Despite success for almost two decades in controlling the spread of sexually transmitted diseases, a new study by the U.S. Centers for Disease Control and Prevention suggests progress may be slowing. In some cases, rates are increasing.
Chlamydia cases hit a new high in 2007 with 1.1 million diagnoses reported, a 7.5% increase from 2006. And gonorrhea infection rates, after decreasing for more than 20 years among teens and adolescents, saw an increase among males age 15 to 19 from 250 cases per 100,000 people in 2004 to 275 cases per 100,000 in 2006. The CDC study combines results from multiple data surveys from 2002 to 2007.
The CDC estimates about 19 million STD infections occur each year and almost half of those are among people ages 15 to 24, though that age group makes up only 25% of people who are sexually active.
Nurses who work in facilities that treat teens for STDs say what they are finding mirrors the national picture.
Mary Reinfried, RN, is a nurse at Englewood (N.J.) Hospital Outpatient Clinic, a state-funded clinic specifically for treating STDs.
We are seeing a large increase in chlamydia, she says. The disease can be spread through oral, anal, or vaginal sex, and according to the CDC, about three-quarters of infected women and about half of infected men dont have symptoms.
I just dont think people think it will happen to them, Reinfried says. They come in and say theyve had unprotected sex.
Peer pressure also plays a big part in teens sexual choices. Weve had a couple of young girls come in who have done rainbow parties, Reinfried says. Thats when a group of girls all wear a different shade of lipstick and the guy will see how many colors he can collect on his penis. We are definitely seeing more of these. They dont think its sex. Im always incredulous.
Englewood is a free walk-in clinic available three days a week. After patients fill out a questionnaire, nurses review the information and begin testing. Nurses counsel patients on safe-sex habits and give them written and verbal information.
Because were state funded, we cant do as much as wed like to, Reinfried says. For instance, we dont test them for HIV we have to refer them out for that.Serena Hammie, RN
To reverse the increasing trend of STDs in teens, nurses at Englewood Hospital Outpatient Clinic are focused on education and prevention.
We educate them ideally on abstinence, but I dont think thats a reality in todays world, Reinfried says. We primarily promote the use of condoms.
Education also is at the heart of the work done with infected teens who come to the ob-gyn clinic at the Osborn Family Health Center in Camden, N.J.
Elizabeth Bishop, RN, says nurses at the center talk with teens about how the diseases are transmitted and offer HIV testing. They also tell teens how to protect themselves and reinforce that their partners need to be treated, too. If the patient doesnt have a family physician, they give information about where they can go.
Theyve heard of these diseases but I dont think it really sinks in. They dont really recognize how dangerous this can be to their health, Bishop says. I always tell my patients that every person you have sex with, youre having sex with every person theyve ever had sex with, too.
Teens need to realize that risky sexual behaviors can lead to uncurable infections, as well.
[At the clinic] if you have gonorrhea or chlamydia we can give you things to treat that, Bishop says. But with HPV (human papilloma virus) or HIV, that puts your life in jeopardy. They are living in the moment and dont think far enough about the consequences.
Consequences can be severe. Chlamydia and gonorrhea, the two most commonly reported infectious diseases in the U.S., pose a particular risk to women since both can lead to infertility, ectopic pregnancy, chronic pelvic pain, or other serious health problems if not treated. And the majority of cases go undiagnosed.
Serena Hammie, RN, BSN, director of nursing at the Southern Jersey Family Medical Centers in Salem, N.J, says the girls who come in for treatment often have symptoms of vaginal odor or discharge. Teen boys may have experienced a burning sensation when urinating or have discharge as well. Hammie says sometimes the most intimidating part of the visit is when they talk about needing to tell a partner or multiple partners about positive test results.
Thats where the scary part comes in, Hammie says. They may not even know who gave it to them. But we do tell them that if they are not comfortable explaining the disease to their partner, we ask that they bring the partner in and we will talk with both of them. Sometimes they will do that.
There are few surprises left when youre a nurse in an STD clinic in an urban setting like New York City, says Lizette Feliciano, RN, charge nurse for Betances Health Center. But one thing has surprised her recently, she says: the age of the patients.
Theyre getting younger and younger, she says. Its alarming. Weve had them in here as young as 11. They dont know anything about the disease they have, just that they found a spot or feel pain.
Feliciano, RN, says sex education in schools should start as young as age 8. We have to educate parents that by the time they think they need to talk about prevention, their child is already having sex, she says.
After nine years of helping teens who have come to the Englewood clinic with symptoms of diseases they never expected to get, Reinfried says her job is full of rewards and frustrations.
They do leave here somewhat better educated, she says. But theres still a frustration that teenagers are risking their lives just to have a good time.