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Gonorrhea, shown here, affected 3,474 Arkansans under the age of 30 in 2007, according to statistics from the Arkansas Division of Health. Of those documented cases, 1,391 were for children and teens.

In response to a widely reported national study on sexually transmitted diseases in adolescent females, two Arkansas health leaders are calling for increased sexual education in the state.

Researchers this spring announced that about 3.2 million teenage girls in the United States are estimated to have a sexually transmitted disease.

At the 2008 National STD Prevention Conference in Chicago, the Centers for Disease Control and Prevention (CDC) released the study, which estimated that one in four female adolescents in the United States between ages 14 and 19 is infected with at least one of the most common STDs.

The study analyzed data on 838 teenage girls who participated in the 2003-04 National Health and Nutrition Examination Survey, an annual study that assesses a broad range of health issues. The teens were tested for human papillomavirus (HPV) infection, chlamydia, herpes simplex virus type 2 (HSV-2) infection and trichomoniasis.

Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said that because the health effects of STDs (ranging from infertility to cervical cancer) are particularly severe for women, STD screening, vaccination and other prevention strategies for sexually active women are among “our highest public health priorities.”

Dr. Karen J. Kozlowski of Arkansas Children’s Hospital agrees.

“I think the number-one thing is that if girls are sexually active, they need to be screened,” she said. “If you have HPV, which is considered a sexually transmitted infection, there are no symptoms, but it’s picked up on a Pap smear.”

Almost half the black teens in the CDC study had at least one sexually transmitted infection, compared to 20 percent among both white and Mexican-American teens.

“High STD infection rates among young women, particularly young African-American women, are clear signs that we must continue developing ways to reach those most at risk,” stated Dr. John M. Douglas Jr., director of the CDC’s Division of STD Prevention.

Dr. James Phillips, branch chief of infectious diseases for the Arkansas Department of Health, said the disparity is caused by a number of hard-to-verify factors, but noted two primary reasons for the high rate of infection among black girls.

“The areas with high proportional African-American population tend to be areas of the country where sex education is de-emphasized or discouraged. That’s one factor,” Phillips said. “Another factor is sexual protections among certain groups. Even if education is provided and received, they are reluctant to demand protection from their partners.”

About half of the girls the CDC surveyed reported having sex; of those confirming sexual activity, 40 percent had an STD infection.

The study showed that even among girls reporting only one lifetime partner, one in five (20.4 percent) had at least one STD. Girls with three or more partners had a prevalence of over 50 percent. The predominant STD was HPV.
In Arkansas, the Health Department does not track all of the STDs in the CDC study.

Phillips said the CDC study was looking for four particular STDs — HPV, genital herpes, chlamydia and trichomoniasis — but Arkansas does not keep records for HPV, trichomoniasis or genital herpes. “So we cut our comparisons with other areas of the country with these three,” he explained. “But, like most health departments, we keep records of gonorrhea, chlamydia infections and syphilis.”

For those three STDs, Phillips provided the following 2007 statistics:

• In 2007 in Arkansas, among the entire population, the state had 155 cases of gonorrhea per 100,000. The national average is 120 per 100,000. Arkansas is 12th out of all the states.
• Arkansas had 207 cases of chlamydia per 100,000. Nationally, the average is 345 cases per 100,000. Arkansas is 31st out of all states.
• Arkansas reported 2.8 cases of syphilis per 100,000. Nationally, the average is 3.3 cases per 100,000. Arkansas ranked 18th out of all states.

“Arkansas is ranked pretty high (in STDs),” he said. “Chlamydia may have under-representation. We were a little slower than some other states to do ... more sensitive testing for chlamydia, and because of that ... our numbers might be a little bit lower than actuality.”

Arkansans Kozlowski and Phillips both urged more sex education for teens.

“No doubt about it, abstinence is the best. But education is important. We preach to use condoms, and condoms are very important, but condoms do not prevent 100 percent of STDs,” Kozlowski said. “I think a lot of people stick their heads in the sand — you have to be honest with the way the world is and comfortable talking about it (with a teen). Having an honest, ongoing conversation where you feel comfortable talking to young people and they feel comfortable talking to you is key.”

Kozlowski noted that younger adolescents naively think that STD infections won’t happen to them.

“I think every chance that anyone has a teenager as an audience, they should get in their licks toward sexual education,” Phillips said. “The emphasis the last eight years of education has been almost entirely abstinence programs ... and with that, sexual education and good sexual-protection practices are taking the very back seat on the bus.”



June 2008

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