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Thursday, March 13, 2008 - 8:30 AM

Prevalence of Sexually Transmitted Infections and Bacterial Vaginosis among Female Adolescents in the United States: Data from the National Health and Nutrition Examination Survey (NHANES) 2003–2004

Sara E. Forhan, Sami L. Gottlieb, Maya R. Sternberg, Fujie Xu, S. Deblina Datta, Stuart Berman, and Lauri E. Markowitz. Division of STD Prevention, CDC, 1600 Clifton Road, Mailstop E-02, Atlanta, GA, USA

Adolescent females have a high burden of several individual STIs; however, there have been few population-based estimates of the overall burden of STIs in this group.

To estimate the prevalence of the most common STIs and bacterial vaginosis (BV) among a representative sample of 14-19 year-old females in the U.S.

Female participants aged 14-19 years in NHANES 2003-2004 underwent testing of (1) urine for Chlamydia trachomatis (CT) using BD ProbeTec (n=793); (2) sera for herpes simplex virus type 2 (HSV-2) using an immunodot assay (n=729); (3) self-collected vaginal swabs for Trichomonas vaginalis (TV) using PCR (n=695), BV using gram stain and Nugent score ≥7 (n=685), and human papillomavirus (HPV) using PCR (n=652). We evaluated prevalence of any of 23 oncogenic HPV types or types 6 or 11, responsible for most genital warts (HR/6/11 HPV). We defined “any STI” as CT, HSV-2, TV, or HR/6/11 HPV.

Among 838 participants, 404 reported ever having had sex. Weighted prevalence of “any STI” was 25.7 (95% CI: 20.1-32.9) among all female adolescents and 39.5% (95% CI: 31.1-50.3) among those who reported having had sex. The most prevalent STI was HR/6/11 HPV (18.3%), followed by CT (3.9%), TV (2.5%), and HSV-2 (1.9%). The prevalence pattern was similar among those who reported having had sex: HR/6/11 HPV (29.5%), CT (7.1%), TV (3.6%), and HSV-2 (3.4%). Among those with any STI, 15% had >1. Almost 25% of female adolescents had BV, regardless of sexual experience. Applying these estimates to 2007 census data, we expect >3.2 million prevalent cases of these STIs and >3 million BV cases among U.S. 14-19 year-old females.

STI prevalence is high among U.S. adolescent females. Prevention of STIs and their complications remains an urgent public health priority for this group.

Public health efforts should be increased to prevent STIs among adolescents.