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With Teens, Ignorance of STDs Is High, and So Is Risk


Teens are deluged with images about sex. On TV alone, it is estimated that the average teen sees 14,000 sexual messages each year, less than 1% of which deal with sexual responsibility or consequences, according to a definitive study by Planned Parenthood. Unfortunately, thousands of teens face the very real consequences of sexually transmitted diseases (STDs) every day.

By the 12th grade, nearly two-thirds of U.S. high school students have had sexual intercourse, and approximately one-quarter have had four or more sex partners, according to a report done in recent years by the federal Centers for Disease Control and Prevention. Yet almost half of sexually active teens did not use a condom the last time they had sex, the report said.

The math is elementary: Sex minus condoms equals today's teen STD epidemic. Teens 15 to 19 have the highest rates of gonorrhea and chlamydia of any age group in Los Angeles County, and account for nearly one-third of all reported STD cases. Recent studies have found that nearly 10% of girls in some L.A. County high schools are infected with chlamydia. Other studies have found similar rates of human papillomavirus (HPV), the virus that causes genital warts, in teen girls.

Teens are particularly susceptible to STDs for several reasons. Many know little about the STDs that most commonly affect them. Instead, misconceptions abound, such as: "If a person looks 'clean,' they can't have an STD." In fact, most people with an STD have no initial symptoms at all. Or, "I don't need to use a condom--I'm on the pill." In fact, birth-control methods such as the pill or Depo-Provera offer no STD protection. And, "my boyfriend / girlfriend loves me." Love and trust have nothing to do with it--most people with an STD don't even know they're infected.

Risk-taking, living for the moment and sexuality itself are normal aspects of adolescence, which can also place teens at risk for STDs. The long-term consequences of STDs seem remote, and are obscured by the more immediate wish to explore sex and experience intimacy. Normal adolescent insecurity over being liked and desired by peers can inhibit a teen from asking a partner to use a condom or from talking about STDs.

Sexy media messages often don't help. And "just say no" messages can have unintended consequences. Because many teens believe they're not supposed to be having sex, they don't carry a condom or plan ahead. But they may end up having unsafe sex when they are swept up in the moment.

Schools are an important partner in helping teens reduce STD risk--in fact, they are the primary source of STD information for most adolescents. Studies have found that classroom education can reduce sexual risk-taking in teens, and can be even more effective if supported by condom-availability programs and student health services. A recent evaluation of New York City's school condom-availability program showed that the program increased condom use among students at higher risk for STDs without increasing sexual activity overall. So far, three of the 52 L.A. County school districts with high schools have implemented condom-availability programs and school-based clinics.

Seeking help for symptoms of an STD is often embarrassing for teens--just as it is for adults. In addition, many teens don't know where to go for STD testing, assume they can't afford it, or delay or forgo a clinic visit because they're afraid their parents will find out. Untreated STD infections can have potentially serious consequences even if initial symptoms are absent or have disappeared. Even without symptoms, teens can pass STDs to other sexual partners.

The health impact of STDs can be especially devastating for young people. Untreated chlamydia and gonorrhea infections, for example, can lead to infertility in those just entering their reproductive years. An HPV infection acquired by a 15-year-old girl, for example, can lead to cervical cancer by the time she's in her 30s. Painful herpes sores can recur for years or decades. Up to 10% of teens infected with hepatitis B will become chronic carriers, at increased risk of developing liver cancer and other complications.

Sexually active teens should get tested for STDs at least once a year, or more often if they have new or multiple partners. Teens should know that by state law they can receive STD testing and treatment without their parents' permission or knowledge, and that many clinics in L.A. County offer these services for free. The hepatitis B vaccine is also available free to eligible children and teens through the Vaccines for Children program.

No teen needs to suffer from an STD. Besides practicing safer sex and getting STD tests, teens should realize that putting off sexual involvement is a viable option: After all, in 12th grade, more than one-third of high school students have never had sex. But both teens and parents need to remember that there will come a time when children grow up and have sex for the first time. Will they know enough about STDs? Will they know how to use a condom? Will they be able to talk about these issues with a partner? By facing up to the facts about teen sexuality, we can make it a much safer world to grow up in.


Robyn Davis is director of the Community Outreach and Education Division of the Los Angeles County Sexually Transmitted Disease Program. Harlan Rotblatt is director of the program's Adolescent STD / HIV Services Project.

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