‘Hidden epidemic’ of sexually transmitted infections among teenagers: more cases, fewer visits to the doctor and gaps in education | Society

Something is not working in the prevention of sexually transmitted infections (STIs) in Spain, and the youngest people are paying most of the consequences. This is evidenced by the work of researchers from the Basurto Hospital (Bilbao), a center for these diseases in the province of Vizcaya, which shows that adolescents aged 14 to 18 suffer from a high prevalence of STIs (especially women). are less likely to use condoms than older people and are less likely to use health services.

“These data describe only the tip of the iceberg, underneath which lies a growing epidemic of unknown proportions,” conclude the authors of the paper, titled The hidden epidemic of sexually transmitted infections among teenagers and presented at the congress of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), recently held in Zaragoza.

Joana de Miguel, chief scientist, explains how the idea for the work came about. “We realized that we didn’t see enough teenagers. This group accounted for only 2% of consultations, while their weight in the population is much larger and we know that they are especially vulnerable. “Where are they?” – we asked ourselves. It is unlikely that we will be able to find out what is happening to them and help them prevent it if they do not contact our services,” he says.

To answer these questions, the researchers collected all information on patients treated for bacterial STIs at the Bombero Echanis Medical Center, affiliated with Basurto Hospital, between 2014 and 2023 and focused on the age group of 14 to 18 years. The first revealing fact is that the prevalence of STIs among adolescents is markedly higher than among people aged 19 years and older.

The incidence of gonorrhea is 15.5% among patients aged 14 to 18 years, while among older patients the percentage drops to 10.3%. The difference is much more pronounced among women (15.5% and 5.3%, respectively). The prevalence of chlamydia is 25.3% in adolescents and 14.2% in older adults (29.3% and 15.2% in women). Only for syphilis, although not significantly, is the percentage of adolescents a smaller percentage (2.1% to 3.4%), although if we look at women, it is more than twice as high among adolescents as among those 19 years of age and older (1 .4% by 0.6%).

However, to interpret these data, two factors must be taken into account. First, if one compares five-year age groups rather than the 14 to 18 year group with all adults, some incidence rates may be higher in other groups (eg, 20 to 24 year olds or 20 to 24 year olds). years or among adults). from 25 to 29, depending on the infection), according to data from the Carlos III Institute of Health. Secondly, older people are more likely to go to the doctor for preventive purposes – tests and consultations when a contact person tests positive… – while teenagers, as a rule, go only when symptoms appear, which introduces a systematic error in the samples.

In any case, according to the authors, the results reveal pressing and troubling issues. “First of all, we don’t really know the real extent of the problem. Some STIs may remain latent, and one may be an asymptomatic carrier but still transmit the infection. If minors come only when they have symptoms, all other cases will not notice us,” warns De Miguel. Adolescents, the authors emphasize, practically do not go to the centers on their own to undergo screening for prevention. “Only 15% come on their own initiative. Most are referred by a family doctor,” adds this specialist.

The limited knowledge about this phenomenon is also reflected in the lack of studies focusing on minors. “We found only one similar study with similar results, done at the Sandoval Center in Madrid,” also specializing in sexual health, explains the researcher.

The second point that the study highlights is that there are still “barriers” that make it difficult to access specialist services. “Teenagers come less often. It’s probably out of shame because they don’t know much about the healthcare resources available because they’re afraid of what others will think… Adolescence is a time when you feel vulnerable. The serious thing is that it prevents or delays diagnosis and treatment,” adds De Miguel. The study authors warn of the consequences this could have in the future, especially for them: “Untreated or late treated STIs increase the risk of infertility, chronic pelvic pain…”

This lack of information, the authors emphasize, affects adolescents precisely when they need it most. “There are some anatomical features (less cervical mucus production and greater cervical ectopia) that make patients of this age more susceptible to STIs. There are also behavioral factors: they have more contacts than adults, which is facilitated by new technological applications, and despite this they use condoms less,” says De Miguel.

The study’s findings coincide with warning messages that have been repeated in recent years, with a steady increase in the incidence of STIs in the general population. However, all sources interviewed insist that the problem of adolescents has its own characteristics that require special strategies.

“Barriers to access are still a major unsolved problem,” warns Cristina Espalza, pediatrician at the 12 October Hospital (Madrid) and member of the Spanish Society of Periatric Infectology (SAIP) and GeSIDA. This expert gives the example of Madrid, where there is only one center specifically targeting this group – dependent on the city council – which seeks to better adapt to their characteristics. “It’s open to everyone, they don’t ask you for a card, the city councils have all the means available, they’re doing the outreach…” he says.

Better treatment than prescriptions

Another barrier is money. “Often we prefer to give treatments instead of prescriptions, and you never know if they will actually buy them. This also applies to condoms: they should be very accessible and free,” adds Espalsa.

This expert insists on the idea: “Today’s teenagers are tomorrow’s adults. If we don’t get it right now, we will pay for it in the future, just like this bad data shows that something was done wrong in the past. We must promote education that influences knowledge and healthy sexuality, respect and self-acceptance… If we achieve this, it will be most natural for adolescents to seek sexual health services when they think they need it. “.

Felix Notario, president of the Spanish Society of Adolescent Medicine (SEMA), which is part of the Spanish Association of Pediatrics (AEP), emphasizes the importance of adapting to the special needs of adolescence. “If many people feel uncomfortable talking about STIs, imagine at that age everything in your life changes, you form new relationships, the group becomes more meaningful… The key is to create zones of trust where your teen can feel comfortable explaining to you , which worries him,” he says.

One feature of the healthcare system that is not helping at this stage is that teenagers stop seeing their pediatrician throughout their lives when they turn 15 and start seeing their family doctor. “The pediatrician has been a mentor to these children since they were children, and with the change, a very important space of participation may be lost. They usually have some sort of “hidden agenda”. They come for something else and, if it’s convenient for them, they ask what really interests them: this itching, some kind of discharge…” says Notario.

Early age of access to pornography is another factor that experts point to. “Research shows that pornography is the first sex educator for our youth. And it shows very specific models, usually violent and sexist, where the woman is the object and condoms are also not used. It also does not promote the visibility of erotic practices through which one can protect oneself and gain pleasure,” laments José García, coordinator of the sex education program. Neither ogres nor princesses government of Asturias.

According to this expert, “a lot of things have been going wrong for a long time” in terms of sex education. It has been 17 years since Spanish law established that all students must attend classes in this subject, which in practice is very irregular. “This is an issue that continues to cause social divisions, and this is not helping. Sometimes this happens for electoral reasons, sometimes for ideological reasons. There are people who are against sexuality education because it shows a diverse reality in which not everyone feels comfortable. The problem, after all, is that teenagers often do not receive proper training,” he concludes.