Chlamydia epidemic detected in teens Twice-yearly tests for sexually transmitted diseases urged in study

One-third tested positive

August 12, 1998|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Investigating the quiet epidemic of sexually transmitted diseases among teen-agers, researchers say that adolescent girls and boys who have sex need to be screened twice as often as doctors thought for the most common infection, chlamydia.

The recommendation, published in today's Journal of the American Medical Association, stems from a three-year Johns Hopkins University study of about 3,200 Baltimore teens ages 12 to 19, mostly girls. Roughly a third of them tested positive for chlamydia, a finding that confirms smaller studies.

Chlamydia is a bacterial infection that can be diagnosed with a urine sample and cured with a week's worth of antibiotics. Untreated, it can lead to infertility among women and other serious complications in both sexes.

Like other sexually transmitted diseases, or STDs, it is at epidemic levels.

It's the most commonly reported infectious disease in the United States, yet a combination of factors has conspired to keep the high incidence and the tragic consequences secret.

Nine out of 10 women don't get any symptoms, and, uncomfortable with the issue, physicians and the public rarely discuss it.

"We don't talk about STDs; we assume that they aren't there, that other people get them, and that other people's patients get them," said Dr. Donald P. Orr, professor of pediatrics at Indiana University School of Medicine, and director of theMid-America Adolescent STD Research Center.

In an editorial accompanying the study, he said more frequent screening should be done in cities such as Baltimore that have a high incidence of STDs.

By 12th grade, statistics show, 70 percent of teen-agers have had sex, and a quarter of them have had four or more partners. Typically, doctors test these teens about once a year, based on certain risk factors.

The Johns Hopkins study, the largest of its kind, found those criteria useless and says all sexually active teens should be tested every six months.

"The only predictor that we found was just being a sexually active adolescent, and most of these infections didn't have any symptoms," said the study's lead author, Dr. Gale R. Burstein, a pediatrician and adolescent medicine specialist at Hopkins.

That makes it difficult for some to believe anything is wrong.

"I was kind of like, 'I don't have it.' That was my attitude. I thought, 'They're wrong,' and I wanted to be retested," said one young woman who was diagnosed with chlamydia at age 16.

Now, fearing infertility, the Baltimore teen says she gets tested every few months. She asked that her name be withheld and said she hasn't shared the experience with others.

"I really didn't say anything about it to my friends. It's kind of embarrassing to say, 'Hey, I had chlamydia.' They're like, 'What's that?' "

Race and class factors

Since most of the girls in the study were African-American and of lower socioeconomic class, it was unclear how much Burstein's findings could be generalized to other populations.

Some studies have found chlamydia rates higher than 10 percent in suburbs and rural areas. In urban areas, such as Indianapolis and New Orleans, studies have found roughly 30 percent of teens infected.

In the Hopkins study, Burstein and her colleagues detected infections emerging every six months, meaning screening needs be doubled. Another surprising discovery was that 14-year-old girls had the highest infection rate.

Doctors say biology and sociology may explain why 27.5 percent of all 14-year-olds tested positive for chlamydia. The cervix of a young teen is physically different from that of an older woman, making the teen more prone to infection, Burstein said. The 14-year-olds also may be dating men five to 10 years older, a relationship in which negotiating safe sex is difficult, she said.

Many teen-agers also are known to have what's called "serial monogamous relationships," Burstein said, in which teens date a series of people. But because they were faithful in each relationship, they think their chances of acquiring an STD are low.

They couldn't be more wrong. Because of biology and other factors, teen-agers are hardest hit by STDs, experts say. Even a single act of unprotected sex with an infected partner can leave an adolescent with one of several diseases including HIV, genital herpes or gonorrhea. The fallout from these infections includes mild symptoms, infertility, spontaneous abortion and cancer.

In men, chlamydia can cause painful urination, tenderness and pain in the groin, and inflamed joints and tendons. In women, infection can progress up through the pelvis within days, weeks or months, causing pelvic inflammatory disease.

At least 15 percent of all infertile American women are infertile because of tubal damage caused by pelvic inflammatory disease. According to Orr, if a woman has a few episodes of chlamydia, her risk for a potentially fatal ectopic pregnancy is as high as 30 percent.

Rare visits to doctors

But for all sorts of reasons, many teens, especially males, don't see doctors annually, much less twice annually. A sore throat or sprained ankle is usually what lands them in a doctor's office.

Even in clinical settings, many physicians won't raise the issue. Only one in 10 health providers initiated conversations about STDs with a new patient, according to a national survey. And although most clinics and physicians have a policy of confidentiality, teen-agers still worry that their parents may find out.

One positive development is a new technique that allows people to give urine samples, rather than submit to invasive procedures such as pelvic exams, to test for STDs.

Meanwhile, experts encouraged the public to remember this isn't only a women's issue.

"People tend to look at the women and blame them," said Dr. Ligia Peralta, medical director of adolescent medicine at the University of Maryland Medical Center. "We should also concentrate on the men."

Pub Date: 8/12/98

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