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Am Fam Physician. 2000;61(3):866-872

Most adolescents are sexually active by the 12th grade. Of these, a significant number will also acquire a sexually transmitted disease (STD). Adolescent females are at high risk for STDs because their lower genital tract is more susceptible to these infections. Females in this age group are also more susceptible because they often lack the social power and skills to refuse sexual activity or demand safer sex. A component of the prevention of STDs in this population is to identify patients at high risk and provide screening for STDs. Bunnell and colleagues studied the prevalence of STDs in female adolescents and explored risk behaviors and partner characteristics.

The study was a six-month prospective cohort trial. The persons enrolled in the study were all sexually active adolescent females from 14 to 19 years of age who attended four adolescent health clinics. The data collected included results of an interview to collect demographic information, sexual and reproductive history, STD knowledge and history, contraceptive practices, drug and alcohol use, and information on current and past sexual partners. Evaluations for Chlamydia, gonorrhea, herpes simplex virus (HSV), trichomoniasis, syphilis, hepatitis B and hepatitis C were also performed during the visit. All participants were asked to return in six months, when the assessment was performed a second time.

At the initial assessment, 40 percent of the adolescent females had an STD, with Chlamydia being the most common infection. During the follow-up visit, 23 percent had an incident infection. Chlamydia was again the most common infection. At the enrollment or follow-up visit, 53 percent had at least one STD. One important note is that 30 percent of patients who reported having only one lifetime partner had an STD.

The authors conclude that the prevalence of STDs was high in the adolescent female population. This was true even in adolescents who reported having only one lifetime partner. When providing health care for adolescents, screening should be based on the total risk of the population and not on individual risk.

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