Evidence Based Practice

Evidence Based Practice

Evidence Based Practice

The risk of acquiring a sexually transmitted disease is one of the most significant and immediate risks to the health and well-being of adolescents. From an economic and social standpoint, these infections continue to exact a significant toll on adolescents and ultimately on society. This toll can be measured in terms of projected costs of certain infections, such as chlamydia infections (Washington, Johnson, & Sanders, 1987) and in terms of health outcomes, such as the number of ectopic pregnancies (Chow, Darling, & Greenbert, 1987) and the rate of infertility (Westrom, 1980). The real concern, however, is that in an era when a sexually transmitted infection, human immunodeficiency virus infection (HIV), can result in a fatal illness, the acquired immunodeficiency syndrome (AIDS), we have begun to measure the impact in terms of deaths of adolescents and young adults from AIDS. For this reason, the potential impact of sexually transmitted diseases is all the more significant and prevention of these infections an even higher priority.

STDs and associated morbidity

STDs are a generic term for infections attributable to sexual transmission. They can be caused by a broad spectrum of etiologic agents, including bacteria, viruses, and parasites. The sequelae of STDs are particularly devastating to the female reproductive tract, often resulting in infertility or ectopic pregnancy. Although many common STDs can be cured with medication, viral STDs (e.g., human papillomavirus and genital herpes) remain intransigent to treatment and serve as a significant source of morbidity for adolescents as they enter adulthood. While a detailed review of each etiologic agent and its associated STD is beyond the scope of this chapter, table 27.1 provides more information about

STDs disproportionately affect adolescents

Adolescents are disproportionately affected by a wide range of STDs. In the United States, more than 15 million new cases of STDs occur annually (American Social Health Association, 1998). Each year, about one-quarter of all STDs occur among adolescents (Eng & Butler, 1997). By age 24, at least one in three sexually active young adults is estimated to have contracted an STD (Alan Guttmacher Institute, 1993). Females are much more likely than males to be diagnosed with STDs. Table 27.2 contrasts rates for specific STDs by gender between adolescents and the US population. This comparison shows that adolescents, particularly females, bear most of the STD burden. These findings are alarming because the figures do not reflect the fact that fewer adolescents than adults are sexually experienced. When sexually inexperienced adolescents are removed from the denominator, the gap between adolescents and adults becomes even greater (Berman & Hein, 1999).

Another adolescent subgroup that has experienced excess burden associated with STDs is minority adolescents. Minority adolescents, particularly African Americans, bear a disproportionate STD burden. For example, a national survey of 14-21-year-olds indicated that African Americans were more than 3.5 times as likely to report a history of STD than other adolescents, and this difference was not attributable to sexual-risk behavior or sociodemographic factors (Ellen, Aral, & Madger, ...