Instinct vs. consequences: the troubling truth of teen sexuality

by Mike Kroll

There is nothing new about raging hormones in teenagers nor in the sexual behavior those hormones elicit. Just as invariable is the unwillingness of many adults, especially parents, to think of their youngster(s) as sexual beings. Hence the common desire of many adults to fear frank discussion and comprehensive sex education. The result is the ongoing problem of teenage pregnancies coupled with a striking increase in the numbers of young people (and others) infected with a wide variety of sexually transmitted diseases. Health officials at the national and state level have documented these disturbing trends, but more importantly, Knox County's own Health Department recently released local data that place our county 18th highest in the rate of both chlamydia and gonorrhea among Illinois counties, the two most common STDs.

Local health department data show the number of cases of chlamydia among Knox County residents rising from 137 in 2001 to 206 in 2005 while the county population has declined slightly. Perhaps most significantly, 88 of those 2005 cases were among ages 10-19, the second highest rate among that age group in Illinois. According to the Centers for Disease Control (CDC) “Chlamydia trachomatis infections are the most commonly reported notifiable disease in the United States. They are among the most prevalent of all STDs and, since 1994, have comprised the largest proportion of all STDs reported to CDC.” The CDC's “STD Surveillance 2005” report goes on to note, “Gonorrhea is the second most commonly reported notifiable disease in the United States.” Knox County data show gonorrhea cases among residents increasing from 47 in 2001 to 84 in 2005 and once again the incidence among Knox County teens is the second highest rate in the state.

A local special education teacher recently commented to me that she has long ago recognized that “sexual behavior must be instinctual because even teenage students who can't seem to learn much else figure it out without much help.” Despite the availability of free condoms at both the Health Department and the downtown Galesburg office of Family Planning a large portion of Knox County teens who are sexually active do not regularly use condoms, or any other form of birth control either.

Laura Fullerton, director of chronic disease and clinical services for the Knox County Health Department, echoes much the same observation as she points out just how little real understanding many of their clients have of sexuality and its consequences, “yet an amazing number of area teens are sexually active in one form or another. I spoke to one young couple barely in junior high who told me how they experimented and experimented until they figured out the mechanics of intercourse. For the longest time they kept trying to use the girl's belly button until they accidentally discovered 'a better fit' in her vagina. By the time I spoke to them they had it mastered and the girl was pregnant at barely 12 years old. These two had no understanding of what was involved in conceiving a child or the other risks but their desire to become sexually active was high. These two kids badly needed parenting themselves and certainly weren't ready to become parents.”

According to Fullerton sexual activity among area teens is much higher than most adults recognize. “Not all of our sexually active teens are engaging in intercourse. Oral sex appears to be much more common.” The lack of understanding among area teens has led many to wrongly believe that oral sex is free of risk explained Fullerton. “What they don't comprehend is that while oral sex avoids the risk of pregnancy it offers no protection from the transmission of STDs. The level of ignorance is appalling. What is even more shocking is the number of clients who repeatedly contract STDs and return again and again for treatment.”

The unwillingness of American society to deal with sex education in a comprehensive manner is a part of the problem as is the societal change in attitude toward both unwed pregnancy and infection with an STD. “The social stigma is now gone, many teens and young adults no longer see any reason for embarrassment when either unintended pregnancies occur or they get an STD, other than herpes or HIV,” explained Fullerton. “Gonorrhea and chlamydia are seen as easily treatable, almost an acceptable risk. But you can see the panic in their eyes when we have to tell someone that they have herpes or HIV. They may not understand much about STDs but they know there is no magic bullet to cure either of those.”

What little good news that can be found in recent federal, state and local reports on sexually transmitted diseases concerns syphilis which has all but disappeared from the Knox County radar of STDs. The CDC reports “the rate of primary and secondary syphilis reported in the United States decreased during the 1990s; in 2000, the rate was the lowest since reporting began in 1941.” However the CDC also notes that reported cases of syphilis actually showed a national increase of over nine percent between 2004 and 2005, primarily among men. In Illinois reported cases of syphilis increased by only one percent between 1996 and 2005. There were only two reported cases of syphilis in Knox County in 2005.

CDC national data show that from 1975 to 1997 “the national rate of gonorrhea declined by 74 percent following the implementation of the national gonorrhea control program in the mid-1970s. National gonorrhea rates thereafter remained essentially constant for a few years before showing a slight upward trend in the 2005 data.” Furthermore, “[nationwide] gonorrhea rates continued to be highest among adolescents and young adults. The overall gonorrhea rate was highest for 20- to 24-year-olds (506.8), which is over 4 times higher than the national gonorrhea rate.” Illinois specific data on gonorrhea show an overall increase of four percent between 1996 and 2005 but the trend data is currently declining. The Illinois Epidemiologic Summary on Sexually Transmitted Diseases 2005 reported: “Teens and young adults are disproportionately affected by gonorrhea in Illinois. Infected persons ages 15-24 years accounted for 62 percent of reported cases during 2005.”

Chlamydia first became a reportable disease in Illinois in 1987 but it has rapidly become the most reported STD locally, statewide and nationally. “From 1996 through 2005 the number of reported cases increased more than 90 percent” statewide.” Knox County data show a 50 percent increase in reported chlamydia cases between 2001 through 2005 with 95 percent of those cases falling into the age group of 10-29, the largest concentration between ages 15-19.

“We have gotten much better at detecting chlamydia in recent years,” explained Greg Chance, Public Health Administrator for the Knox County Health Department. “Better tests do account for some of the increase in the number of chlamydia cases but certainly do not account for the clear upward trend itself. Chlamydia is a serious health issue in Knox County and the rate of incidence is increasing. The rates of infection within our community indicate that there continues to be a number of misconceptions, as well as a lack of knowledge concerning sexually transmitted disease. The STD statistics obviously indicates that we are fracing a tremendous public health challenge in Knox County.”

The impact of untreated sexually transmitted diseases is two-fold. First they present serious long-term health problems to those infected and secondly the combination of promiscuity and untreated STDs leads to more rapidly increasing rates of infection. Left untreated chlamydia often results in pelvic inflammatory disease (PID) including severe fallopian tube inflammation and damage potentially including infertility. Gonorrhea is a bacterial infection that can also lead to PID and infertility. Both chlamydia and gonorrhea are frequently asymptomatic among women and therefore more likely to be left untreated. The symptoms of gonorrhea are much more pronounced in men who are therefore more likely to seek testing and treatment. In many cases infected women are discovered only after an infected man sought treatment and the health department conducts the required notification and testing of his sexual partners. Left untreated gonorrhea can lead to blindness, sepsis, arthritis and meningitis.

“Genital herpes is a contagious viral infection that affects an estimated 45 million Americans,” according to the Illinois Epidemiologic Summary 2005. Herpes typically causes lip sores called fever blisters or cold sores as well as genital symptoms of painful lesions and ulcerations. The risk of transmitting herpes is greatest during outbreaks of such symptoms. “many persons infected with [herpes simplex virus] never notice symptoms, but can still transmit the virus to others because of this intermittent viral shedding. This life-long ability to unknowingly transmit the virus is one of the reasons that HSV is so prevalent among sexually active adults.” At the present there is no known cure for herpes and only the symptoms can be treated in the more than 20 percent of adult Americans infected.

Free or inexpensive testing and treatment of STDs is available through the Knox County Health Department. Persons of any age who are sexually active are strongly encouraged to visit the Health Department to obtain free condoms, as well as information and/or counseling regarding the potential risks of sexual activity with our without protection. If a sexually active person has any reason to believe they may be infected or they have had sex with multiple partners it is recommended that they seek testing for STDs. The cost is low, just $15 for men and $20 for women (women also receive a pap smear) and perhaps less if you qualify for a state or county health program.

The key to this problem is prevention and earlier detection of infection through more effective education and testing. “STDs are trending up across the state,” said Chance, “and unfortunately Knox County finds itself well above the statewide average. It is critical that we get this information out to our residents, particularly teens and their families. The Health Department is committed to working with community partners to teach those who are sexually active how to prevent STDs or reduce their potential for infection. This is a public education challenge that has to be emphasized among our teens and young adults who together account for the highest rates of sexually transmitted diseases. Despite living in a society that seemingly revolves around sexuality somehow we find it so difficult to speak candidly about sexuality with our children, ignorance is definitely not bliss.”

Fullerton forcefully supported chances comment: “While there is no disputing that abstinence itself works pretty darn well in preventing both STDs and pregnancy, statistics have proven beyond a doubt that abstinence-only education does not! Many Knox County teens are sexually active yet most make little or no use of contraception and few sufficiently understand the physiology and potential consequences of sexual activity. Ignorance and misconceptions predominate among area youth and these problems will not go away until the community develops an effective way of teaching comprehensive sexual education to our children. I see the results of our failure to address this problem directly every single day.”

6/28/07