Trends in STDs among Young People in New York State

Transcription

1 Trends in STDs among Young People in New York State Kris Mesler, Bureau of Child and Adolescent Health Alison Muse, Bureau of Sexually Transmitted Disease Control New York State Department of Health

2 Figure courtesy of the University of Chicago Press. From the American Journal of Sociology,, Vol. 100, No. 1. "Chains of affection: The structure of adolescent romantic and sexual networks," Bearman PS, Moody J, Stovel K.

3 Sexual Behaviors that Affect STDs Preventing STDs requires a complex approach Promoting abstinence and condom use Reducing the number of sexual partners Avoiding concurrent sexual partners Increasing the number of weeks or months between sexual partners Testing for and treatment of STDs, vaccination against HPV and hepatitis B

4 Risk and Protective Factors Teen s biological makeup Home and community environments Teen s friends and peers (especially their sexual values and behavior) Teen s romantic partners Teen s own sexual values and attitudes Connection to family, school, and other groups

5 Factors that shape young people s sexual behavior Young people subjectively assess the risks from sexual partners on the basis of whether they are clean or unclean Sexual partners have an important influence on behaviors in general Condoms can be stigmatizing and associated with a lack of trust

6 Factors that shape young people s sexual behavior Gender stereotypes are crucial in determining social expectations and behavior There are penalties and rewards for sex from wider society Reputations and social displays of sexual activity or inactivity are important Social expectations hamper communication about sex

7 Etiologic Classification of STI Bacteria Gonorrhea Chlamydia Syphilis Mycoplasma Ureaplasma Chancroid HIV Herpes simplex virus Hepatitis B and A virus Trichomonas Entamoeba histolytica Pubic lice Granuloma inguinali Bacterial vaginosis Group B Streptococcus Shigella sp. Campylobacter sp. Salmonella sp. Viruses Protozoa Ectoparasites Cytomegalovirus Human papillomavirus (warts) Molluscum contagiosum Giardia lamblia Scabies (mite)

8 Estimated Annual Incidence and Prevalence of Selected STD in the United States STD Incidence Prevalence Chlamydia 3,000,000* Not Available Gonorrhea 650,000* Not Available Syphilis 18,334 Not Available Chancroid 143 Not Available Trichomoniasis 5,000,000* Not Available HPV 5,000,000* 24,000,000* HSV 1,000,000* 31,000,000* HBV 120,000* 417,000 * AIDS 41, ,000* HIV 40,000* 650, ,000* * estimated

9 STD among adolescents and young adults 25% of sexually active population 9 million new infections annually

10 2008 Communicable Diseases Reported in New York State All other communicable 42,913 AIDS/HIV 10,127 chlamydia 88,460 gonorrhea syphilis 5,450 17,120 STD = 110, ,000 40,000 60,000 80, ,000 Number of Cases STDs account for nearly 2/3 (68%) of all reportable communicable disease

11 Burden of Reportable STDs among Youth NYS, 2008 NYS Cases Year Olds (% of NYS) Year Olds (% of NYS) Chlamydia 88,460 29,858 (34%) 29,587 (33%) Gonorrhea 17,120 4,654 (27%) 5,257 (31%) Syphilis 5, ( 2%) 548 (10%) year olds account for 64% of reported STDs in NYS but only 14% of total population.

12 Rates of Gonorrhea and Chlamydia by Age Group and Gender New York State, Gonorrhea Rate/ 100,000Population Chlamydia 3000 Rate / 100,000 Population Male Female

13 Long Way to Go to Reach Health Equity Higher rates of all STDs among minority racial and ethnic populations when compared to whites, with the exception of Asians / Pacific Islanders. Example: African Americans Gonorrhea rate 18 x higher than whites Chlamydia 10 x higher than whites Hispanics Gonorrhea and Chlamydia rate 3 x higher than whites

14 Prevalence of Infection among Youth in Juvenile Detention Study setting: NYS secure juvenile detention facilities, 2008 Population characteristics ~ 2,800 youth detained annually Average age is 14.7 years, 80% male, 50% African American Chlamydia: Gonorrhea: 4% males, 15% females 0.5% males, 3% females

15 Studies on Adolescent Risk Taking Behaviors Almost one in 10 young people reported having sex while under the influence of alcohol and later regretting it and 10% reported having had unsafe sex. Alcohol-related sexual risk-taking is most closely associated with symptoms of depression and anxiety. Increased marijuana use emerging as a significant predictive factor in the choice for sexual activity vs. abstinence. More alcohol use was predictive of choosing multiple partners vs. monogamy. For new sexual partnerships, regardless of the type of sex experience, knowing the partner for less time was associated with an increased likelihood of drinking.

16 Studies on Adolescent Risk Taking Behaviors Juvenile arrestees reported more alcohol and drug use, substance use during sex, unprotected sex acts, STI diagnoses, suicide attempts and psychiatric hospitalizations than non-arrestees. Having an arrest history may serve as a marker for adolescent HIV risk and substance abuse Sexual-risk-behavior increased with the number of drugs used. Alcohol and marijuana use were associated with the highest sexual-risk-behavior. Persons dually diagnosed with severe mental illness and substance abuse disorder have disproportionately high rates of HIV and other sexually transmitted infections.

17 Where Does the 1 in 4 Adolescents Will Have an STD Statistic Come From? National studies on adolescents that include biomarkers for specific STDs (including viral STDs which are not routinely reported to the health department); These community studies collect lab specimens to establish actual prevalence.

18 Prevalence = # who tested positive at time of study / all participants

19 Classification of STD by syndromes and complications Acquired immunodeficiency syndrome Pelvic inflammatory disease Infertility and ectopic pregnancy Fetal and neonatal infections Complications of pregnancy Lower genital tract infections in women Neoplasia Genital warts Viral hepatitis Genital ulcers Urethritis in men Acute epididymitis Gastrointestinal infections Arthritis Tertiary syphilis Mononucleosis Benign nusiance syndromes

20 Classification of STD by syndromes and complications Pelvic inflammatory disease Infertility and ectopic pregnancy Fetal and neonatal infections Genital Ulcers Urethritis Complications of pregnancy Lower genital tract infections

21 Characteristics of teens at risk for STD Multiple partners Drug use HIGH RISK Female Young age at 1st coitus

22 Adolescents females at greater risk Physical changes of the cervix and vagina through puberty Areas of exposed columnar epithelium increases vulnerability to STDs Hormones and vaginal flora change during puberty resulting in a change of ph Sexually Transmitted Diseases, third edition

23 Teen Sexual Behaviors: NYS, Youth Risk Behavior Surveillance System Ever had sex Currently sexually active Ever had 4+ partners Did not use a condom* Did not use birth control pills* Used drugs/alcohol* % of Students in Grades *Among those who had sexual intercourse in past 3 months

24 STD Prevention Strategies Primary (prevention of infection) Vaccination Education Secondary (detection of early infection and treatment to avert complications) Provision of clinical services to symptomatic pts Screening high-risk populations Counseling of infected pts to reduce the risk of reinfection

25 Teach the Prevention of STDs Only abstinence is 100% effective Using a latex condom the right way, every time they have sex, lowers risk Using drugs or alcohol can get in the way of protecting oneself

26 Prevention cont d Having sex with only one sex partner whose status is known lowers risk Inform teens that: persons with an STD are a greater risk of getting HIV Minors do not need parental permission to access STD services in NYS

27 What Can We Do to Help? Provide access to educational materials, information and resources Be empathetic and non-judgmental when interacting with teens Use teachable moments, maintain confidentiality Encourage routine examination and screening for sexually active teens

28 Contact Information: Kris Mesler Bureau of Child and Adolescent Health, NYSDOH (518) Alison Muse Bureau of STD Control, NYSDOH (518)