Sexual health in adolescents in the UK: What do the data show? Dr Gwenda Hughes and Dr Anthony Nardone Health Protection Services Colindale

Transcription

1 Sexual health in adolescents in the UK: What do the data show? Dr Gwenda Hughes and Dr Anthony Nardone Health Protection Services Colindale 30 November 2011

2 Overview Present data on sexual health in adolescents Briefly explore factors associated with poor sexual health Summarise recent interventions Daily Star, Wednesday 20, May 2009 Daily Express, Wednesday 20, May 2009

3 Consequences of poor sexual health Teenage pregnancy associated with: Lower birth weights Increased risk of infant mortality Exacerbates socio-economic disadvantage Sexually transmitted infections (STIs) associated with: Short term morbidity e.g. painful discharge, ulcers etc. Long-term sequelae e.g. Pelvic inflammatory disease, tubal infertility, cervical cancer etc. Mother-to-child transmission e.g. congenital syphilis, ophthalmia neonatorum Stigma and discrimination

4 Under-18 conception rate Under-18 conception rate for England: Provisional 2008 under- 18 conception rate for England was 40.5 per 1000 girls aged Year Source: Office for National Statistics and Teenage Pregnancy Unit, 2010 Rate per thousand females aged data are provisional a decrease of 3.1% from the 2007 rate lowest rate for over 20 years Since the 1998 baseline, the under-18 conception rate has fallen by 13.3%.

5 Number of diagnoses Trends in new diagnoses of STIs in England, , ,000 Total new community Chlamydia diagnoses Total new STI diagnoses (GUM) 300, , , Steadily increasing trends over past 10 years Changes in sexual behaviour Improved test performance (sensitivity) Increased access to testing services

6 Percentage of STI diagnoses among those aged < 20 yrs GUM clinics, UK: 2008 In women, between 33% and 50% STI diagnosed in those <20 years Includes first episode of genital herpes and warts and primary and secondary syphilis.

7 Rate per 100,000 Rate per 100,000 Rate per 100,000 Age distributions of STIs, England 2009 a. Chlamydia (GUM) Men 1400 Women Rapid increase in STI rates between ages 15 and19 Peak age in women ~19 years Peak age in men ~ years Age b. Gonorrhoea c. Genital warts Men Women Men Women Age Age

8 Systematic review of chlamydia prevalence studies* Setting Prevalence estimate from meta-analysis (%) by age group (females) <20 yrs yrs yrs 30+ yrs Overall Population-based General Practice Contraceptive service Youth/Antenatal/TOP GUM clinic * Adams et al. Sex Transm Infect 2004; 80:

9 % positive % positive % positive % positive Seroprevalence of HPV antibodies in females aged 10-29yrs Jit et al. Br J Cancer 2007; 97(7): At least 10% have been infected by one of these HPV strains by age 16 40% HPV 6+ 40% HPV % 30% 20% 20% 10% 10% 0% Age 0% Age 50% 40% HPV % 30% HPV % 20% 10% 20% 10% 0% Age 0% Age

10 Young people are more likely to become reinfected with STIs Acute STI re-infection by age group, England: 2008/9 < Time (Years) ~ 11-12% of 16 to 19 year olds presenting with an acute STI at a GUM clinic will become re-infected with an STI within a year

11 Why are young adults at greatest risk? Sexual behaviour 1 More sexual partners More concurrent sexual partnerships Less likely to use contraception More likely to use emergency contraception Teenagers may lack the skills to negotiate safer sex 2 Link between alcohol, drugs and risky sexual behaviour 3 1. Johnson et al Lancet 358: Shepherd et al. Health Technol Assess Feb;14(7):1-206, iii-iv. 3. Independent Advisory Group on Sexual Health and HIV. Sex, Drugs, Alcohol and Young People. June 2007

12 National Survey of Sexual Attitudes and Lifestyles II Number of heterosexual partners in last 5 years: Women Mean = Overall 2.4, Median = Overall 1, to 4 5 to No. of partners Source: Johnson et al Lancet 358: 1835

13 % of respondents Contraception use, UK, 2008/ Used at least one method of contraception at the time of interview * *Estimates may be unreliable due to small sample size. Includes women aged Opinions Survey Report 41, ONS, 2008/9

14 % of respondents Emergency contraception use, UK: 2008/9 18 Used emergency contraception at least once during the year prior to interview Includes women aged Opinions Survey Report 41, ONS, 2008/9

15 Recent outbreaks of syphilis and gonorrhoea among young heterosexuals across the UK Five syphilis outbreaks among young heterosexual outbreaks in the UK in recent years Outbreaks investigations reveal common themes: Typically 20 years and under (especially females) Living in deprived areas Numerous sexual partners Often vulnerable and hard to reach in care, sheltered accommodation, unemployed Often poor service access Congenital syphilis cases Simms I, Bell G, Hughes G. Infectious syphilis in young heterosexuals: responding to an evolving epidemic. International Journal of STD & AIDS 2011; 22:

16 Interventions for young people Network of open access sexual health clinics National Chlamydia Screening Programme Opportunistic screening for year olds HPV vaccination programme Routinely vaccination of girls aged years against cervical cancer Improving awareness and knowledge Health promotion campaigns Sex education in schools Public health policy (proposed public health outcomes framework) Rates of under 18 pregnancy Rates of chlamydia diagnoses among 16 to 24 year olds

17 % coverage Coverage of chlamydia tests over time in those aged 15-24, England Tests in National Chlamydia Screening Programme, GUM clinics and elsewhere GUM clinic tests¹ 50% 45% 40% Other tests Programme tests 39.4% 42.5% 35% 30% 30.9% 25% 20% 19.6% 22.3% 15% 12.8% 10% 5% 0% Males Females Males Females Males Females 2008/9 2009/ /11

18 HPV vaccination coverage in the UK: Females aged years Source: Annual HPV vaccine coverage in England in 2009/2010, Department of Health/HPA

19 Discussion and conclusions Adolescents (particularly females) experience particularly poor sexual health Highest rates of STIs and STI re-infection Outbreaks in vulnerable populations associated with high rates of partner change, poor service access Less likely to report use of any contraception Public health interventions need to continue to focus on Maintaining and improving access to sexual health services (STI testing and contraception) Maintaining high uptake of HPV vaccination Increased knowledge and awareness Behaviour change

20 Acknowledgements Thanks very much to: All staff at GUM clinics, NCSP settings and laboratories who provide the data Colleagues in NPHS for Wales, ISD and HPS Scotland, and DHSSPS in Northern Ireland who compile the national datasets Stephen Duffell, Emma Savage, Ian Simms and Kate Soldan at HPS Colindale