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Sexually Transmitted Infections

This section of ReCAPP focuses on Sexually Transmitted Infections (STIs) — including HIV/AIDS, the risk they present to sexually active teens, and our role as educators in STI prevention. This section includes the following:

  • Definitions of Sexually Transmitted Infections
  • An Overview of the Issues
  • What Educators Can Do
  • More Information/Resources
  • Learning Activity: Teaching about Sexually Transmitted Infections
  • Report: Comprehensive Approach Needed to Combat Sexually Transmitted Infection Among Youth
  • Skills for Youth: Talking with your Partner about Protection
  • Quote on Sexual Health
  • Statistics on STIs

  • Definitions

    Sexually transmitted infections (STIs) are infections that can be spread from one person to another by intimate sexual activity such as oral, vaginal, and anal intercourse. Some STIs can also be transmitted by intimate skin-to-skin contact such as rubbing genitals with a partner. "Sexually transmitted infections" is an umbrella term for more than 30 different types of infections caused by a variety of organisms, including bacteria, viruses and parasites.

    Sexually transmitted infections are sometimes referred to as sexually transmitted diseases (STDs) and venereal disease (VD). However, sexually transmitted infection is considered a more accurate term because not all of the organisms may necessarily cause a disease. For example, individuals can live with chlamydia without any evidence of disease or discomfort. In fact, about 75% of women and 50% of men do not show any symptoms. (Hoff et. al. 2003) However, they are still infectious, meaning they can pass the infection to other persons even though they feel no symptoms of disease.

    HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS and is an STI that is transmitted between people by exchange of blood, semen, vaginal fluids and breast milk. HIV infects human cells and uses the energy and nutrients provided by those cells to grow and reproduce. After developing a number of these infections or reaching a certain blood count level, an HIV-positive person is diagnosed with Acquired Immunodeficiency Syndrome (AIDS). This is a disease in which the body's immune system breaks down and is unable to fight off infections — known as "opportunistic infections" — and other illnesses that take advantage of a weakened immune system. There is substantial biological evidence demonstrating that the presence of other STIs increases the likelihood of both transmitting and acquiring HIV. (CDC, 1998)

    As mentioned above, people with STIs may have only slight symptoms or no symptoms at all. Therefore, a person can have an STI without knowing it. Because of differences in anatomy, females are more likely not to have signs of a problem or to experience symptoms. For example, a woman may not see or feel a sore located inside her vagina. On the other hand, if untreated, there can be severe consequences for females with an STI such as infertility or Pelvic Inflammatory Disease (PID). Therefore, while there is not a universally accepted recommendation about STI testing, for individuals who are sexually active (and using protection consistently and correctly) most medical experts recommend an annual STI exam. Individuals who do not use protection consistently and correctly should have more frequent STI exams.

    Instead of attempting to teach youth all of the facts for each STI, it is more useful to help them understand the big picture, that is give them a general idea of the signs and symptoms that should cause concern. A health care provider is the best person to diagnose and treat STIs. However, educators can discuss or elicit a general list of signs and symptoms that may indicate an STI, such as:

    Genital area

    • Itching
    • Bumps or growths
    • Blisters
    • Soreness, redness, irritation, or rashes
    • Pain or burning during urination
    • Unusual discharge from the penis, vagina or anus
    • Changes in the look, feel, or smell of genital area

    General

    • Swollen glands
    • Painful menstrual periods for women
    • Abdominal pain
    • Fever


    Overview of the Issues

    Unfortunately, STI incidence (the rate of new occurrences) and prevalence (the rate of existing cases) are particularly high among American teens. Adolescents need information and skills to prevent and control the spread of STIs. Consider the following facts about STIs:

    General facts about STIs:

    • The U.S. has the highest STI rates of any country in the industrialized world. (ASHA STD Overview)
    • STIs are associated in several ways with HIV. Because STIs and HIV are spread by similar types of sexual activity, people who engage in behaviors that transmit HIV are also more likely to contract STI, and vice versa. Epidemiological evidence shows that populations and geographical regions in the U.S. with the highest STI rates also tend to have the highest rates of HIV. (Highleyman, 2000 as cited in thebody.com)
    • The direct medical costs of treating STIs are over $8.4 billion a year. The indirect costs are much higher, including lost wages and productivity, as well as human costs such as anxiety, shame, anger, depression and physical pain. (ASHA STD Overview)

      For fact sheets with comprehensive information on STIs, go to the CDC website at http://www.cdc.gov/std/healthcomm/fact_sheets.htm or to the ASHA website at http://www.ashastd.org/news/news_factsheets.cfm

    Youth are particularly at risk:

    • While adolescents represent approximately 25% of the sexually active population, they account for about 50% of all new STIs (Weinstock et. al., 2004.) This means that half of the 19 million new STI cases each year occur in youth ages 15-24. (Healthy Teen Network Fast Facts)
    • Young people are at greatest risk for STIs because, as a group, they are more likely to have unprotected sex and have more than one sex partner. (ASHA STD Overview)
    • One in four (26%) female adolescents in the United States has at least one of the most common STIs, including human papillomavirus (HPV) infection, chlamydia, herpes simplex virus type 2 (HSV-2) infection, and trichomoniasis. (CDC, National Health and Nutrition Examination Survey 2003-2004)
    • According to the CDC 2003/04 National Health and Nutrition Examination Survey, for adolescent girls with STIs, the most common STIs were cancer- and genital wart-associated HPVs (18.3%), followed by chlamydia (3.9%), trichomoniasis (2.5%), and HSV-2 (1.9%). Among the teenage girls who had an STI, 15% had more than one. (CDC, National Health and Nutrition Examination Survey 2003-2004)
    • Among STI rates in youth, there are some disproportionate risks among populations:
    • African American women ages 15 to 19 have a chlamydia rate almost 7 times higher than the rate for white females of the same age. (CDC, 2002; Alford, 2003)
    • African American men ages 15 to 19 have a chlamydia rate almost 12 times higher than the rate for white men of the same age. (CDC, 2002; Alford, 2003)
    • HPV type 16, which can cause cervical cancer, is twice as prevalent in U.S. women as it is in U.S. men. (Alford, 2003; Stone et. al., 2002)
    • There is a rising rate of chlamydia, gonorrhea and syphilis in young men who have sex with men. (Alford, 2003)
    • Compared to older women, young women are particularly vulnerable to STIs such as chlamydia and gonorrhea because of changes in the cervix due to puberty. (ASHA STD Overview)
    • Half of the 20,000 new HIV infections a year in the U.S. are among youth ages 13 to 24. This means that every hour a young person in this country is infected with HIV. (Vasques, 2006 as cited in thebody.com)

    Addressing STIs with youth:

    • Most adolescents have some information about STIs. However, they are missing knowledge about transmission since 1 in 5 believe they would "know" if their partner had an STI, and 1 in 6 believe that STIs are spread only when symptoms are present. (Hoff et. al., 2003)
    • An HPV vaccine was approved by the FDA in 2006 for women ages 9-26 (and especially recommended for 11-12 year olds.) This vaccine prevents the most common cancer-causing HPV types (types 16 and 18) and most of the types that cause genital warts (types 6 and 11.) (For more details go to the Planned Parenthood Federation of America website.)

    What Educators Can Do

    1. Educators have valuable opportunities to reach young people with information about STIs.
      Health teachers, community educators, and patient educators can promote STI prevention strategies in their settings, in groups or in one-on-one interactions with youth. Below is a list of prevention strategies with questions designed to encourage discussion between youth and educators.
    • Being abstinent:
      Abstaining from sexual intercourse (and avoiding intimate sexual contact) is the most effective way to prevent a sexually transmitted infection. What are some alternatives to sexual intercourse that are less risky?
    • Limiting sexual partners:
      Reducing your number of partners also reduces the chances of coming in contact with an STI. However, there may still be a risk even if you have only one partner. How can you find out how many sexual partners your sexual partner has had in the past, or if she/he has had an STI?
    • Reducing the frequency of sex:
      Chances of pregnancy or transmitting any STI during a single act of sex are less than p=1.0. Multiple acts increase chances, up to a limit. How comfortable are you in expressing that you want to keep sexual contact to a minimum, except for safer practices?
    • Practicing safer sex using latex or polyurethane condoms with spermicide:
      The risk of contracting an STI is reduced if a couple uses condoms or dental dams (for oral sex on a woman) correctly and consistently. Since some infections, like genital warts and herpes, may be outside the vagina or the penis, a condom may not offer full protection, so the risk for infection with these STIs may still be high. How comfortable or confident do you feel using a condom or dental dam correctly and consistently?
    • Talking to your partner about STIs:
      Communicating about STIs and sexual health is essential to developing a healthy relationship and preventing STIs. An individual may want to think twice about engaging in sexual activity with someone who does not value these types of discussions. How would you begin a conversation with your partner about STIs?
    • Informing your partner:
      Telling a partner about having an STI can be very difficult. Nevertheless, informing a partner is an important step to taking responsibility for preventing further infection. How would you feel if your partner did not tell you that she/he had herpes or another type of STI?
    • Increasing the time gap between sexual partners:
      Infectivity of some STIs decline with time. Therefore, waiting to have sex for 3 to 6 months between sequential partners can substantially reduce the viral load of some STIs and subsequent possibility of infection. What are some ways you could develop a new relationship without engaging in sexual activity for several months?
    • Getting tested and treated:
      Many teens (both male and female) can have an STI without knowing it. For those who are sexually active, regular STI exams can help in obtaining effective treatment and preventing infection of partners. There are also vaccinations available for preventing HPV and Hepatitis B. How does going to your health care provider for an STI exam make you feel?
    1. Educators can also help young people connect with important resources.

      For example, educators can:
    • Give young people information about the availability of reproductive health services. Resources such as a local Planned Parenthood, public health center/clinic, school-based or school-linked health center, and a private doctor's office may offer STI testing, treatment and counseling. There may also be services that specialize in working with gay, lesbian and transgender youth. Confidentiality is often a concern for teens. Advise teens to ask about confidentiality policies in these health care settings if confidentiality is an issue for them.
    • Review condom and dental dam availability in your community.
    • Let young people know how they can get access to more information on sexually transmitted infections, such as an STI or HIV/AIDS hotline, health education web sites, books, pamphlets, etc.
    • Help adolescents build skills and encourage them to communicate about sexuality and decision-making with a parent or other trusted adult.


    More Information/Resources

    National organizations with additional information on STI and HIV/AIDS include:

    National Hotlines for further information include:

    • National STI Hotline: 1-800-227-8922
    • National AIDS Hotline:
      1-800-232-4636 (English)
      1-800-344-7432 (Spanish)

    Educational materials and sources that may be useful in designing an STI or HIV prevention program for adolescents include:

    Check out the web sites under National Organizations, listed above, for additional materials.

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