Testing for Sexually Transmitted Infections
Important for Disease Prevention in Youth

James R. Allen, MD, MPH
Medical Adviser
American Social Health Association (ASHA)

We don't like talking with our youth about sex. Parents have difficulty talking with their adolescent children about sex. Schools often are constrained by societal pressures and funding sources to provide “abstinence only” messages rather than comprehensive sexual health information. In contrast, our entertainment media portrays human sexuality as spontaneous and idyllic, without complications of relationships or sexually transmitted infections and unintended pregnancy.

The truth is that sexually transmitted infections (also called sexually transmitted diseases or STDs) are an enormous problem in the United States, especially for adolescents and young adults. April is STD Awareness Month and a good time to talk about this uncomfortable but important issue.

Each year, one of every four sexually active teens will get a sexually transmitted infection. By age 25, half of all youth will have acquired one or more infections. The number of new cases of sexually transmitted infections is more than 9 million in people under the age of 25 each year.

Even worse, many of these are silent infections without clinical symptoms. Despite the absence of symptoms, long-term damage such as infertility can occur if infections are not diagnosed and treated. And many youth (and adults) assume that they would know if they or their partner had an infection.

The best way to be diagnosed with a sexually transmitted infection is to be tested for it. Great strides have been made in recent years in development of reliable tests for many STIs using patient specimens that can be obtained easily.

Most youth assume they are being tested for “all” STIs when they go to their doctor. In fact, testing rarely occurs even for the more common infections, even though health care guidelines and medical associations recommend testing be done routinely.

Communication is an important issue in obtaining testing. Just as adults are reluctant to discuss sexual health issues with youth, youth are also reluctant to discuss this with adults, including health care providers. Young people need the necessary information to know what and how to ask for tests for STIs.

Testing, treatment and communication are all important in addressing the STI epidemic. But they are not sufficient. Knowledge and prevention are essential also.

Of great concern is the politicization of sexual health information, which makes it difficult to be certain about the accuracy and context of messages. Groups that attack the effectiveness of condoms for preventing STIs, for example, hope this will encourage abstinence. Instead, it leaves our young people at risk.

The simple fact is that condoms, used correctly and consistently, provide substantial protection against many STIs, including HIV infection. They do not protect against all STIs or under all circumstances, but for a person who chooses to be sexually active, using a condom is much better than not using one.

The stigma attached to many diseases such as cancer a generation ago has disappeared. But sexual behaviors and STIs remain highly stigmatized in our country. This stigma inhibits discussion with parents, partners, and health care providers and discourages youth from seeking needed health care. Stigma is a significant barrier to prevention. Social attitudes that reinforce this shame do not reduce frequency of sexual contact but they do reduce prevention behaviors and increase risk of infection.

It is biologically certain that our children will grow up and become sexually mature. STIs have been with humans for centuries. Information, education, supportive social environments, and sound, well-funded public health programs are effective at reducing risks of infection. Our failure to address these issues leaves our youth vulnerable. We as a nation need to review the lessons of the past and make effective control of STIs a high priority.

The American Social Health Association (ASHA) is a 92-year-old not-for-profit organization with offices in Washington, DC and Research Triangle Park, NC. It is dedicated to educating about and preventing sexually transmitted diseases and their complications.