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INTRODUCTION

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The rate of sexually transmitted infections (STIs) acquired during adolescence remains high despite widespread educational programs and increased access to health care. By senior year in high school, over half of youth will have had sexual intercourse. The highest age-specific rates for gonorrhea, chlamydia, and human papillomavirus (HPV) infection occur in adolescents and young adults (15–24 years of age). While this age group accounts for only 25% of the sexually active population, it accounts for almost half of the incident STI infections. Adolescents contract STIs at a higher rate than adults because of sexual risk taking, age-related biologic factors, and barriers to health care access. In every state and the District of Columbia, adolescents can provide consent for the diagnosis and treatment of STIs without parental consent; 18 states allow for the disclosure to a parent. In many states, adolescents can also provide consent for human immunodeficiency virus (HIV) counseling and testing. Since individual state laws vary, health care providers should be knowledgeable about the legal definitions regarding age of consent and confidentiality requirements in their state.

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Providers should screen sexually experienced adolescents for STIs and use this opportunity to discuss risk reduction. Since not all adolescents receive regular preventive care, providers should use acute care visits to offer screening and education. Health education counseling should be nonjudgmental and appropriate for the developmental level, yet sufficiently thorough to identify risk behaviors because many adolescents may not readily acknowledge engaging in these behaviors.

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ADOLESCENT SEXUALITY

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The spectrum of sexual behavior includes holding hands and kissing, touching, mutual masturbation, oral-genital contact, and vaginal and anal intercourse. Each has its associated risks. A small, but statistically significant, trend has occurred in the epidemiology of sexual risk taking toward less sexual involvement and later onset of vaginal intercourse. The most recent Youth Risk Behavior Survey (2015) reports that 42% of high school students have had vaginal intercourse; 44% of teenagers initiated sex by age 13. Racial and gender differences exist; non-Hispanic black adolescents report a higher prevalence of sexual activity and an earlier age of initiation. Thirty percent of students had sex in the 3 months prior to the survey—46% of twelfth-graders and 16% of ninth-graders. Over 11% of students reported having had four or more lifetime sexual intercourse partners. Among those youth currently sexually active, 57% reported that either they or their partner had used a condom during their last sexual intercourse. Paradoxically, condom use decreases with age—60% of ninth-graders reported condom use at their last intercourse compared with 53% of twelfth-graders. Substance use contributes to an increase in risky sexual activity and 21% of sexually active youth report that they used alcohol or drugs prior to their last intercourse.

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Although there may be variations among groups of teens, oral sex is relatively common in adolescents with approximately two-thirds of 15–24-year-olds reporting oral sexual activity. Anal intercourse occurs in both hetero- and ...

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