Background:
An accurate assessment of sexual risk behaviors by medical providers is essential to the delivery of appropriate clinical and preventative services. Some reports indicate rising national rates of adolescent participation in oral and anal sex.

Objective:
To examine changes in prevalence between 1994 and 2004 in reported recent oral and anal sex among inner city youth attending city STD clinics in Baltimore, Maryland.

Method:
This was a records-based historical cohort study. We examined electronic data captured from the standardized medical evaluation which included documentation of recent (approximately 90 days) sexual exposures of clients aged 12-25 years visiting either of 2 public STD clinics. We used records for the first visit for each individual during 1994 and 2004. We used chi-square analysis to test for differences in prevalence of reported sexual exposures in each cohort. We also used multivariate logistic regression to adjust for age, gender of client, gender of sex partner, and race.

Result:
There were 2598 (62% male) records from 1994 and 6438 (51% male) records from 2004 meeting eligibility criteria. Reported recent oral sex increased dramatically between 1994 and 2004, from 16% to 32% (p<.0001) in males and 14% to 38% (p<.0001) in females. Among male clients reporting a same sex partner, rates of oral sex also increased from 33% to 75% (p=.006). Receptive anal sex also increased among females from 3% to 6.5% (p=.0003). After adjusting for gender, age, and race, heterosexual clients seen in 2004 were almost three times as likely to report having oral sex (OR = 2.6, 95%CI: 2.3 – 3.0) than those seen in 1994.

Conclusion:
Local rates of oral and rectal sex reported by youth are increasing, consistent with national trends.

Implications:
To optimize STD screening practices among youth in the community, STD programs should promote increased provider awareness of changing sexual behavior in this population.