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Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences
chronic pelvic pain (Chandra and Stephen, 1998; USDHHS, 2000). In addition, women are biologically more susceptible to infection when exposed to a sexually transmitted disease agent, and sexually transmitted diseases are more difficult to diagnose in women because of female physiology and the anatomy of the reproductive tract (USDHHS, 2000).
Sexually transmitted diseases pose a risk to unborn children. The diseases not only cause serious health problems in pregnant women, but they can result in the death of the fetus or newborn (Brunham et al., 1990; USDHHS, 2000). Sexually transmitted disease in a mother also can result in congenital or perinatal infections that permanently damage the child’s brain, spinal cord, eyes, auditory nerves, or immune system. Sexually transmitted infection can complicate a pregnancy even without directly reaching the fetus or newborn, causing spontaneous abortion, stillbirth, premature membrane rupture, or premature delivery (Goldenberg et al., 1997; USDHHS, 2000). Women with bacterial vaginosis, for instance, are 40% more likely than women without this condition to deliver a preterm, low-birthweight baby (Hillier et al., 1995; Meis et al., 1995; USDHHS, 2000).
Sexually transmitted infections disproportionately affect adolescents and young adults for several reasons, including behavioral, social, and biological (Alan Guttmacher Institute, 1994; USDHHS, 2000). In 1996, 15-to 19-year-olds had the highest reported rates of chlamydia and gonorrhea (USDHHS, 1997b; USDHHS, 2000), and the herpes infection rate of white adolescents between the ages of 12 and 19 was shown to have increased almost 5-fold over just 10 years (Fleming et al., 1997; USDHHS, 2000). Several factors contribute these incidences. Because many teenagers are sexually active, they are at risk for sexually transmitted infections; in 1995, just over 50% of females aged 15–19 indicated they had already had sexual intercourse, and more than 51% of high school males reported having experienced sexual intercourse by age 16. Teenagers are more likely than older persons to have serial sex partners who are active in a sexual network that already is infected with untreated sexually transmitted diseases (USDHHS, 2000).
Rates of sexually transmitted diseases are higher for minority and ethnic groups (primarily African American and Hispanic populations) than for whites. For example, although chlamydia is a widely distributed sexually transmitted infection in all racial and ethnic groups, the prevalence is higher in minorities. In 1996, African Americans accounted for approximately 78% of the total number of gonorrhea cases reported—32 times the rate for whites. These high rates also apply to African American ado-