One in 4 Teen Girls Has a Sexually Transmitted Disease

(HealthDay News) -- More than 3 million teenaged girls have at least one sexually transmitted disease (STD), a new government study suggests.

The most severely affected are African-American teens. In fact, 48 percent of African-American teenaged girls have an STD, compared with 20 percent of white teenaged girls.

"What we found is alarming," Dr. Sara Forhan, from the U.S. Centers for Disease Control and Prevention, said during a teleconference Tuesday. "One in four female adolescents in the U.S. has at least one of the four most common STDs that affects women."

"These numbers translate into 3.2 million young women nationwide who are infected with an STD," Forhan said. "This means that far too many young women are at risk of the serious health effects of untreated STDs, including infertility and cervical cancer."

These common STDs include human papillomavirus (HPV), chlamydia, herpes simplex virus and trichomoniasis, Forhan said.

Forhan announced the results as part of the CDC's 2008 National STD Prevention Conference, in Chicago.

"These findings are really giving us a lot of pause about how we provide care to adolescent girls who are sexually active," said Dr. Elizabeth Alderman, an adolescent medicine specialist at Children's Hospital at Montefiore in New York City and chairperson of the Executive Committee of the Section of Adolescent Health of the American Academy of Pediatrics. "The numbers are really astonishing."

Forhan noted that most of the burden of STDs falls on young African-American women. "Among African-American teenagers, about one in two were affected compared to one in five white teens," she said.

In terms of the racial disparity, "it's what we've always seen, which is very unfortunate," Alderman said.

In the study, Forhan's team collected data on 838 girls aged 14 to 19 who took part in the 2003-2004 National Health and Nutrition Examination Survey. The study did not include syphilis, gonorrhea or HIV, as earlier studies found very low prevalence of these diseases in this age group.

HPV and chlamydia are the most common STDs found among teenage girls, Forhan said. "Almost one in five overall had a strain of HPV associated with cervical cancer or genital warts," she said.

"We need to be screening adolescent girls who are sexually active and providing them with HPV vaccine," Alderman said. "The recommendations are to screen sexually active girls, but many girls don't disclose to their health-care provider that they are sexually active, even when asked," she said.

As for chlamydia, 4 percent of teenaged girls had this STD, Forhan said. "The majority of chlamydia infections do not have symptoms. If left untreated, it can lead to pelvic inflammatory disease, which leaves these young women at risk for atopic pregnancy, chronic pelvic pain or infertility," she said.

In addition, the study found that 2.9 percent of young women had trichomoniasis, and 2 percent were infected with genital herpes, Forhan said.

According to Forhan, about 50 percent of the teens reported having sex, and the prevalence of STDs in this group was 40 percent. "Even for young women with only one reported lifetime sexual partner, one in five had an STD," she noted.

"If you choose to be sexually active, you need to protect yourself and be screened for these infections," Alderman said. "And all girls between the ages of 11 and 26 should get vaccinated for HPV."

Among women with an STD, 15 percent had more than one infection, Forhan added.
"These data provide a clearest picture to date of the overall burden of STDs in adolescent women in the United States," Forhan said. "The study also underscores the importance of addressing racial disparities in STD rates among young women."

Race itself is not a risk factor for STDs, Forhan said. However, factors such as limited access to health care, poverty, community prevalence of STDs, and misperceptions about individual risk are some of the reasons that STD rates are particularly high among African-Americans, she said.
More information
For more on STDs, visit the U.S. Centers for Disease Control and Prevention.

Chlamydia Screening Programs Don't Work: Expert

(HealthDay News) -- Population-wide screening programs for chlamydia, the most commonly reported sexually transmitted disease, may not actually work, a Swiss expert contends.
That's especially true for so-called "opportunistic" programs, which routinely test patients for chlamydia whenever they seek medical care.

"We do not have sufficient evidence that this approach to a screening program does more good than harm at reasonable cost," said Dr. Nicola Low, an epidemiologist at the University of Bern.
But despite that, and despite increasing rates of infection in nations that have screening programs, more countries continue to adopt this approach, Low wrote in an article appearing in this week's British Medical Journal.

U.S. social health experts took a neutral tone when discussing the report.

"We support current guidelines from the Centers for Disease Control and Prevention, which recommend annual chlamydia screening for sexually active females ages 25 and younger as well as older women at risk for this disease," said Fred Wyand, a spokesman for the American Social Health Association in Research Triangle Park, N.C.

"We believe it's especially important for women to be tested for chlamydia, since the infection is often asymptomatic, but if undetected and untreated can lead to serious health complications, such as pelvic inflammatory disease and infertility," Wyand added. "We are also in favor of discussion and research to determine which approaches to screening are most effective, in terms of both cost and in reducing the incidence of chlamydia infection."

Infection with the Chlamydia trachomatis pathogen is the most common preventable cause of pelvic inflammatory disease (PID) in young women. PID, in turn, can lead to ectopic pregnancy and infertility.

Chlamydia infection, which usually causes no symptoms, is easily treated, often with a single dose of antibiotics. Detection is also easy, with a urine-sample test; results are generally available within a day.

But recent evidence is emerging to suggest that chlamydia may result in fewer severe complications that previously thought. Chlamydia is currently the only sexually transmitted infection for which population screening has been implemented, stated a BMJ editorial.
Two types of screening programs exist. Proactive screening involves using population registries to invite people to be screened for a particular infection at regular intervals. Opportunistic screening targets people using health services for other reasons.

Chlamydia screening is currently recommended in Sweden, the United States and Canada, according to the BMJ report. An opportunistic screening program for all sexually active women and men under 25 years of age, the National Chlamydia Screening Programme, is scheduled to start in England in 2008.

But the evidence for such programs is weak, Low said.

In Sweden, a drop in chlamydia rates in the mid-1990s was attributed to widespread testing, but, in fact, the fall in rates coincided with a national campaign to prevent a more dangerous pathogen, HIV. Since 1995, chlamydia infection rates have been rising again in Sweden.
Similarly, in the United States, decreases in rates of chlamydia infection have been attributed to opportunistic screening programs.

Yet no randomized, controlled trial has shown that screening reduces long-term complications from chlamydia. And studies that do show a value have not been well-designed, while tending to overestimate the cost-effectiveness of the screening programs, Low noted.

Low argued that a consistent definition of "screening program" is needed and that screening programs for all diseases should be standardized.

"There is a difference between 'screening' and a 'screening program,' " Low said. "Any benefits of screening in a population will only be achieved if screening is implemented as a program. This means regular repeated screening of all those in the target population. Opportunistic screening as usually practiced does not ensure that people who have been screened once are invited for subsequent screening tests."

The bottom line, according to the Swiss expert: "Low overall coverage and infrequent screening will not control the spread of an asymptomatic, infectious disease."

There also needs to be more research to determine if screening programs really are effective, especially the more targeted, proactive kind, Low said. "There are trials of proactive chlamydia screening showing a benefit after one round of screening," she said. "The sustainability and duration of benefit of this approach to screening are therefore unknown."

Any screening program shouldn't replace prevention, another expert stressed.

"Prevention is really the best way to go, and sexually transmitted diseases are no exception to that rule," said Dr. Patricia Sulak, professor of obstetrics and gynecology at Texas A&M Health Science Center College of Medicine and an ob/gyn at Scott & White Hospital in Temple, Texas.
"Really, the best way for us to reduce problems is to look at the source of the problems, and that's multiple sexual partners," she said. "The earlier you start having sex, the greater the chance of becoming infected. We want to make sure we get prevention across."

More information
For more on chlamydia, visit the U.S. Centers for Disease Control and Prevention.