Background:
The highest burden of sexually transmitted infections (STIs) are among adolescents. Pregnancy and acquisition of STIs are outcomes of unprotected sex; thus pregnant adolescents may be at greater risk for STIs.

Objective:
To describe sexual and treatment-seeking behaviors among pregnant adolescents.

Method:
We identified adolescents age 13-17 attending two public STD clinics in Baltimore, MD during 1996-2002, who were pregnant and matched nonpregnant controls by clinic and year of visit. We compared differences between groups using Student's T-test, Pearson's chi-squared and logistic regression.

Result:
6% (N=7009) of adolescent females attending the clinics were pregnant. 38.9% of pregnant adolescents knew they were pregnant upon clinic presentation (“known”); Known pregnants were more likely to report a +STI test (12.2% vs. 0.9%, p<0.001) or STI contact (20.3% vs. 10.3%, p=0.01) as their reason for visit and less likely than those diagnosed pregnant at clinic visit (“diagnosed”) to report condom use in the past 30 days (30.4% vs. 49.8%, p<0.001). 48.9% of all pregnant adolescents delayed seeking treatment for >11 days. Self-reported STI symptoms were predictive of early treatment-seeking behaviors among diagnosed (OR=7.38, p<0.001) but not for known pregnant adolescents. 51.7% of all pregnant adolescents were diagnosed with at least one STI. Illicit drug was high among all adolescents (37.7%).

Conclusion:
Though typically monogamous, pregnant adolescents engage in unprotected sex and have a high burden of STIs, and often delay seeking treatment. Specialized interventions to promote self-protective behavior during pregnancy and early treatment-seeking during pregnancy may reduce the complications of teen pregnancy.

Implications:
Understanding patterns of sexual behaviors and determinants of delays in treatment seeking behaviors among pregnant adolescents allows for development of interventions that integrate counseling messages promoting the benefits of condom use in monogamous relationships and early treatment-seeking behaviors, to ultimately decrease rates of unwanted pregnancy, STIs, and adverse pregnancy outcomes.