Chlamydia and gonococcus are the most frequent sexually transmitted infections in adolescents, one of the few population groups worldwide in which a decrease in new HIV diagnoses has not been achieved.
They also point out that more than 50% of minors between the ages of 14 and 17 regularly consume porn on the internet and consider that the role of paediatricians, family members and educational centers is crucial to guarantee responsible sexual behavior among the youngest.
The incidence of sexually transmitted infections (STIs) follows an upward trend in practically all population groups, including adolescents.
According to the latest report from the National Epidemiology Center, between 2016 and 2019 the incidence of gonococcus, chlamydia and syphilis has doubled in young people aged 15 to 19 in Spain.
A worrying reality that pediatricians warn of coinciding with the European Day of Sexual Healthwhich is commemorated every February 14.
for the doctor Cristina Epalza Ibarrondomember of the working group on HIV and sexually transmitted diseases of the Spanish Society of Pediatric Infectious Diseases (SEIP), the data “are especially alarming” in other sexually transmitted infections without a cure today, such as HIV infection.
According to this specialist, adolescents constitute one of the few population groups worldwide in which a decrease in new diagnoses has not been achieved. In them also, late diagnosis is a worrying reality that already affects 30 percent.
Leaving aside the human papillomavirus, which is the most prevalent sexually transmitted infection worldwide – and whose prevalence is estimated to be between 50% and 60% in the first two years after the start of sexual intercourse -, the most common sexually transmitted diseases (STIs) in adolescents are chlamydia and gonococcus.
Epalza points out that around 30% of chlamydia diagnoses and 25% of gonococcus correspond to young people under 19 years of age, in the United States, according to data from the Centers for Disease Control and Prevention (CDC). , for its acronym in English).
Sexual health and adolescents
For pediatricians it is clear that the esexual education is the pending issue of the health system and schools.
One aspect that worries pediatricians is how little is said about STIs and sexual health among adolescents, taking into account that the age of onset of sexual relations decreases more and more and access to inappropriate sexual content increases.
As the doctor explains Talia Sainz Costaa pediatrician specializing in Infectious and Tropical Diseases and a member of the SEIP, adolescents, who are more vulnerable and easily influenced, “receive sexual references that do not favor global sexual education, where respect for themselves and others is transmitted.”
In this sense and according to Félix Notario, president of the Spanish Society of Adolescent Medicine (SEMA), more than 50% of adolescents between 14 and 17 years old regularly watch porn on the internet.
Something that familiarizes them with risk practices and contributes to a decontextualization of sexuality:
“Adolescents have more information than ever, but between their knowledge and their behavior there is a great contradiction. They lack legitimate information from family, school and health professionals, they do not feel comfortable talking about sexuality with their environment and this does not favor responsible behavior”.
Risky sexual behaviors not only cause an increase in STIs, but also unwanted pregnanciesabuse and frustration in relationships.
For this reason, and taking into account that sexual health forms an important part of the development of individuals, and more especially of adolescents, specialists insist on the fundamental role played by paediatricians, families and schools in this regard and They warn that sexual education continues to be the great pending subject in Spain.
The president of the EMS proposes that in all schools there be at least one sex educator who can give specific guidelines and adapt sex education programs for each of the cycles, as well as the creation of spaces designed for them where they can be attended free of charge and personally by part of trained professionals and without the presence of their tutors.
“Paediatricians for our part, we must open the door to a broader consideration of health that includes sexual health, incorporating, for example, questions about sexuality in our routine clinical interviews,” concludes Dr. Notario.
Poverview: what the WHO says
According to information available to the World Health Organization (WHO), More than 30 different bacteria, viruses, and parasites are transmitted through sexual contact today.
Eight of these pathogens have been linked to the highest incidence of sexually transmitted diseases (STIs).
Four of these diseases can currently be cured: syphilis, gonorrhea, chlamydia and trichomoniasis.
The other four are incurable viral infections: Hepatitis B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV).
STIs are spread predominantly through sexual contact, including vaginal, anal, and oral sex. Some STIs can also be passed from mother to child during pregnancy, childbirth, and breastfeeding.
A person can have an STI without showing symptoms. The most common symptoms of STIs are: vaginal discharge, urethral discharge or burning in men, genital ulcers and abdominal pain.
Magnitude of the problem
According to this United Nations organization, every day, more than a million people contract an STI.
And it is estimated that, in 2020, there were about 374 million new infections of one of these four STIs: chlamydia (129 million), gonorrhea (82 million), syphilis (7.1 million) and trichomoniasis (156 million).
The number of people with genital HSV (herpes) infection was estimated to exceed 490 million in 2016, and more than 300 million women are infected with HPV, the leading cause of cervical cancer.
About 296 million people have chronic hepatitis B. Both genital herpes and hepatitis B can be prevented by vaccination. Beyond the immediate effect of the infection, STIs can have serious consequences.
- Some STIs, such as herpes, gonorrhea, and syphilis, can increase the risk of becoming infected with HIV.
- Transmission of an STI from mother to child can cause prenatal or neonatal death, prematurity and low birth weight, sepsis, pneumonia, neonatal conjunctivitis, and congenital anomalies.
- It is estimated that more than one million pregnant women had active syphilis in 2016, which caused complications in around 350,000 births, including 200,000 deaths of the fetus or newborn.
- HPV infection causes cervical cancer. Globally, cervical cancer is the fourth most common type of cancer among women, with an estimated incidence for 2018 of 570,000 new cases and more than 311,000 deaths from the disease each year.
- In 2019, hepatitis B caused an estimated 820,000 deaths, mainly from cirrhosis or hepatocellular carcinoma (primary liver cancer).
- Some STIs, such as gonorrhea and chlamydia, are important causes of pelvic inflammatory disease and female infertility.
Prevention of sexually transmitted diseases
When used correctly and consistently, condoms are one of the most effective methods of protection against STIs, including HIV infection.
According to the same source, condoms also protect against unwanted pregnancy in consensual sexual relations.
Although highly effective, condoms do not offer protection against STIs that cause extragenital ulcers (ie, syphilis or genital herpes).
Whenever possible, a condom should be used for all vaginal and anal sexual activity.
There are safe and highly effective vaccines to prevent two of the viral STIs: hepatitis B and HPV infection. These vaccines have brought important prophylactic advances against these infections.
By the end of 2020, the HPV vaccine had been introduced into routine immunization programs in 111 countries, mostly high- and middle-income countries.
In low- and middle-income countries, where the majority of cervical cancer cases are concentrated, this vaccination could prevent the death of millions of women in the next decade if vaccination coverage of more than 80% is achieved in girls from 11 to 15 years old.
Research on herpes and HIV vaccination is well advanced, and clinical trials are beginning with several experimental vaccines.
There is increasing evidence that the vaccine to prevent meningitis (MemB) confers cross-protection against gonorrhea.
It is necessary to continue investigating chlamydia, gonorrhea, syphilis and trichomoniasis, points out the aforementioned organization.
Finally, he points out that there are other biomedical interventions to prevent some STIs, such as circumcision in adult men and the use of microbicides.
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