Sexual activity increases dramatically with age among adolescent females. NSFG data tabulated by the National Research Council indicate that in 1988, 10% of females reported engaging in sexual intercourse before age 15; 35% reported intercourse before age 17; and nearly 70% of young women reported sexual intercourse before age 20.32 (See Table 7) Table 7: Percent of Never-Married Females Born Between 19641972 Who Report Engaging in Sexual Intercourse, By Age at First Intercourse and Race(m) Rates of sexual activity are also increasing among adolescent males. NSAM data (of males living in metropolitan areas) indicate that the proportion of males who had intercourse by age 19 increased from 78% in 1979 to 86% in 1988.33 As shown in Figure 3, in 1988, 33% of males age 15 reported having engaged in premarital intercourse. Among 17-year-old men, the proportion who were sexually active doubled to 66%; for those age 19, 86% reported having engaged in premarital sexual intercourse.34 (m) Reprinted with permission from AIDS: The Second Decade, c.1990 by the Percent Figure 3: Percent of Never-Married Males Ages 15-19 Who Have Had Sexual Intercourse, By Age, According to Race/Ethnicity, 1988(n) (n) Reprinted with the permission of The Alan Guttmacher Institute from Freya Many Youth Report Multiple Sexual Partners Once teens initiate sexual activity, many continue to engage in intercourse, often with multiple partners. Despite relatively short histories of sexual activity, 58% of sexually experienced females ages 15-19 reported having had sex with two or more partners. NSFG data also indicate that while nearly one-fourth of women ages 18-19 are not sexually active, almost the same proportion reported having had three to five partners and 11% reported having had six or more partners. 35 Young men residing in metropolitan areas also reported numerous sexual partners. Nearly 20% of men ages 18-19 reported having had between three and five partners, and about the same proportion reported six to ten partners. 36 One in Six Teens Affected by a Sexually Transmitted Disease Each Year, Prevalence of STDs Serves as Proxy for Sexual Risk Taking Among Youth The aggregate annual costs of herpes, gonorrhea, chlamydia, and pelvic inflammatory disease are estimated to total $8.5 billion.37 In 1980, a National Institute of Allergy and Infectious Diseases Study Group concluded that STDs were the most pervasive, destructive, and costly communicable diseases confronting adolescents.38 Ten years later, the transmission of STDs in adolescents remains an urgent public health concern. 39 Adolescents are at higher risk for sexually transmitted infection than members of other age groups for a variety of behavioral, biological, and psychosocial reasons. The CDC estimates that three million teens, or one in six, are affected by an STD annually and that nearly two-thirds of the more than 12 million STDs diagnosed in 1990 were among persons under age 25.40 Left untreated, STDs may result in a number of serious health consequences including death, pelvic inflammatory disease, infertility, ectopic pregnancy, adverse pregnancy outcome, infant pneumonia, infant death, mental retardation, immune deficiencies, and neoplasia. The prevalence of STDs in young adults is particularly troubling in light of recent studies showing that HIV transmission is enhanced when genital lesions from other STDs are present. 42 No reliable sources of national data exist regarding STDs among adolescents. 43 Because states are not required to report various STDs, there is little uniformity in data collection about the prevalence and incidence of most sexually transmitted diseases.44 Estimates of the prevalence of STDs are drawn from reportable disease registries, surveys of visits to office-based practices, data on patients attending specialized health facilities, and information gained from nationally representative samples of the population. 45 STD rates among teens vary by sex and race, with more STDs reported among females than males, and among minority youth than whites. As noted by the Office of Technology Assessment (OTA) in its recent Adolescent Health report, differences between males and females may be explained in part because sexually active females are more likely than males to seek reproductive health care or family planning services where they may be screened for STDs. High STD rates among AfricanAmerican and Hispanic youth may reflect the tendency of these adolescents, who are disproportionately from low-income families, to use public health clinics which report STDs more completely than private practitioners. Additionally, higher rates of sexual activity among African-American youth may account for higher rates of STDs in this population.46 48 As of March 1, 1989, only three states required reporting of chlamydia infections, the most common type of STD infection among adolescents.47 Data from selected studies show that chlamydia infection rates vary from 3% to 37% depending on the surveyed population. According to OTA, chlamydia infection has been found to be highly prevalent among certain subgroups of sexually active adolescents, particularly among AfricanAmerican inner-city teenagers from low socioeconomic backgrounds. However, since the data are based on selected studies of teenagers attending various types of clinics, this finding may reflect the fact that many STD clinics are located in large metropolitan areas.49 All 50 states require reporting of gonorrhea and syphilis.50 Because of the large number of cases reported every year, trends in gonorrhea provide the best estimates of STD patterns in teenagers.51 During the 1980s, while gonorrhea rates declined in most age groups, they increased in males ages 15-19. Similarly, females ages 15-19 assumed the highest age-specific gonorrhea rate in 1984, and widened the gap over the next several years. By 1989, more than one in four (29%) newly reported gonorrhea cases occurred among youth ages 10 to 19 years. 53 52 Information about the prevalence of other STDs also indicate that significant numbers of adolescents may be at risk of HIV. In 1989, the most recent year for which data are available, the number of syphilis cases reported in the United States was at its highest level since World War II.54 B 1977 and 1987, the incidence rate of syphilis among fem es 10-14 and 15-19 increased approximately 120%. By early 10% of newly reported cases of syphilis were among persons ages 10-19.55 The most common consequence of STD infection for women is pelvic inflammatory disease (PID). Between 1975 and 1981, more than 260,000 women ages 15 to 44 experienced an episode of PID. Of these women, more than one in seven (16%) were teens ages 15 to 19 years. Nearly half (43%) of women hospitalized with PID are under age 25.56 Condom Use Increased During 1980s, Yet Many Adolescents Remain Unprotected From HIV and Other STDs The most effective way to prevent infection from HIV and other STDs is to abstain from sexual intercourse. For those who are engaging in sexual intercourse, however, various studies among adults have found that correct and consistent use of latex condoms lubricated with the spermicide nonoxynol 9 provides an effective barrier to prevent transmission of STDs, including HIV,57 At hearings in June 1991 entitled: "The Risky Business of Adolescence: How to Help Teens Stay Safe," some Members of the Select Committee expressed concern that promoting condom use among sexually active adolescents could actually increase risk |