1995). Compared to older women, female adolescents and young women are also more susceptible to cervical infections, such as gonorrhea and chlamydial infection, because the cervix of female adolescents and young women is especially sensitive to infection by certain sexually transmitted organisms (Cates, 1990). In addition, adolescents and young people are at greater risk for substance use and other contributing factors that may increase risk for STDs than older persons; these issues are discussed in Chapter 3.

Although overall rates of gonorrhea have been declining in the general population for over a decade, this decline has been less pronounced among adolescents than in other age groups. During 1993 and 1994, the gonorrhea rate for 15-19-year-old adolescents actually increased nearly 3 percent (CDC, DSTDP, 1995). The increase in gonorrhea among adolescents can be entirely attributed to increases in gonorrhea among female adolescents of all races, while rates of gonorrhea among male adolescents during this period leveled off. If one takes into account that not all teenagers are sexually active, the actual risk for acquiring an STD among sexually active teens is even higher than the rates themselves may suggest (Aral et al., 1988). Chlamydial infection has been consistently high among adolescents; in some studies, up to 30-40 percent of sexually active adolescent females studied have been infected (Toomey et al., 1987; Cates, 1990). In general, rates of chlamydial are at least two to four times higher than rates of gonorrhea in this age group (Washington et al., 1986; Shafer et al., 1987). Viral STDs also are becoming increasingly prevalent at younger ages as adolescents initiate sexual intercourse earlier (Moscicki et al., 1990). Cervical cancer rates and cohort mortality from cervical cancer (Krone et al., 1995; Kathleen Toomey, Georgia Department of Human Resources, unpublished data, 1996) are increasing among young women, undoubtedly a reflection of increased exposure to STDs such as human papillomavirus.

Other Groups at Risk

Reported STD rates in the United States vary among ethnic and racial groups (CDC, DSTDP, 1995). African Americans and Hispanic Americans have higher reported rates of chlamydial infection, gonorrhea, and syphilis than European Americans. Data on STDs among other ethnic or racial groups are more limited because of their smaller populations in the United States. Rates of certain STDs, however, among some American Indian/Alaska Native populations are high (Toomey et al., 1993). National surveillance data suggest that rates of reportable STDs, except for hepatitis B virus infection (Alter, 1991), are low among Asian Americans/Pacific Islanders compared to the general U.S. population (CDC, DSTDP, 1995).

Although national surveillance data may overrepresent cases diagnosed among some racial and ethnic groups (CDC, DSTD/HIVP, 1995), the higher prevalence of some STDs among African Americans and Hispanic Americans



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