Biology, behavior raise STD risks for adolescents.(Gynecology)

NEW YORK -- Adolescents are disproportionately affected by sexually transmitted diseases because of biologic, psychological, cognitive, and behavioral factors, as well as poor access to health care, Dr. Robin Recant said at a gynecology conference sponsored by Mount Sinai School of Medicine.

Female adolescents are biologically at higher risk for STDs such as chlamydia and gonorrhea because of the columnar epithelium on their ectocervix, said Dr. Recant, of the New York City Department of Health and Mental Hygiene Bureau of Sexually Transmitted Disease Control.

Both chlamydia and gonorrhea preferentially attach to the columnar epithelium, she said. Also, HIV acquisition and shedding may be increased with cervical ectopy.

Mucus production in the adolescent female is increased, but the mucus is thinner than in older women, which may make it easier for pathogens to attach to the epithelium. Adolescent females also have lower vaginal pH, though there are no studies on the significance of this in terms of STD infection, Dr. Recant said.

Psychological and cognitive factors also make both female and male adolescents more vulnerable. For instance, these young adults may not appreciate the consequences of their actions. "Their lack of foresight is often compounded by the use of drugs and alcohol," Dr. Recant said.

Adolescents also may have difficulty with complex, ordered tasks, such as correct condom use. And they may use sexual activity as a form of rebellion against their parents. Adolescents are likely to experiment both with relationships and sexual behaviors. And since they are going through a formative stage of social development, it may be hard for them to negotiate with older sex partners, she said.

On the behavioral front, sexually active adolescents frequently have multiple sex partners, putting them at greater risk for STDs. Adolescents are frequently serial monogamists who have a series of short-lived sexual relationships, ...