Teens, Sex & an Epidemic?

The Epidemic Defined

An epidemic occurs when, in a particular community, there is an extensive and growing prevalence of a disease that attacks many people simultaneously.

Using that definition, there is no question that our teenagers are experiencing an epidemic of sexually transmitted diseases.   

Epidemic is also defined as a disease that does not naturally exist within a certain place. When it comes to STDs, that place is our kids’ bodies. Our teens have naturally occurring yeast and bacteria in their bodies that act to enhance their health, aiding in digestion and helping maintain healthy homeostasis. But STDs don’t belong in children’s bodies. They are foreign invaders. They infect healthy organs and tissues in the reproductive tracts, the bloodstreams, and the mouths of our children.

Furthermore, the STD epidemic is not a single epidemic. The Centers for Disease Control and Prevention (CDC) consider it a multiple epidemic of at least 25 diseases—nearly 50 if you count the various strains of virus groups. The most common STDs are HPV, herpes, chlamydia, hepatitis B, gonorrhea, syphilis, HIV/AIDS, trichomoniasis, and chancroid. And there are a host of others that threaten our kids, most with only clinical names that sound as foreign as another universe. Consider some of them: Mycoplasma hominis; Ureaplasma urealyticum; bacterial vaginosis; granuloma inguinale; shigellosis; Campylobacter; hepatitis A, C, and D; cytomegalovirus; genital molluscum contagiosum; human T-cell lymphotrophic virus types 1 and 2; amebiasis; Giardia; and Candida albicans.

All of these wreak havoc on young bodies in different ways; some work quickly, some take their toll slowly.

It’s so hard to grasp the vastness of these infections. Just picture flying 10,000 feet above Yellowstone National Park, looking out the window, and seeing thousands of small fires. Some are blazing and spreading, others crackle and smolder, and still others just spit out some smoke and a few sparks. Although they all have varying degrees of seriousness, when you’re flying at 10,000 feet, all those flames merge and the entire park appears engulfed in fire. That’s what’s happening to the population of our kids.

Lifelong, Life-Threatening

In the 1960s, a simple shot of penicillin could cure the two known STDs: syphilis and gonorrhea. Today, there are no simple cures and in many cases there are no cures at all.

Take herpes. Currently, more than 45 million Americans are infected with the herpes simplex type 2 virus because there is no way to cure it. A 1997 study published in The New England Journal of Medicine sent shock waves through the medical community when its authors reported that 20% of those 12 and older tested positive for this strain of herpes.12 Initially, I, like many physicians and parents I speak to, assumed the researchers were testing people in STD clinics. So of course the numbers would be high; these people are going to the clinic because they think they have an STD. But that was not the case. The researchers tested people in the general population, not groups of people with high-risk behavior. When I tell audiences about this, many don’t believe me. I had to read the article twice to believe it myself.

Overall, teenagers today are five times more likely to have herpes than they were in the 1970s.13 

This should terrify you as much as it does me, since herpes spreads only through sexual contact, and can remain hidden with no symptoms for months or years. Herpes is a lifelong disease that can resurface again and again, causing bouts of painful genital ulcers, disrupting lives, putting barriers between its victim and his or her partner, providing a constant reminder of mistakes made 10, 20, 30 years ago. Not something you want your teenager to live with.

Or consider HPV, one of the most prevalent sexually transmitted diseases in this country. HPV is the infection most responsible for my personal crusade to help teenagers avoid sex. It has the dubious distinction of being one of the few causes of cancer we know about, and is responsible for 99.7% of cervical cancer cases and the deaths of nearly 5000 women each year.14

Men aren’t safe from HPV’s devastating effects either. The virus is linked to penile and anal cancer, and troubling new research suggests it may also play a role in some head and neck cancers.15 Although vaccines are being researched, nothing is available today to the general public. Likewise, there is no medication, no treatment that will eliminate the virus. Just careful watching for the first precancerous cells to appear. Even worse: Most victims have no symptoms (just 1% develop genital warts). Having this virus without knowing it is like living with a ticking time bomb.

Then there’s HIV, the virus that causes AIDS. You’ve no doubt heard of the nearly miraculous new drugs for HIV, medications that significantly improve the quality and duration of life for those infected with the virus. Those medications, however, haven’t changed the ultimate truth about AIDS: It is fatal.

And although the majority of HIV cases still occur between men having sex with men, the number of HIV-infected women is rising rapidly. In 2000, nearly half (45%) of all AIDS cases among 13- to 24-year-old women were acquired through heterosexual sex.16 Here’s an even more frightening number: More than half (61%) of young people between 13 and 19 who were infected with HIV that year were women.17 More young women than young men are getting HIV. Again, the disproportion exists even within HIV: Half of all new infections are in our youth!18

Even if your child is “lucky” enough to catch a “curable” STD, such as chlamydia or gonorrhea, there’s no guarantee that we, her health care providers, will catch and cure it before it causes significant damage. In young girls, for instance, the bacteria that cause these infections can “escape” from the cervical area (where we can get a culture and identify it) into the uterus and up through the fallopian tubes, causing a secondary infection called pelvic inflammatory disease (PID). As it races through their bodies, PID leaves girls’ fallopian tubes and ovaries severely scarred and permanently damaged, perhaps rendering these girls infertile, or subject to a potentially fatal tubal pregnancy. We’ve seen PID rates skyrocket in the past 15 years. Today, almost a quarter of a million teenagers are diagnosed with PID every year, as a direct result of the spread of STDs—and chlamydia and gonorrhea in particular.19

The spread of gonorrhea, one of the oldest STDs, was coming down in numbers until the late 1990s, when the rate of infection began inching up again. If you think this STD isn’t worth worrying about because a quick dose of antibiotics can cure it, think again. Today, public health officials are alarmed by rising numbers of antibiotic-resistant strains of gonorrhea. And because gonorrhea, like chlamydia, rarely announces its presence with symptoms, teenagers infected with it are at risk for a host of more serious complications, including PID.

STDs Don’t Discriminate

The next time you’re at the mall, take a moment to observe that pack of teens you’re likely to see roaming the storefronts. Chances are good you’ll spot a bright young girl sporting a stomach-baring tank top. Even as she window-shops at American Eagle Outfitters, there’s a one in four likelihood that a virus is working its way up through her reproductive tract, changing the cells in her cervix so that in a few months, maybe in a few years, she’ll find she has a precancerous condition requiring surgery. You may spot a boy in low-rider jeans and a backwards-turned baseball cap. Chances are one in twenty that he’s got a sore on his penis he’s too embarrassed to ask anyone about. Even if he did get up the courage to ask, he’s not sure whom to confide in. And that group of ten girls moving together like a school of brightly colored tropical fish? At least one has a bacterial infection she doesn’t know about, an infection that will leave her infertile.

We’re not talking about troubled teens: We’re talking about all teens—yours and mine. The teens who belong to the church youth group, work at the local gas station, or hand you ice cream across the counter. They have personalities and faces. Look at their faces and see who you think might be infected. If you look at more than five, chances are you’ll see at least one infected with a horrible disease.

Black, white, Asian, Hispanic. Rich kids or poor. Straight-A students or dropouts. It doesn’t matter. Sexually transmitted viruses, bacteria, and parasites don’t discriminate. They attack all sexually active teens. Consider just one example:

An astonishing 15 to 20% of all young men will be infected with the herpes virus by the time they reach adulthood.20

Like a Match to Gasoline

The reasons for the current epidemic among our children are clear. I’ll outline just a few of them here; later in the book, I’ll go into much more detail.

Birth control and condoms. Public health officials and doctors have been fighting teen pregnancy for decades now with two heavy-duty weapons: oral contraceptives and condoms. The overwhelming goal that we’ve dealt with has been to reduce teen pregnancy. Congratulations: Teen pregnancy dipped in the late 1990s, and now every year, about 1 million teen girls get pregnant.

I myself worked for nearly a decade prescribing birth control to teens. I believed that oral contraception was the most powerful weapon I had to help teens avoid life-altering dilemmas that can and do cause irreversible physical and psychological harm. But I realize now that what we’ve been doing has been akin to rearranging the deck chairs on the Titanic. We now face a gargantuan consequence of that sexual freedom: At the same time teen pregnancies declined, the STD epidemic shot through the roof. The sexual freedom that birth control allows teens has done a good deal to promote the rise in disease.

Condoms are no answer either. As you’ll see in Chapter 7, condoms do little to prevent many viral infections spread by skin-to-skin contact, especially HPV and herpes. We’ve talked for decades about “safe sex,” and while condoms are somewhat effective at birth control, when it comes to STDs, the best they can do is reduce the risk of infection. And the risk of reduction, as you’ll see, is far too inadequate and in some cases nonexistent.

What they don’t know can hurt them. If you figured the sex education classes your teenager takes in middle and high school would include information about STDs, think again. One study found that most teens fail a simple test on their knowledge of STDs. When researchers gave 66 young adults (13 to 24 years old) attending a health fair a 13-question exam, most came up with only six correct answers.21 Some of the questions stumped nearly everyone.

Four out of five, for example, didn’t know that most people who get an STD never develop symptoms.22

They’re starting too young. Half of all students in ninth through twelfth grade have had sexual intercourse. This is particularly dangerous, since studies show that the earlier a teen begins having sex, the more partners he or she will have. In fact, of those having sex, between 12 and 20% have had four or more sexual partners in their young lives.23 The more partners, the more exposure to infection. The 17-year-old who’s had six sexual partners (all of whom have had six sexual partners, and so on and so on) may have been exposed to the diseases of 63 people.

I cannot stress this enough:

The longer a teen can wait to begin sexual activity, the less likely it is that he or she will contract a sexually transmitted disease.

They’re confused about what “sex” means. Millions of American teenagers have seen infamous sex scandals unfold on the six-o’clock news, codes of acceptable language disappear from television and popular music, and an inescapable deluge of sexual images floods movies, electronic games, magazines, and comic books. Sexual pictures, stories, and advertising copy pop up on their computer screens while they’re doing their homework. No wonder the very definition of sex seems unclear to our kids.

Out of the thousands of teens I’ve counseled, most reason they can safely engage in oral sex and “outercourse” (in which they mutually masturbate with their clothes off). To them, these activities are acceptable recreation, not “real” sex. Since semen doesn’t enter the vagina, kids think they’re playing it safe, while still maintaining their virginity and staying disease-free. So today they’re having oral sex in the back of school buses and in dark movie theaters. (Ask any middle school teacher.)

And oral sex is becoming a fad with kids. Very recent studies show that even oral herpes has shifted from causing 25% of genital herpes infections to 75% of them.24 How? Through oral sex. Here’s another oral sex statistic if you want one: An online sex survey done by Twist magazine found that out of 10,000 girls who responded, over half (5,700) were under 14. Amazingly, 25% of girls who said they were virgins responded that they engaged in oral sex.25

Unfortunately, just because they’re avoiding penetration doesn’t mean they’re avoiding disease. Many of these infections can spread simply from any sexual contact—mouth to penis, semen to skin—without intercourse.

Teens are also having group sex, and moving from one relationship to another, often within weeks or even days. Some engage in such behavior for the thrill or because they’re bored. Others do it to be popular with their peer group. If you think your kid could never do such things, think again. Peer pressure is subtle, pervasive, and powerful. For the sake of your kids, you cannot afford to be naïve. You need to know exactly what your teen is up to sexually. Your child’s life depends upon it.

Teenage anatomy and health. There are differences in a teenage girl’s anatomy that make her far more vulnerable to infection than an adult woman is. For instance, the cells covering a teenage girl’s cervix are physiologically different from the cells lining a 25- or 30-year-old woman’s cervix, and are therefore far more susceptible to infections.

Treating sexually active teens is also more difficult because many parents stop taking their children to pediatricians for regular -checkups and immunizations after age 10 or 12. Yet it is precisely during those adolescent years that health needs climb and teenagers desperately need someone to talk to. I’ve found that most of the kids who are reluctant to tell their parents they’re sexually active are relieved to finally tell someone else—their doctor, for instance. So even if your teenager is healthy and you’re certain he’s not sexually active, please, take him to see a family physician at least once a year.

Because teens often have questions about psychological issues, their own development, or sex, make sure you choose a doctor who knows how to talk to teenagers, and is willing to give these kids all the time they need to discuss whatever’s on their minds. I always schedule my teenage patients for 45-minute visits (instead of the 15-minute visits younger children get) because I know we’ll do so much talking.

From Your Kids At Risk: How Teen Sex Threatens our Sons and Daughters by Dr. Meg Meeker, chapter 2.  Request your copy today!