Grading the Nation
According to the CDC, after a long period of decline in the rates of sexually transmitted disease and pregnancy seen among young adults, the numbers of diagnoses have steadily begun to rise over the last few years. Chlamydia, gonorrhea, and even syphilis have been seen in increasing numbers among young people, even though all of these diseases are largely preventable with the use of condoms.
Much of this increase, at least anecdotally, can be tied to the Bush administration’s abstinence-only focused sex education policies. Telling teenagers that they need to wait to have sex until they get married does not teach them how to have sex safely (even if/when they are married). So, if and when teens choose to explore their sexuality—and they will—they don’t have the information to do so without accidentally acquiring one of the natural consequences of unprotected sex: a baby or a disease.
Regardless of why the problem exists, it is undeniably huge. The results of another CDC survey, released in 2008, suggested that more than one in every four teenage girls has a sexually transmitted disease. Most common, by far, is HPV, the virus responsible for most cases of cervical cancer, genital warts, and some rectal, penile, and oral cancers—but other diseases are also found in non-trivial percentages of the population as well. Another national survey of adolescents published in 2008 found that more than 6 percent of 15- to 24-year-olds tested positive for gonorrhea, trichomoniasis, or Chlamydia [Crosby RA, Danner F. (2008) “Adolescents' sexually transmitted disease protective attitudes predict sexually transmitted disease acquisition in early adulthood.” J Sch Health. 78(6):310-3].
Thanks to the basics of male biology, young men generally have lower rates of STDs than young women. However, they are still at risk, and there are a few STDs that show up at higher rates among young males than their female counterparts. Syphilis and HIV are both more common among males, at least in part because of the relatively high rates of these diseases among young men who have sex with men. Scientists have several hypotheses as to why these diseases have shown such a strong resurgence in recent years. Syphilis, in particular, is thought to be on the rise because of the inaccurate belief that oral sex is “safer sex.” (When syphilis sores are present in the mouth they can easily go undetected while being spread to a partner.)
Biology and Behavioral Sciences
It’s a sad fact that for purely anatomical reasons, women are more at risk from heterosexual sexual encounters than men. It is less well known, however, that younger women are at particularly high risk for contracting certain sexually transmitted diseases due to the way the structure of the cervix changes with age. The lining of the cervix is made up a different type of cells than the surface, and these cells are more susceptible to infection by Chlamydia and gonorrhea—two of the most common types of STDs seen in college-aged women. The younger a woman is, the more the cells normally found in the lining are also found on the surface of the cervix, where they are easier to infect. The transformation zone where the two cell types meet is also larger in younger women, and is particularly susceptible to infection with certain types of HPV.
Although young women are biologically more likely than older women to contract STDs, college-aged youth of both sexes may also be at increased risk as a result of their behavior. In addition to the fact that young people may have difficulty accessing sexual health services because of financial reasons, discomfort, or confidentiality concerns, they are also prone to making poor choices that heighten the likelihood of infection.
College students may not yet fully comprehend that their actions have consequences. Due to this and other factors—including a lack of effective sex education—it can be extremely difficult for some young adults to negotiate safer sex, even in the absence of any partner resistance. Often, they don’t even fully understand that the need for safer sex, or that the warnings about STDs they’ve heard apply to them.
Another major problem on many college campuses is binge drinking. A recent study found that more than 40 percent of students had consumed five or more drinks on at least one occasion during the month prior to the survey (Hingson RW, Zha W, Weitzman ER  “Magnitude of and trends in alcohol-related mortality and morbidity among U.S. college students ages 18-24, 1998-2005.” J Stud Alcohol Drugs Suppl. :12-20). This behavior may also be a factor contributing to the STD epidemic. People who engage in sex with new partners while impaired are less likely to have, or be able to negotiate, safer sex. Binge drinkers are also more likely to have multiple partners and casual hook-ups (Howard DE, Wang MQ  “Multiple sexual-partner behavior among sexually active US adolescent girls.” Am J Health Behav. 28:3-12).
Will There Be A Test On This?
Some students may be too worried about academic tests to be concerned about STD tests, but many others simply may not believe they are at risk for STDs. Part of this denial is the result of a lack of preventative messages targeted to the college population. One of their biggest misconceptions is that you can tell if someone is HIV-positive, or infected with another STD—just by looking at them. However, there is no way to tell if someone is infected with an STD unless they have been tested, and even testing will not always pick up an infection if a person has recently been exposed to a disease.
The vast majority of STDs are asymptomatic in most people: someone who is positive for an STD may display no symptoms for years, while still spreading the disease to others. This is why regular testing for STDs is so important. Interestingly, although the CDC recommends that sexually active young women be screened for Chlamydia and gonorrhea once a year, they make no such recommendation for men. In part, this is because STDs in men are more likely to be symptomatic, but it also probably reflects the fact that it’s easier to get sexually active young women in for testing since, like a donkey with a carrot, they can be lured in for examinations with a package of birth control pills hanging off the end of a nice long stick.
Unfortunately, even among young women, regular screening rarely takes place. This is partly because young people are hesitant to bring up their sexual health with their physicians, but it doesn’t help that far too many doctors are uncomfortable addressing sexual issues, as well. Case in point: the relatively new—and wildly discussed—universal HIV testing guidelines that the CDC put out in 2006, which recommend routine testing for everyone between the ages of 13 and 65 with yearly follow-ups for those at high risk, are not well followed.
In the future, a large number of HPV infections will be preventable through use of vaccines, but right now scientists suggest that more than half of all sexually active people will be infected with some form of their virus during their lifetime. Vaccines for Hepatitis A and B are also available, but for most other commonly transmitted sexual diseases, the only way to curb transmission is through behavior modification. Regular screenings and treatment can help to reduce the prevalence of curable STDs, but for HIV and herpes, the only option is to prevent them altogether.
Fortunately, condoms and dental dams are an effective way of, if not totally preventing, at least reducing the risk of acquiring most STDs, but they have to be used consistently. This can be particularly difficult for those who are just beginning to explore their sexuality. If young people don’t start out their sex lives with the intention of using protection each and every time they have sex, it can be hard for them to break out of bad habits.
Hopefully, as college administrators become aware of the problem of STDs on their campuses, they will start incorporating more sex education into their orientation activities. Talking about the potential dangers of drugs and alcohol is great, but it does everyone a disservice to ignore the potential dangers of sex.