Rates of sexually transmitted infections have climbed for the fourth consecutive year in the United States. While young people (ages 15-24) only account for one quarter of the sexually active population, they represent half of all new cases of chlamydia, gonorrhea, genital warts, and HIV. Why are teens and young adults contracting STIs at twice the rate of all other age groups? Your Teen asked Dr. Susan Ernst, chief of gynecological services at the University of Michigan’s University Health Services, for some answers and advice.
Q: What are the most common STIs you see in college students?
Ernst: For bacterial infections, we see primarily three: chlamydia, gonorrhea, and syphilis. These infections can be treated with antibiotics. Gonorrhea infections require treatment with two antibiotics to prevent drug resistance. Other common STIs are viral infections, such as human papillomavirus (HPV) and herpes simplex virus (HSV-2). These viral infections are nonreportable because it can be difficult to diagnose them and there is no effective treatment or cure to get rid of them.
Q: Why are these STIs on the rise?
Ernst: The CDC is not certain why the rates of STIs are increasing. We are able to identify the increase of STIs in certain groups that have high risk behaviors, including men having sex with men. Inadequate screening for STIs, lack of appropriate treatment of STIs, and missed opportunities for partner treatment may explain some increase in infections. We also believe that antibiotic resistance may be a contributing factor. For example, two antibiotics are now recommended to treat gonorrhea, but despite this change, resistance may be developing to the second antibiotic.
Q: What behavioral factors are contributing to the increase?
Ernst: We know from surveys of high school and college students that there is an “extended adolescence” phenomenon. Students are engaging in many typical risk-taking behaviors later, including sexual activity. Many incoming college students simply do not have any experience dealing with risk, sexual activity, or protection. They may also lack relationship experience and the communication skills to talk about things such as protection, monogamy, or health.
We can also see that students this age simply do not perceive their risk for STIs. They may cognitively understand the risk of contracting an STI through unprotected sex, but when you ask them whether they think they will get one, they don’t believe they personally are at risk. Some of this is directly attributable to the adolescent brain, which isn’t fully developed, especially that part of the brain which evaluates risk. They may not understand the risk of engaging in sexual behaviors, particularly when under the influence of alcohol or drugs.
Q: What do you wish students knew before they get to college?
Ernst: We like to explain to high school and college students the differences between their perceptions of what they think everyone is doing versus the reality. We know from the American College Health Association (ACHA) national survey that college students believe that 80 to 90 percent of their peers are drinking, smoking pot, and having sex. In reality, however, the numbers are much lower. For example, less than 20 percent of college students use marijuana, and about 40% have never been sexually active. Teens and young adults should feel comfortable saying they do not want to participate in these activities and not feel pressured by the notion that “everyone is doing it.”
Q: What can parents do?
Ernst: Parents need to have an open, ongoing dialogue with their teenagers about their family’s values about sexual activity. Talk about the risks associated with sexual activity, alcohol, and drugs. Talk about prevention: There are vaccines for HPV and hepatitis A and B, and parents should consider these before kids go to college. Your teenager should know about protection. Even if they are using oral contraceptives or an IUD for pregnancy prevention, they still need to use a condom for STI prevention. Lastly, your teenager should understand that there are resources at almost all colleges for student health services, counseling and psychological services for mental health issues, as well as sexual assault prevention services, so they are equipped to deal with these issues if they arise.
Q: What advice do you have for parents preparing their teens for college?
Ernst: Have these conversations now with your child so they know they can talk to you. I have had students who are having health problems or struggling with mental health crises who will say, “I can’t tell my parents, they wouldn’t understand,” or they’re so afraid of their parents’ reactions that they don’t want them to know about their problems. Make sure your child is comfortable coming back to you, so you can support them, help them find resources, and get treatment when they need it.