Why Are So Many Teens Getting STDs?

According to public health experts at a recent adolescent health symposium, rates of sexually transmitted diseases are on the rise, and young people, especially teenagers, have the highest risk of acquiring a sexually transmitted infection of any age group.

More than 170 clinicians attended the event organized by the New York City STD Prevention Training Center at the Columbia Mailman School, one of the eight Centers for Disease Control and Prevention STD Prevention Training Centers (PTCs) nationally. The daylong symposium featured expert presentations on the risks for STDs alongside opportunities for prevention and treatment.

“April is STD Awareness Month, and there has never been a more crucial time to increase awareness and reduce the risk of infection,” said event emcee Alwyn Cohall, director of the Harlem Health Promotion Center and the New York STD PTC, and professor of Sociomedical Sciences and Population and Family Health. “Half of all STIs occur in young people aged 15 to 24.”

The stats paint a stark picture: In 2017, there were 2.3 million cases of chlamydia, gonorrhea, and syphilis cases in the United States, an increase of 10 percent over the previous year. Since 2003, syphilis is up 76 percent, and gonorrhea is up 67 percent. One likely culprit, said Cohall, is the “combustible combination” of sexually transmitted diseases and substance use—particularly the growing numbers of young people misusing opioids.

Opioids

To stem the spread of STIs, keynote speaker Bruce Trigg, a physician and addiction treatment expert, said more people—not least of all, clinicians—need the facts on how to treat opioid misuse. Common wisdom says the way to help a young person using heroin is to send them to rehab. In reality, however, rehab could be a deadly mistake. Whenever someone leaves a rehab facility after detoxing, there is a very good chance he or she will relapse, and with their drug tolerance diminished, they could easily overdose. “That [approach] results in funerals,” said Trigg. Instead, he said, children ages 16 and older should be treated using buprenorphine, which both eliminates cravings and prevents overdose. One major obstacle, however, is a lack of clinicians trained to prescribe the drug.

(Two Columbia Mailman professors were just awarded a grant through the Irving Institute for Clinical and Translational Research to educate students on college campuses about opioids and train them to use naloxone, the overdose reversal drug.)

Adverse Childhood Experiences

Even if a young person isn’t using drugs themselves, the presence of drugs in their life can lead to health issues, including STIs. Along with abuse, neglect, incarceration, and divorce, household substance abuse is considered an adverse childhood experience (ACE). In her presentation, Virginia Rauh, professor of Population and Family Health, said that the accumulation of ACEs can overwhelm a child’s coping mechanisms, rewiring the way he or she responds to stress. The greater the number of ACEs, the more likely they are to engage in risky behaviors, including sex, raising their chances of acquiring an STI. The evidence suggests a new way to think about troubled teenagers. “Instead of asking what is the matter with you,” said Rauh, “the question is really, ‘what has happened to you?’”

Prevention Through PrEP

A time-honored way to prevent STIs is sex education, particularly around the use of condoms. But even with the correct information, teens continue to have unprotected sex. Jason Zucker, internal medicine and pediatric infectious diseases fellow at Columbia Irving Medical Center, spoke about similar challenges around PrEP, a drug to prevent HIV. Approved last May for teenagers at high risk for HIV, the medication is over 96 percent effective when used as prescribed. However, persistence among adolescents falls off by two-thirds over six months. Thankfully, this situation may improve once an injectable form of PrEP is approved.

“We need more ways to keep people in care,” said Zucker, who sees patients through Project STAY, which is administered by the Harlem Health Promotion Center and NewYork-Presbyterian Hospital, and at the Comprehensive Health Program at Columbia University Irving Medical Center. He pointed to a number of factors that seem to help: an openness to walk-in appointments, assistance with payment, and an emphasis on sex positivity. “It’s very important that there is no shame.”