which viral STIs are curable and which are incurable?
- What is the difference between sexually transmitted infection (STI) and sexually transmitted disease (STD)?
What is the impact of nonmarital teenage pregnancy?
According to recent studies, one out of every three females in the US gets pregnant at least once before the age of 20. This results in over 800,000 teen pregnancies each year. Three out of every ten of these pregnancies ends in abortion. Non-marital teenage pregnancies are life-affecting for the mother, father, child, extended family and society.Teen parents are more likely than other teens to:
- – drop out of school
- – have additional out-of-wedlock children
- – change jobs
- – be on welfare
- – have mental and physical health problemsChildren born to teens are at increased risk for:
- – low birth weight
- – lower cognitive scores
- – school failure
- – becoming teenage parents
- – incarceration
- – drug abuseReferences:
- (1) The National Campaign to Prevent Teen Pregnancy. 14 and Younger, The Sexual Behavior of Young Adolescents. Washington, DC: The National Campaign to Prevent Teen Pregnancy; May 2003. Available at http://www.teenpregnancy.org. Accessed August 15, 2005.
- (2) National Center for Health Statistics. Births: Final data for 2002. National Vital Statistics Reports. 2003;52(10). Hyattsville, MD: National Center for Health Statistics, US Dept of Health and Human Services; 2003. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_10.pdf. Accessed August 26, 2005.
- (3) Centers for Disease Control and Prevention. Abortion Surveillance – United States, 2000. MMWR 2003;52(SS-12). Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2003. Available at: http://www.cdc.gov/mmwr/PDF/SS/SS5212.pdf. Accessed August 26, 2005.
- (4) Coley RL, Chase-Lansdale PL. Adolescent pregnancy and parenthood: Recent evidence and future directions. Am Psychol. 1998;53(2):152-166.
- (5) US General Accounting Office. Teen Mothers: Selected Socio-Demographic Characteristics and Risk Factors. Washington, DC: US General Accounting Office; June 1998. GAO/HEHS-98-141. Available at: http://www.hi-ho.ne.jp/taku77/refer/teenmo.pdf. Accessed August 26, 2005.
Generally speaking, how old are males who father nonmarital births?
-
- Nonmarital teenage pregnancies and births often result from relationships with males who are substantially older than the teen mother. In fact, the pregnancy rate in teens with older partners is 4 times the rate in girls whose partner is close in age.Some of the most specific statistics extant are from an older 1992 California report which showed that:
- 30% of all pregnant teens had a male partner 3 – 5 years older
- 20% of all pregnant teens had a male partner 6 or more years older
- Males aged 20 years or older father five times as many births among middle school aged-girls as middle school-aged boys
How serious is the sexually transmitted infection epidemic?
- For many reasons, it is difficult to determine either the exact prevalence (number of currently infected persons) or incidence (number of new cases per year) of sexually transmitted infections.However the STI incidence rate was estimated at 18.9 million per year for the year 2000 – a 6 million increase over the 1996 estimate.[2]Below are incidence and prevalence rate estimates for specific STIs in 2000:[2]
| STI |
Incidence |
Prevalence |
| HPV |
5.5 million |
20 million |
| trichomonas |
5 million |
unknown |
| chlamydia |
3 million |
2 million |
| genital herpes |
1 million |
45 million |
| gonorrhea |
650,000 |
unknown |
| hepatitis B |
120,000 |
417,000 |
| syphilis |
70,000 |
unknown |
| HIV |
43,000 |
930,000(3) |
References:
(1) Weinstock H, Berman S, Cates W, Jr. Sexually transmitted infections among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health.;36(1):6-10.
(2) Centers for Disease Control and Prevention. Tracking the hidden epidemics 2000: Trends in STIs in the United States. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2000. Available at: http://www.cdc.gov/nchstp/od/news/RevBrochure1pdftoc.htm. Accessed August 15, 2005.
(3) Centers for Disease Control and Prevention. HIV/AID Surveillance Report, 2003. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2003. Available at: http:www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf. Accessed August 4, 2005.
What is the difference between “reported” and “estimated” STI cases?
- “Reported” STI cases are those for which the results of a medical test have been reported at the local, state or federal level. While STI reporting requirements and mechanisms have improved, they do have limitations. Even the best national STI reporting system falls far short of determining the actual number of STI cases. Here are some of the reasons:- Many STIs cause no symptoms at all or result in “delayed” symptoms
– For a variety of reasons, even when they have symptoms of an STI, some persons still don’t seek medical care
o They may not know where to go
o They may not have the financial resources to pay for treatment
o They may deny that they have symptoms
– Doctors often treat patients for STIs without performing a laboratory test that would help them make a specific diagnosis
– Doctors and laboratories may fail to report patients with laboratory-confirmed STIs
Public health officials are highly aware of the limitations of the reporting system, and consider all of these factors when they “estimate” the number of STI cases.
For example, although just over 877, 000 cases of chlamydia were reported in 2003, the estimated number of new chlamydia infections is more than three million.[1]
Reference:
(1) Centers for Disease Control and Prevention. Sexually Transmitted Infection Surveillance, 2003. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; September 2004. Available at: http://www.cdc.gov/sti/stats/03pdf/Survtext.pdf. Accessed August 26, 2005.
How many STIs are there and what are their names?
- The number of STIs (sexually transmitted infections) will vary depending on what is counted as an STI and whether sexually transmissible infections are also counted. The Medical Institute uses a list of STIs that is adapted from chapter headings in a standard STI textbook (usually referred to by the name of its primary editor, KK Holmes). This list, which appears below in alphabetical order, has 29 different infections.
Bacterial:
1 bacterial vaginosis
2 campylobacteriosis
3 chancroid
4 chlamydia
5 Donovanosis
6 gonorrhea
7 lymphogranuloma venereum
8 mycoplasmas, genital
9 salmonellosis
10 syphilis
11 treponematoses, endemicEctoparasitic:
12 lice, pubic
13 scabiesFungal:
14 candidiasis, vulvovaginal
- Protozoal:
15 amebiasis
16 cryptosporidium
17 giardiasis
18 trichomoniasisViral:
19 cytomegalovirus
20 Epstein Barr virus
21 hepatitis A
22 hepatitis B
23 hepatitis C
24 hepatitis D
25 herpes simplex virus (HSV-1 & HSV-2)
26 human immunodeficiency virus (HIV)
27 human papillomavirus (HPV)
28 human T-cell lymphotropic virus (HTLV-1)
29 molluscum contagiosum
- Reference:
- Holmes KK, Sparling PF, Mardh P, et al. Sexually Transmitted Infections. 3rd ed. New York, NY: McGraw Hill; 1999:vi-vii. (chapter headings).
How many people in America are infected with an STI? Are many of those who are infected adolescents?
- In 2004, it was estimated that in 2000 there were
– 18.9 million new cases of STIs
– 68 million total cases of STIs – a combination of new and chronic cases.About half of the new cases occurred among 15- to 24-year-olds. Three STIs (human papillomavirus, trichomoniasis and chlamydia) accounted for 88% of all new cases of STI among 15- to 24-year-olds.Reference:
Weinstock H, Berman S, Cates W, Jr. Sexually transmitted infections among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36(1):6-10.
- What makes adolescent females so susceptible to STIs?
In all females the cervix is covered with 2 cell types—epithelial (skin-like) cells and columnar (like the cells lining the intestine) cells. In mature females, the outer part of the cervix (ie, the part the doctor sees when he or she looks at the cervix to obtain cells for a PAP smear) is covered with multiple layers of hardy (squamous) epithelial cells, and the upper part inside the cervical canal is lined with fragile columnar cells. Where the 2 cell types meet is referred to as the squamocolumnar (SC) junction. The location of this junction varies considerably between adolescents/young females and mature females. Adolescents/young females have a normal condition referred to as ectopy. With ectopy, the junction between the 2 cell types is somewhere on the outer cervix (where a physician could see it on pelvic exam) rather than inside the cervical canal. The more ectopy there is, the larger the diameter of fragile columnar cells on the outer exposed surface of the cervix. In addition to being highly susceptible to STIs, the exposed columnar and SC junction cells are more easily transformed into precancerous cells or into cancer if infected with human papillomavirus.
- What is meant by “consistent” condom use?
Consistent condom use means using a condom 100% of the time during every sex act. Few individuals actually manage to use condoms consistently and correctly for any length of time. Typical condom use is inconsistent. Studies have shown that even in couples in which one partner is known to be infected with HIV, consistent use was attained by only 45% of the participants.[1]
How do teens fare? A study conducted over a period of six months found that “always” condom use was reported by adolescent females only 13% of the time.[2] In another study, just 50% of females reported consistent condom use.[3] Generally, adolescent males report slightly more condom use than females.[4]
Unfortunately, inconsistent use provides little to no risk reduction for most STIs. According to NIH panel on condom effectiveness, even if 100% consistent condom use could be attained, it would not totally eliminate the risk of acquiring any sexually transmitted infection, including HIV.[5]
References:
(1) Buchacz K, van der Straten A, Saul J, Shiboski SC, Gomez CA, Padian N. Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples. J Acquir Immune Defic Syndr. 2001;28(3):289-297.
(2) Bunnell RE, Dahlberg L, Rolfs R, et al. High prevalence and incidence of sexually transmitted infections in urban adolescent females despite moderate risk behaviors. J Infect Dis. 1999;180(5):1624-1631.
(3) Crosby RA, DiClemente RJ, Wingood GM, Lang D, Harrington KF. Value of consistent condom use: a study of sexually transmitted infection prevention among African American adolescent females. Am J Public Health. 2003;93(6):901-902.
(4) Sonenstein F, Ku L, Lindberg L, Turner C, Pleck J. Changes in sexual behavior and condom use among teenaged males: 1988 to 1995. Am J Public Health. 1998;88(6):956-959.
(5) National Institutes of Health. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Infection Prevention. Bethesda, MD: National Institutes of Health, US Dept of Health and Human Services; 2001. Available at: http://www.niaid.nih.gov/dmid/stis/condomreport.pdf. Accessed August 26, 2005.
I heard that there are 6 steps to correct condom use. What are they?
According to the Centers for Disease Control and Prevention (CDC), the following are the “six steps to correct condom use.”
1. Use a new condom with each act of sexual intercourse.
2. Carefully handle the condom to avoid damaging it with fingernails, teeth or other sharp objects.
3. Put the condom on after the penis is erect and before any genital contact with the partner.
4. Use only water-based lubricants with latex condoms. Oil-based lubricants can weaken latex.
5. Ensure adequate lubrication during intercourse, possibly requiring the use of exogenous lubricants.
6. Hold the condom firmly against the base of the penis during withdrawal, and withdraw while the penis is still erect to prevent slippage.
Almost no studies actually measure correct condom use. In theory, condom effectiveness against STI transmission is further diminished if a condom is used incorrectly. In a study of college males, more than a third reported major errors in condom use over a three-month time period, despite having received instructions on correct use.
References:
(1) Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines 2002. MMWR 2002;51(RR-06). Atlanta, GA: Centers for Disease Control and Prevention, US Dept. of Health and Human Services; 2003. Available at: http://www.cdc.gov/mmwr/PDF/RR/RR5106.pdf. Accessed August 25, 2005.
(2) Crosby RA, Sanders SA, Yarber WL, Graham CA, Dodge B. Condom use errors and problems among college men. Sex Transm Dis. 2002;29(9):552-557.
How effective are condoms in preventing STIs?
- Condom breakage and slippage is estimated to occur 1-4% of the time. This is known as method failure.
By far the most extensive research on condom effectiveness has been done for HIV. A number of authors have performed meta-analyses (summaries) of other studies. These meta-analyses show that with 100% consistent condom use, condoms reduce the risk of HIV transmission by about 85%.[4] Condom effectiveness against transmission of bacterial diseases like gonorrhea, chlamydia and syphilis is significantly lower than for HIV.[2] Conclusive evidence is lacking for condom effectiveness against transmission of several other specific STIs, such as HPV and T. vaginalis, which each affect over 5 million people annually.[2] Finally, effectiveness is seriously limited for the many STIs which are transmitted through skin-to-skin contact, since condoms do not cover all the areas of the body which may be the source of transmission.
The major factor affecting “condom effectiveness” is not method failure, over which the user has no control, but user failure — the incorrect and inconsistent use of condoms during sexual acts.
References:
(1) Steiner M, Dominik R, et al. Contraceptive Effectiveness of a polyurethane condom and a latex condom: a randomized controlled trial. Obstet Gynecol. 2003;101(3):539-547.
(2) National Institutes of Health. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Infection Prevention. Bethesda, MD: National Institutes of Health, US Dept of Health and Human Services; 2001. Available at: http://www.niaid.nih.gov/dmid/stis/condomreport.pdf. Accessed August 26, 2005.
(3) Frezieres RG, Walsh TL, Nelson AL, Clark VA, Coulson AH. Evaluation of the efficacy of a polyurethane condom: results from a randomized, controlled, clinical trial. Fam Plann Perspect. 1999;31(2):81-87.
(4) Macaluso M, Kelaghan J, Artz L, et al. Mechanical failure of the latex condom in a cohort of women at high STI risk. Sex Transm Dis. 1999;26(8):450-458.
What can be done about the epidemics of STIs and nonmarital pregnancy facing our country? Are teens really listening?
People who postpone sexual activity until marriage to an uninfected partner are completely protected from STIs and nonmarital pregnancy. If this behavior choice (ie, abstinence) were to become normative again, it is likely that these epidemics would be reversed.
There is evidence that many teens are getting this message. According to Youth Risk Behavior Surveillance data, over half of teens in high school are not having sexual intercourse. From 1991 through 2001 the number of teens not having sexual intercourse increased from 46% to 54%. Additionally, the number of teens with four or more lifetime partners decreased significantly from 1991 to 2001.[1] Most adolescents will postpone sexual activity (become or remain abstinent) with proper instruction and encouragement, especially from parents.
Reference:
(1) Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines 2002. MMWR 2002;51(RR-06). Atlanta, GA: Centers for Disease Control and Prevention, US Dept. of Health and Human Services; 2003. Available at: http://www.cdc.gov/mmwr/PDF/RR/RR5106.pdf. Accessed August 25, 2005.
What is abstinence?
Abstinence is refraining from all sexual activity.
Sexual activity means sex as well as other actions intended to result in sexual arousal or gratification.
– Sex includes penile-vaginal, anal and oral sex.
– Other actions intended to result in sexual arousal or gratification, include, but not limited to, masturbation, mutual masturbation, fondling, the use of sex toys and the viewing of pornography.
Abstinence is the healthiest behavior for unmarried individuals.
What is secondary virginity?
“Secondary virginity” is a return to abstinence following sexual debut. A commitment to secondary virginity is often made with the goal of remaining abstinent until committed to a life-long monogamous relationship, such as marriage. Increasing numbers of teens and young adults are making this decision to reduce their considerable risk for sexually transmitted infections and nonmarital pregnancies. Parents, peers, family physicians, youth directors, teachers and health educators all play important roles in encouraging sexually active youth to turn to abstinence.
Should parents discuss sex with their teens?
Absolutely. Multiple studies demonstrate that parent-child communication has an important protective effect on adolescent sexual behavior.Parents need to be actively involved with their teens and take time to clearly communicate their own values and expectations.
– Teens who feel close to their parents are much less likely to engage in risky behavior.
– Teens whose parents express disapproval of nonmarital sex and contraceptive use are less likely than their peers to have sex.
– Teens who talk to a parent about sex tend to wait to have sex, have fewer sexual partners, and are more likely to name a parent than a peer as a good source of information about sex.
References:
(1) Karofsky PS, Zeng L, Kosorok MR. Relationship between adolescent-parental communication and initiation of first intercourse by adolescents. J Adolesc Health. 2000;28(1):41-45.
(2) Resnick M, Bearman D, Blum R, et al. Protecting adolescents from harm. Findings from the national longitudinal study on adolescent health. JAMA. 1997;278(10):823-832.
(3) DiIorio C, Kelley M, Hockenberry-Eaton M. Communication about sexual issues: mothers, fathers, and friends. J Adolesc Health. 1999;24(3):181-189.
(4) Jaccard J, Dittus P, Gordon V. Parent-teen communication about premarital sex: factors associated with the extent of communication. J of Adolesc Res. 2000;15(2):187-208.
(5) Lederman RP, Chan W, Roberts-Gray C. Sexual risk attitudes and intentions of youth aged 12-14 years: survey comparisons of parent-teen prevention and control groups. Behav Med. Winter 2004;29(4):155-163.
(6) Whitaker D, Miller K. Parent-adolescent discussions about sex and condoms: impact on peer influences of sexual risk behavior. J Adolesc Res. 2000;15(2): 51-273.
Are viral STIs curable? Which STI’s are incurable?
Herpes and HIV: These are the only two viral STIs which are always chronic. Even though people with herpes or HIV cannot currently be cured, their symptoms can be treated.
HPV: In females, 70-90% of HPV infections are cleared by the body’s immune system within 12-24 months of detection.[1-2] Those who are infected with high-risk (cancer-causing) HPV types and do not clear their infection quickly are at risk for persistent infection. There is no cure for persistent HPV. Persistant HPV infection is a risk factor for the development of cervical cancer. All woman should have routine pap smears by age 21. Females who initiate sex before 18 should consult their doctor.[3]
Hepatitis B: Most adults who are infected with hepatitis B virus (HBV) recover from their infections; the remainder develop chronic infections.[4]
Hepatitis C: Approximately 15% of those who are infected with hepatitis C virus (HBV) recover from their infection; however the vast majority develop chronic infections.[5]
References:
(1) Moscicki, A. Cervical cytology screening in teens. Curr Womens Health Rep. 2003;3(6):433-437.
(2) Ho GY, Bierman R, Beardsley L, et al. National history of cervicovaginal papillomavirus in young women. N Engl J Med. 1998;338(7):423-428.
(3) ACOG Guidelines.
(4) Lemon SM, Alter MJ. Viral Hepatitis. In: Holmes KK, et al. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw Hill; 1999:361-384.
(5) Watts DH. Hepatitis C, D, and E in pregnancy. In: Mead PB, Hager WD, Faro S, eds. Protocols for infectious Diseases in Obstetrics and Gynecology. 2nd ed. Malden, MA: Blackwell Science; 2000:215-224.
What is the difference between sexually transmitted infection (STI) and sexually transmitted disease (STD)?
These terms are often confused, but they are not inter-changeable. Sexually transmitted infection is the broadest term. All STDs are STIs, but not all STIs are STDs.
Sexually Transmitted Infection: Invasion of and multiplication in bodily tissue by a microorganism (eg, bacterium, virus, protozoan) that is usually (more than half the time) passed from one person to another during during intimate bodily contact meant to give or derive sexual gratification.
Sexually Transmitted Disease: Pathology (ie, damage) with or without symptoms secondary to an infection that is usually (more than half the time) passed from one person to another during intimate bodily contact meant to give or derive sexual gratification.
