DataBank Indicator

Download Report

After 3 years of decline, reported rates of chlamydia and gonorrhea among 15- to 19-year-olds rose slightly in 2015.  

Importance

There are more than 25 kinds of sexually transmitted infections (STIs), acquired primarily through sexual activity.[1] Some are bacterial, such as chlamydia, syphilis, and gonorrhea; others are viral, such as hepatitis B, herpes, HIV, and HPV (human papillomavirus), or parasitic, such as trichomoniasis. Bacterial STIs are curable, but while viral STIs can be treated effectively, they cannot be eliminated. However, detection and treatment of STIs are hindered by the fact that many STIs have mild symptoms or no symptoms at all.[2] In 2006, a vaccine was made available to protect against HPV (the most common STI in the U.S.[3]), for females, while a similar vaccine has been available for males since 2009. However, rates of vaccination are very low among adolescents. In 2015, 42 percent of girls (ages 13 to 17) had received the full vaccination schedule, and 8 percent of boys had received full vaccination.[4][5]

Although some STIs result only in minor discomfort, others can have lasting health consequences. For example, if untreated, chlamydia and gonorrhea, the two most common reportable STIs, can cause infertility, pregnancy complications, adverse pregnancy outcomes, pelvic inflammatory disease (PIV), and increased risk of HIV infection. Additionally, some strains of HPV, which is extremely widespread, are linked to cervical cancer.[6],[7] The economic costs are also high. The lifetime medical costs of STI incidence in young adults who were ages 15-24 in 2000 were estimated at $6.5 billion.[8]

Approximately half of the new STI cases that occur each year are acquired by individuals between the ages of 15 and 24, even though they represent only one-quarter of the sexually active population.[9] Sexually active youth are more likely than older individuals to engage in certain sexual behaviors, such as unprotected sex and having multiple sex partners, that increase their risk of acquiring an STI.[10] Youth also face barriers to reproductive health care services, related to availability, ability to pay, transportation, and confidentiality concerns.

Trends

Chlamydial infection, as of 2011, had increased by 91 percent since 1996, from 1,081 to 2,121 cases per 100,000. (Figure 1) After decreasing between 1998 and 2004 (from 547 to 422 cases per 100,000), rates of gonorrhea increased slightly until 2007 (to 458 cases per 100,000).  Since then, gonorrhea rates have mostly been declining, hitting a new low in 2014 (325 cases per 100,000). However, there was a 5-percent increase in gonorrhea rates between 2014 and 2015 (to 342 cases per 100,000). Syphilis rates have generally been low between 1996 and 2015, starting at a high of six cases per 100,000 in 1996. While primary and secondary syphilis rates declined between 1996 and 2003, reaching a low of two cases per 100,000, they increased between 2003 and 2009, increasing to five cases per 100,000.  After declining briefly between 2009 and 2011, syphilis rates have been on the rise, once again reaching five cases per 100,000 in 2015.

Differences by Gender

Adolescent females are much more likely than males to have a reported case of chlamydia (2,994 versus 768 cases per 100,000), or gonorrhea (442 versus 245 cases per 100,000, in 2015). (Figure 2) However, adolescent boys were more likely than girls to have a reported case of syphilis in 2015 (8.0 versus 2.8 cases per 100,000). (Appendix 1)

Differences by Race/Hispanic Origin[11]

Black youth are much more likely than Hispanic and white 15- to 19-year-olds to have reported cases of chlamydia, gonorrhea, and syphilis.  For instance, in 2015, rates of chlamydia among black adolescents were 4,201 per 100,000, compared with 1,067 for Hispanics, and 775 per 100,000 for whites. (Figure 3) Racial/ethnic differences were even greater for syphilis (although rates were relatively low for all adolescents), followed by gonorrhea, and then chlamydia. (Appendix 1)

State and Local Estimates

Data for chlamydia, gonorrhea, syphilis, and chancroid, by state and some local areas, are available from the Centers for Disease Control and Prevention’s Sexually Transmitted Disease Surveillance Reports.

2013 county and state data for the rate of chlamydia, gonorrhea, and syphilis among young adults ages 15 to 24 for are available from the Centers for Disease Control and Prevention.

International Estimates

Estimated prevalence and annual incidence of curable STIs by region in 2008 are available from the World Health Organization’s “Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections Overview and Estimates.”

National Goals

Through its Healthy People 2020 initiative, the federal government has set national goals to promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases (STDs) and their complications.

More specifically, there are objectives to reduce the proportion of adolescents and young adults with chlamydia trachomatis infections; to reduce gonorrhea rates; reduce the proportion of females with human papillomavirus infection; and to increase the proportion of sexually active females under age 25 who are screened annually for genital chlamydia infections, among others.

More information is available here.

What Works to Make Progress on This Indicator

While testing for STIs has expanded and improved, more needs to be done to protect young adults and reduce the costs associated with STIs.  Well-designed school-based, clinic-based, and community-based programs all have the potential to help educate teens and young adults, change their behavior, and reduce their risk of contracting STIs.[12] However, routine STI testing also should become a standard part of health care visits.[13] Recent research conducted for the Centers for Disease Control and Prevention supports the value of health care providers’ protecting adolescents’ confidentiality when it comes to receiving certain sexual and reproductive health services. Specifically, more than one in eight sexually experienced youth reported they would not seek such care because of concerns their parents could discover it. Also, those adolescents who spent time alone with a provider were more likely to have received a sexual risk assessment than those with a parent present in the room.[14]

See also Sales, J. M., & DiClemente, R. J. (2010). Adolescent STI/HIV prevention programs: What works for teens? New York, NY: ACT for Youth Center of Excellence.

Related Indicators

Definition

Sexually transmitted infections (STIs) refer to a variety of bacterial, viral, and parasitic infections that are acquired through sexual activity.  Health care providers are required to report certain STIs under the Centers for Disease Control and Prevention’s surveillance system.

Data Sources

Centers for Disease Control and Prevention. (2015) Sexually transmitted disease surveillance, {various years}.  Atlanta, GA: Department of Health and Human Services.

Raw Data Source

Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention, Division of STD Prevention, Sexually Transmitted Disease Surveillance System.

http://www.cdc.gov/std/default.htm

 

Appendix 1 – Reported Sexually Transmitted  Infections, Ages 15 to 19: Chlamydia, Gonorrhea, and Syphilis Rates (per 100,000): Selected Years, 1996-2015

1996 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Chlamydia 1080.8 1269.9 1369.2 1373.0 1422.4 1471.6 1516.3 1559.3 1597.2 1644.3 1760.8 1947.7 1992.6 2002.4 2120.8 2028.2 1852.1 1811.9 1857.8
Gender
Male 233.8 301.7 340.5 358.9 374.8 405.2 421.4 453.3 498.0 533.4 606.9 695.9 730.5 757.0 816.3 785.8 715.2 722.4 767.6
Female 1984.0 2297.0 2458.6 2447.0 2531.3 2599.0 2672.5 2724.6 2754.5 2805.7 2966.3 3251.4 3314.7 3299.5 3485.2 3331.7 3043.3 2949.3 2994.4
Race/Hispanic Origin1
Non-Hispanic White 553.9 615.2 644.2 643.0 693.7 715.7 747.8 757.4 766.1 542.2 576.9 616.0 638.5 675.7 741.7 830.1 786.1 741.6 775.2
Non-Hispanic Black 3776.7 4401.8 4738.7 4631.2 4870.0 4887.6 5004.5 5217.4 5348.8 4003.9 4376.7 4781.5 4887.9 4857.3 4868.7 4977.7 4467.5 4151.3 4200.8
Hispanic 1176.5 1319.4 1470.3 1584.9 1544.1 1566.1 1586.1 1562.2 1613.2 1206.3 1222.6 1320.7 1290.2 1171.9 1253.0 1191.0 1128.8 1084.1 1067.0
1996 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Gonorrhea 543.7 547.1 528.8 516.3 498.6 472.7 441.1 421.9 431.8 450.7 457.6 451.2 403.9 400.4 407.2 381.8 337.5 325.0 341.8
Gender
Male 373.6 347.1 337.8 327.9 306.5 285.7 261.2 250.2 257.5 273.4 282.5 276.3 248.3 247.7 252.7 242.4 220.9 222.4 244.8
Female 724.7 758.8 730.8 715.6 701.8 670.4 631.2 602.8 615.3 635.4 639.7 632.5 566.0 557.6 567.7 527.5 459.4 431.7 442.2
Race/Hispanic Origin1
Non-Hispanic White 123.0 123.2 113.5 111.3 114.8 115.2 118.9 116.8 119.3 92.0 91.2 82.8 72.9 73.5 75.4 85.3 85.1 82.4 94.4
Non-Hispanic Black 2924.9 2907.2 2833.7 2739.1 2586.9 2410.6 2165.6 2032.9 2044.5 1633.2 1701.0 1677.2 1496.1 1480.0 1438.9 1513.5 1334.2 1172.6 1218.5
Hispanic 216.2 216.4 228.7 247.1 223.7 213.0 215.9 207.3 211.5 169.4 155.3 152.8 133.0 125.2 138.0 139.7 141.7 144.7 150.6
1996 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Syphilis 6.1 3.1 2.7 2.3 1.9 1.7 1.6 1.7 2.1 2.6 3.1 4.2 4.7 4.2 4.0 4.1 4.2 4.9 5.4
Gender
Male 4.1 1.9 1.8 1.6 1.4 1.3 1.4 1.8 2.3 3.0 3.8 5.3 6.0 5.5 5.5 5.8 6.4 7.1 8.0
Female 8.2 4.4 3.6 3.1 2.5 2.2 1.7 1.5 1.9 2.2 2.4 3.0 3.3 2.9 2.5 2.3 1.9 2.5 2.8
Race/Hispanic Origin1
Non-Hispanic White 0.9 0.4 0.4 0.4 0.2 0.3 0.4 0.4 0.5 0.5 0.7 0.9 0.8 0.7 0.9 1.1 1.2 1.3 1.7
Non-Hispanic Black 35.0 17.5 14.6 12.6 9.7 8.3 6.7 6.7 9.4 12.2 13.4 18.5 22.3 19.3 16.7 17.5 15.8 17.1 1.7
Hispanic 1.8 1.6 1.6 1.5 1.8 1.9 1.9 1.6 1.8 2.0 2.3 3.2 2.7 2.6 2.5 3.4 4.2 5.3 5.7
1 Persons of Hispanic origin may be of any race.

Sources: Centers for Disease Control and Prevention. (2015). Sexually transmitted disease surveillance, {various years}. Atlanta, GA: Department of Health and Human Services. Retrieved from https://www.cdc.gov/std/stats/

 

Endnotes


[1]Centers for Disease Control and Prevention. (2000). Tracking the hidden epidemics: Trends in STDs in the United States, 2000. Atlanta: Division of STD Prevention, U.S. Department of Health and Human Services, Public Health Service.

[2]U.S. Department of Health and Human Services. (2015). Sexually Transmitted Infections (STIs). Office of Women’s Health.  Retrieved from http://www.whscarlisle.com/webdocuments/sexually-transmitted-infections.pdf

[3]Hariri, S., Dunne, E., Saraiya, M., Unger, E., & Markowitz, L. (2011). VPD Surveillance Manual, 5th Edition.  Chapter. 5: Human papillomavirus. Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/vaccines/pubs/surv-manual/chpt05-hpv.html

[4]Centers for Disease Control and Prevention. (2016). 2015 Sexually transmitted diseases surveillance: Other sexually transmitted diseases. Atlanta, GA: Author. Retrieved from https://www.cdc.gov/std/stats15/other.htm

[5]Centers for Disease Control and Prevention. (2016). CDC recommends only two HPV shots for younger adolescents. Atlanta, GA: Author. Retrieved from https://www.cdc.gov/media/releases/2016/p1020-hpv-shots.html

[6]Centers for Disease Control and Prevention. (2000). Op. cit.

[7]Centers for Disease Control and Prevention. (2016) Sexually Transmitted Disease Surveillance, 2015. Atlanta, GA: Author. Retrieved from https://www.cdc.gov/std/stats15/

[8]Chesson H., Blandford J., Gift T., Tao G., Irwin K. (2004). The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health, 36(1), 11-19.enters for Disease Control and Prevention. (2009). Op. cit.

[9]Centers for Disease Control and Prevention. (2016). Op. cit.

[10]Centers for Disease Control and Prevention. (2000). Op. cit.

[11]Hispanics may be any race.

[12]Sales J.M., Milhausen R.R., & DiClemente R. (2006). A decade in review: Building on the experiences of past adolescent STI/HIV interventions to optimize future prevention efforts. Sexually Transmitted Infections, 82, 431-436.

[13]Cook R.L., Wiesenfeld H.C., Ashton M.R., Krohn M.A., Zamborsky T., & Scholle S.H. (2001). Barriers to screening sexually active adolescent women for chlamydia: A survey of primary care physicians. Journal of Adolescent Health, 28(3), 204-210.

[14]Leichliter, J. S., Copen, C., & Dittus, P. J. (2017). Confidentiality issues and use of sexually transmitted disease services among sexually experienced persons aged 15-25 years—United States, 2013-2015. MMWR, 66(0), 237-241.

Suggested Citation:

Child Trends Databank. (2017). Sexually transmitted infections (STIs). Available at: https://www.childtrends.org/?indicators=sexually-transmitted-infections-stis

Last updated: March 2017