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Concerns are being raised about the low test rate for sexually transmitted illnesses among teens and young adults. Eloisa Ramos/Stocksy United
  • Only about 20 percent of sexually active high school students get tested for sexually transmitted illnesses despite the fact that the age group represents 50 percent of all STI cases in the United States.
  • Experts say a lack of access to healthcare and concerns about confidentiality are factors for the low testing rate.
  • They say STIs can cause serious long-term health problems if they aren’t treated.

More than half of all sexually transmitted illnesses (STIs) occur among adolescents and young adults.

However, few high school students get tested for diseases such as chlamydia and gonorrhea.

Only 20 percent of sexually active high school students reported testing for an STI in the previous year, according to data from a national Youth Risk Behavior Survey released by the American Academy of Pediatrics.

The figures included 26 percent of female students and about 14 percent of male students.

That’s far below the STI screening recommendations established by the U.S. Centers for Disease Control and Prevention (CDC) and other health groups.

Those guidelines call for annual testing for chlamydia and gonorrhea for all sexually active women under age 25 and testing for syphilis, chlamydia, and gonorrhea for all sexually active gay, bisexual, and other men who have sex with men, as well as otherwise engaging in risky behaviors such as injection drug use.

The CDC also recommends annual HIV testing for everyone ages 13 to 64.

Nicole Liddon, Ph.D., a study author and a senior health scientist in CDC’s Division of Adolescent and School Health, told Healthline that while the findings were “roughly the same” as those in other studies, the recent incorporation of the STI questions in the annual Youth Risk Behavior Survey will allow researchers to track testing trends over time.

“The fact that females report getting tested at a higher rate suggests some adherence to the national guidelines, but it’s still suboptimal,” said Liddon.

Similarly, young men who reported having sex with other men were more likely (about 30 percent) to get tested than straight men (about 13 percent), but still far below the CDC’s recommended levels.

These concerns were heightened when the CDC released a report showing that cases of syphilis and gonorrhea increased in 2020 during the first year of the COVID-19 pandemic.

Young people ages 15 to 24 years acquire half of all new sexually transmitted infections annually in the United States, according to researchers. They add that one in four sexually active adolescent females in the United States has an STI.

Dr. Gary Schoolnik, professor emeritus of infectious diseases at Stanford Medicine in California and chief medical officer at Visby Medical, told Healthline that HPV rates are as high as 29 percent among adolescent females and 58 percent among women ages 20 to 24.

“There are an estimated 20 million new STI cases reported in the U.S. each year, and chlamydia and gonorrhea are more common among adolescents than any other age group,” said Schoolnik.

Adolescents are more likely to engage in high-risk sex, have sex with multiple partners, and not use condoms than adults, he added.

“They have a higher risk of exposure to STIs and a lower likelihood of being tested and treated,” Schoolnik said.

Chlamydia and gonorrhea are easily treatable, but if left undiagnosed can cause lifelong health problems, particularly for women, said Schoolnik.

Infertility, chronic pelvic pain, and ectopic pregnancies — the latter of which can be fatal — all are linked to untreated chlamydia and gonorrhea. HPV, which can be prevented through vaccination, is known to cause cervical cancer.

Liddon and her colleagues identified a broad range of barriers to STI screening for adolescents and young adults, including lower use of healthcare, confidentiality concerns, limited awareness of the need for screening, and logistical barriers such as transportation and cost.

“Even when adolescents have preventive visits or receive care for acute issues, there may be missed opportunities for sexual history-taking and recommended screening because of provider discomfort, time constraints during the clinical visit, and misperceptions about adolescents’ sexual activity, level of comfort, and honesty,” the study authors wrote.

“About one-third of states require parental notification if a kid seeks an STI test,” noted Schoolnik, who said adolescents also may experience confidentiality breaches if they are covered by their parents’ health insurance policies.

Schoolnik said that interventions such as the mobile STI clinics run by Children’s Hospital of Philadelphia and by Stanford Children’s Health can be a less intimidating setting for teens to get tested than at their doctor’s office or via a school nurse.

The latter uses a rapid STI test developed by Visby Medical that can deliver results in 30 minutes, allowing providers to administer on-the-spot treatment to patients and give take-home medication to their partners.

Visby Medical also is seeking Food and Drug Administration approval for an at-home version of its STI test, which could be available to the public as early as next year, said Schoolnik.