Only one-fifth of sexually active teens report STI testing

Only one-fifth of sexually active high school students reported receiving STI testing within the previous year, a survey found.

The finding was published in Pediatrics and “suggests suboptimal adherence to national guidelines” from the AAP and others, who advise STI testing for all sexually active women and certain young men aged younger than 25 years, researchers wrote.

They examined data from the 2019 national Youth Risk Behavior Survey (YRBS), which for the first time included a question about annual STI testing to find out more about testing prevalence among sexually active adolescents.

“It is estimated that young people aged 15 to 24 years acquire half of all new sexually transmitted infections annually and that one in four sexually active adolescent females in the United States has an STI,” they wrote.

“Given the high rates of STIs among adolescents, serious consequences of infection, including pelvic inflammatory disease and infertility, and cost-effectiveness of Chlamydia screening,” the AAP, United States Preventive Services Task Force, the CDC, and the American College of Obstetricians and Gynecologists “recommend some degree of STI screening for adolescents and young adults,” they added.

Despite these recommendations, adolescents have historically had “lower use of health care,” in part because of concerns regarding confidentiality, “limited awareness of the need for screening, and logistical barriers” that could include transportation and cost, the authors wrote.

They examined data from the 2019 YRBS, which biennially surveys students at public and private high schools across the country. Their sample was limited to students who reported having had intercourse with one or more people in the last 3 months before the survey, resulting in a sample of 2,501 students.

Of that group, one-fifth (20.4%) reported testing for an STI in the previous year, with a higher proportion of female (26.1%) than male (13.7%) students reporting testing (26.1%, CI = 22.4%-30.2% vs 13.7%, CI = 11%-17%). Among eligible respondents, 4.1% reported they were not sure if they had an STI test in the last 12 months (CI = 3.1%-5.4%).

The authors said the findings “underscore the importance of improving implementation of STI testing services.”

“In general, though, there is a need to both increase adolescent access to preventive health services, as well as to ensure youth receive quality health care when at the clinic so as to reduce missed opportunities,” they wrote.

The piece was accompanied by a commentary from Cynthia Holland-Hall, MD, MPH, and Andrea E. Bonny, MD, a member and section chief, respectively, in the adolescent medicine division at Nationwide Children’s Hospital in Columbus, Ohio.

“The authors’ finding that less than one-third of sexually active students report testing underscores the need for more research,” they wrote.

Holland-Hall and Bonny noted that before the COVID-19 pandemic, gonorrhea, chlamydia and syphilis were all reported at record-high rates in the United States, with about one-half of all new infections occurring in adolescents and young adults. They cited YRBS data, which showed that 20% of high school freshman and more than 50% of high school seniors have had sex, whereas less than one-half report having used a condom with their most recent sexual encounter.

“It is, therefore, critical that those who care for adolescents provide STI testing,” they wrote.

They recommended that practices adapt opt-out STI screening strategies as “one means of addressing this need.”

“With opt-out screening, the patient is notified that STI testing will be performed, and they may decline this testing if desired,” they wrote. “This process may occur outside of a more comprehensive conversation about sexual behaviors, for example, when a nurse is initially preparing a patient to be seen by the provider. Although robust research on this practice is lacking, some data suggest that opt-out testing may improve detection rates and be cost-effective in some populations.”

References:

Holland-Hall C, et al. Pediatrics. 2022;doi:10.1542/peds.2021-055954.