Thursday, October 6, 2011

Time From First Sex to First Sexually Transmitted Disease: What Age Women/Girls Are at Risk, and What to Do About It

The time of first sexual activity in young women has always been a subject of debate as it relates to complex social and ethically issues but also for serious health issues. This has been highlighted recently by the debate over the cervical cancer vaccines, Gardasil and Cervarix, as it raises the issue about if/when to vaccine girls/women against a serious form of cancer that is contracted as an sexually transmitted disease (STD) or sexually transmitted infection (SDI).

Screening for STDs in young women/teenage girls is appropriate given sexual behavior in younger women and the high level of morbidity/complications that can occur from untreated STDs, such as pelvic inflammatory disease (PID), ectopic pregnancy, infertility, premature births, and increased risk of contracting HIV.

A group of researchers from Indiana recently tried to determine the age at first sexually intercourse among girls aged 14 to 17, the time interval from the first sexual intercourse to first STD, and the time between infections. The most common infections that were screened for were Chlamydia, Gonorrhea, and Trichomonas.

The goals of the study were to try to establish when it would be appropriate to begin screening sexually active girls once they begin having sex, and then what is the appropriate screening interval to be sure they do not have a 2nd/3rd, etc infection.

A group of 386 girls were studied and followed. They were mostly urban and black ethnicity (89%). The follow up period for the study was 2 yr, and the average number of sexual partners was 3.

The age at first sexual intercourse was on average 14 years old. By age 15, 25% of the girls acquired their first STD, most often Chlamydia, although the median interval between first sex and first STD was 2 yrs. Other infections, as noted were gonorrhea and trichomonas. The time between the 1st and then 2nd infection was on average between 3-6 months, often with the same organism. This concerning fact points to the either the prevalence of STDs among the teenage boys infecting these girls, or the fact that the boys may or may not be treated and may be reinfecting their same sex partners. Interestingly, the younger the girl, the longer it took to screen her from her first sexual encounter, for example, for girls age 10 or 11 who were sexually active, they were not screened for 3-5 years later, while for girls ages 13 or 14, they were usually screened within 1-2 yrs after their first sexual encounter.

What can we learn from such a study? May girls become sexually active while still teenagers, and young teens or pre-teens, and early age of sexual intercourse is correlated with a higher risk of STDs. Multiple sex partners and an urban population increases the risk for STDs, but the finding allows doctors, health advocates, teachers, parents and teens to understand that among the many potential pitfalls with early age sexual activity, also comes the risk and reinfection of STDs. Since often Chlamydia and gonorrhea may not lead to symptoms in girls, untreated infection can lead to serious gynecologic and fertility health concerns, as well as promoting transmitting infection to other sex partners.
If screening for STDs were to be adopted in girls within 1 yr or less from when the begin engaging in sex, it would benefit them by catching them often before they acquire an STD, and can be appoint of education for sex education and prevention.