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Sara E. Forhan, MD, MPH Division of STD Prevention Centers for Disease Control and Prevention

Prevalence of Sexually Transmitted Infections and Bacterial Vaginosis among Female Adolescents in the United States: Data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004. Sara E. Forhan, MD, MPH Division of STD Prevention

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Sara E. Forhan, MD, MPH Division of STD Prevention Centers for Disease Control and Prevention

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  1. Prevalence of Sexually Transmitted Infections and Bacterial Vaginosis among Female Adolescents in the United States: Data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 Sara E. Forhan, MD, MPH Division of STD Prevention Centers for Disease Control and Prevention

  2. Adolescents & sexually transmitted infections (STIs) • Adolescent females vulnerable toSTIsand sequelae • Community-level studies & surveillance data suggest high STI prevalence • No U.S. population-based studies of overall STI burden among female adolescents

  3. Most common STIs in adolescents and their sequelae • Human papillomavirus (HPV) • Can lead to cervical cancer and genital warts • Chlamydia trachomatis (chlamydia) • Can lead to pelvic inflammatory disease (PID) --> infertility, ectopic pregnancy • Trichomonas vaginalis (trichomonas) • Herpes simplex virus, type 2 (HSV-2) • Bacterial vaginosis (BV) ↑ HIV risk

  4. Objective To estimate prevalence of the most common STIs and of BV among a nationally representative sample of 14–19 year-old females

  5. Methods • National Health and Nutrition Examination Surveys (NHANES) 2003–2004 • Female adolescents, aged 14–19 years • Prevalenceof 4 most common STIs: chlamydia, HSV-2, HPV, trichomonas, and of BV • HPV evaluation limited to 23 high-risk types & types 6 or 11 = HR/6/11 HPV

  6. Primary outcome: Overall STI burden • “Any STI” = • chlamydia or • HSV-2 or • HR/6/11 HPV or • trichomonas gonorrhea (GC): data not released syphilis & HIV: no cases in 18–19-year-olds (only 18–49-year-olds tested) Not included:

  7. NHANES 2003–2004 laboratory methods

  8. NHANES 2003–2004 laboratory methods

  9. NHANES 2003–2004 laboratory methods

  10. NHANES 2003–2004 laboratory methods

  11. NHANES analytic considerations and definitions • Complex probability sample to represent the U.S. civilian population • Race/ethnicity: non-Hispanic (NH) white, NH black, & Mexican American • Adolescents, NH blacks, & Mexican Americans oversampled • Sex = oral, vaginal, or anal • All prevalence estimates weighted

  12. Study participants • 838 female adolescents interviewed • 96% had lab results for at least 1 STI or BV • 612 (76%)—evaluated for “any STI” • 750 answered “Have you ever had sex?” • 404 sexually experienced

  13. Prevalence of STIs among 14–19 year-old U.S. females (n=838), NHANES 2003–2004 *Relative Standard Error > 30%

  14. Prevalence of STIs among sexually experienced 14–19 year-old U.S. females (n=404), NHANES 2003–2004 *Relative Standard Error > 30%

  15. Prevalence of BV • Overall prevalence of 24.1% (19.9–29.2) • Did not vary by sexual experience

  16. Multiple STIs • Of those with an STI, 15% had more than 1 • 82% of those with more than 1 STI had HR/6/11 HPV as 1 of their infections

  17. “Any STI” prevalence by race/ethnicity * Positive test for CT, HSV-2, HR/6/11 HPV, or TV †Adjusted for demographic variables, # of lifetime sexual partners, and BV

  18. “Any STI” prevalence by duration of sexual experience *Current age minus age at first sex † Positive test for CT, HSV-2, HR/6/11 HPV, or TV ‡ Adjusted for age , race/ethnicity, poverty index, and BV ¶ RSE > 30%

  19. “Any STI” prevalence by number of lifetime sexual partners • Positive test for CT, HSV-2, HR/6/11 HPV, or TV • † Adjusted for age, race/ethnicity, poverty index, and BV • ‡RSE > 30%

  20. Limitations • STI burden probably slightly underestimated • GC, syphilis, HIV not in composite STI variable • Self-reported behavioral data • STIs among who reported never having had sex

  21. Summary • High STI burden in female adolescents: 1 in 4 infected • Estimated 3.2 million young women with STIs • Substantial racial disparity • High STI prevalence soon after sexual debut, even with few partners • Predominant HPV

  22. Discussion • Important public health priority • Sequelae = infertility, cervical cancer, HIV infection • Comprehensive approach to address the problem • Increased awareness and education • Steps to narrow racial disparities • HPV vaccine • Recommended routinely all 11- and 12-year-old girls • Chlamydia screening • Recommended for all sexually active women, aged ≤ 25

  23. Acknowledgements Sami Gottlieb Maya Sternberg Lauri Markowitz Fujie Xu Eileen Dunne Stuart Berman Deblina Datta "The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of the CDC/ATSDR."

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