Sexually transmitted diseases in children: adolescents.

Introduction Sexually active adolescents are the group at greatest risk of acquiring sexually transmitted infections.' 2 The adverse sequelae that occur as a consequence of some of these infections are particularly devastating in the very young. Teenagers have their entire reproductive future at risk and jeopardise their fertility by infection. Chronic viral infections with long latent periods may exert their influence at a younger age in those infected while teenagers. It is imperative that screening, treatment and prevention of sexually transmitted diseases (STDs) in this age group are regarded as a priority. The increased vulnerability of sexually active adolescents to infection with STDs is likely to be multifactorial. There is good evidence to suggest that while males and females are reaching physical maturity at progressively younger ages,' psychological maturation has not been similarly advanced. This widening gap in physical and psychological maturation, coupled with the unplanned and experimental nature of early sexual encounters increases the risk of unwanted pregnancy and of acquiring sexually transmitted infections. Young people with poorly developed "future time perspectives" cannot conceive that today's romantic encounters could lead to tomorrow's demise.4 Studies which have examined safe sex practises among adolescents have found there to be a low rate of barrier contraceptive use and poor knowledge about acquisition and prevention of sexually transmitted infections.5 Early age of first sexual intercourse is associated both with an increased number of lifetime sexual partners and an increased risk of acquiring sexually transmitted diseases.' The age at which individuals first have sexual intercourse appears to be reducing. The National Survey of Family Growth (NSFG) examined sexual behaviour among 15-44 year old women in the USA and showed that the proportion of girls who had sexual intercourse by the age of 16 years was 4.6% in 1970 rising to 25-6% in 1988. This increase was most marked between 1985 and 1988. In addition, those adolescents who had sex at an early age were more likely to have many sexual partners.' While the data for adolescent males are less complete, they suggest that for each age cohort a higher proportion of boys than girls are sexually active.6 In women, the stage of physical maturation, may also affect their susceptibility to infection.7 The cervix has an important role in excluding infection from the upper genital tract, both nonspecifically by producing mucus which excludes various pathogens and antigens and by specific protective immune mechanisms, including humoral immunity, locally produced phagocytic cells and possibly cell mediated immunity.8 The enhancement of these host defenses occurs when ovulation begins (usually 2-3 years after the menarche). Cyclical progesterone is produced, promoting the defence role of cervical mucus. In addition, the squamo-columnar junction of the cervix lies on the ectocervix until several years after menarche, exposing the mucus-secreting columnar epithelium to potential pathogens. It is probable that this columnar epithelium is more susceptible to infection by N gonorrhoeae and C trachomatis than squamous epithelium and possibly to infection by other sexually transmitted agents (including carcinogens) as well.2 Little is known of the immunology and defense factors of the female genital tract prior to, menarche or to the pubertal male genital tract.