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Nearly half of all new cases of sexually transmitted diseases show up in teenagers and young adults, even though they represent only one quarter of sexually active Americans.
That's according to estimates released yesterday from the Centers for Disease Control and Prevention in two new reports on the numbers and costs of STDs for young people between 15 and 24.
The reports are the first to break out specific information about STDs for that age group. Of the 18.9 million new STD infections in 2000, 9.1 million were found in young people, with the collective medical costs for infections among 15- to 24 year-olds adding up to $6.5 billion over a lifetime of treatment.
"It's not new information that younger people are at greater risk of STDs," said Kathy Harben, a CDC spokeswoman. "We've known for some time they're more likely than other age groups to have multiple sex partners and engage in unprotected sex.
"Now that we have this information, we can look at ways to reduce those numbers."
The findings were published in Perspectives on Sexual and Reproductive Health, a journal of the Alan Guttmacher Institute, a non-profit research group that supports reproductive rights.
A panel of nine young people from around the country, including Kent native Chrissy Kajita, 23, offered comment for a separate report from the School of Journalism and Mass Communication at the University of North Carolina-Chapel Hill. That report, also released yesterday, analyzes the CDC's findings and makes recommendations for curbing STD infections in young people.
Frank discussions between parents and children, specific explanations about how to use condoms and more widespread screening for STDs could help reduce infections, the authors suggest.
The Bush administration has backed increased spending on abstinence education for teens.
The CDC also stresses abstinence for unmarried young people as the only 100 percent effective method of preventing STDs, while also recognizing the effectiveness of condoms in halting the spread of HIV and other STDs.
"Our goals are to increase the number of young people who delay the onset of sexual activity and provide accurate information for those who do not," said Harben.
But a focus on abstinence ignores the teens who are already having sex, said Kajita. The youth panel was recruited by Advocates for Youth, a vocal opponent of the administration's sex education strategy.
"In order to make good decisions, youth need to have every option available and be educated about all of them -- how to use condoms, how to use birth control and who to talk to," Kajita said.
Kajita's own memories of sex education involve an older male teacher explaining spermicide and a lot of giggling.
"There's not enough comprehensive sex education," said Kajita. "I do feel like abstinence should always be somebody's choice, but if they're going to have sex, they have to have all the facts and know how to do it safely."
Education is critical, especially for teenagers, who are often hindered by half-truths and misinformation, agreed Dr. Theresa-Ann Clark, a family physician at the Kent Teen Clinic.
"In order to protect yourself from STDs you really need to believe you're going to have sex," said Clark. "A lot of teens don't think it's sex if you're having oral sex. They don't think it's sex if you're having anal sex. They don't think it's necessarily sex if they don't have full intercourse -- just skin to skin touching."
High numbers of STD infections in young people may appear to conflict with a nationwide decline in teen pregnancies, but the two aren't always related, said Jacqueline Darroch, a former senior vice president at Alan Guttmacher and one of the companion report's advisers.
More teenage girls might be taking advantage of injectable and patch contraceptives, but those same kids aren't always using a condom -- the only contraceptive that's also effective at preventing the spread of STDs, Darroch said.
Teenage girls are often more worried about getting pregnant than getting an STD, Clark said. If they're having anal or oral sex, "They're feeling like I'm safe because I'm not going to get pregnant. Thinking about an STD falls further down on the list."
The CDC report found the three most common STDs in young people -- chlamydia, human papillomavirus (HPV) and trichomoniasis -- accounted for 88 percent of all new cases in 15 to 24 year olds.
In King County, chlamydia hit young women between 15 and 19 the hardest, with 2,113 cases, compared with 474 cases in men the same age in 2002. That gap could be due in part to a lack of screening in boys, according to a county report.
Those three infections often do not cause symptoms, leaving unaware teens vulnerable to diseases that could lead to long-term health problems, said Dr. Peter Leone, medical director of HIV/STD Prevention at the North Carolina Department of Health and Human Services.
HPV, for example, is a relatively benign virus the body often clears on its own. In some cases, however, HPV can cause genital warts or cervical cancer.
Because young people are sometimes reluctant to share their sexual history with a doctor, especially if that same physician also treats their parents, screening can detect diseases that a discussion about sexual behavior might miss.
"People may or may not fib to their beloved docs," said Bonnie Nickle, STD education consultant for the state of Washington. "They may not wish to disclose, especially a young person."
For that reason, every youth who comes through the door at the Kent clinic is screened for chlamydia, which left untreated can cause infertility in women.
Kajita, who coordinates after-school activities at a Seattle middle school, said she's surprised to hear even pre-teens share stories about experimenting with sex.
"It's amazing. They physically look like they're more mature than they are," said Kajita. "They tell me things and I'm like, 'No. I don't want to know that. You're in seventh grade.' "
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