'Hidden epidemic' of sexually transmitted infections among adolescents: more cases, fewer doctor visits and education gaps | Company

Something is not working in the prevention of sexually transmitted infections (STIs) in Spain, and it is the youngest who pay the most for it. This is evidenced by the work of researchers at 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 only describe the tip of the iceberg, beneath which lies a growing epidemic of unknown proportions,” conclude the authors of the article titled The hidden epidemic of sexually transmitted infections among adolescents 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 this work came about. “We realized that we weren’t seeing enough teenagers. This group only represents 2% of consultations, even though their weight in the population is much greater and we know that they are particularly 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, researchers collected all information on patients treated for bacterial STIs at Bombero Echanis Medical Center, affiliated with Basurto Hospital, between 2014 and 2023 and focused on the age group of 14 at 18 years old. The first telling fact is that the prevalence of STIs among adolescents is significantly higher than among people aged 19 and older.

The incidence of gonorrhea is 15.5% in patients aged 14 to 18, while in 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% among adolescents and 14.2% among the elderly (29.3% and 15.2% among women). Only for syphilis, although not significantly, the percentage of adolescents is lower (2.1% to 3.4%), although if we look at women it is more than twice as high among adolescents than among those aged 19 and over (1.4% of 0.6%).

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

Regardless, the authors say, the findings reveal pressing and troubling issues. “First of all, we don't really know the true scale of the problem. Some STIs may remain latent and a person may be an asymptomatic carrier while still transmitting the infection. If minors only come when they show symptoms, all the other cases will not notice us,” warns De Miguel. Adolescents, the authors point out, practically do not go to centers alone to undergo preventive screening. “Only 15% come on their own initiative. Most are referred by a family doctor,” adds this specialist.

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

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

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

The study results coincide with warning messages that have been repeated in recent years, with the incidence of STIs in the general population steadily increasing. However, all interviewed sources insist that the adolescent problem has its own characteristics that require special strategies.

“Barriers to access remain a major unresolved problem,” warns Cristina Espalza, pediatrician at the October 12 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 town hall – which seeks to better adapt to their characteristics. “It’s open to everyone, they don’t ask for a card, the town halls have all the means, they raise awareness…” he says.

Better treatment than prescriptions

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

This expert insists on the idea: “Today's adolescents are tomorrow's adults. If we fail to do this now, we will pay the price in the future, just as this bad data shows that something was done wrong in the past. We must promote education that influences knowledge and healthy sexuality, self-respect and acceptance… If we succeed, it will be more natural for adolescents to seek sexual health services when they think they need them . “.

Felix Notario, president of the Spanish Society of Adolescent Medicine (SEMA), which is part of the Spanish Association of Pediatrics (AEP), highlights the importance of adapting to the particular needs of adolescence. “If many people feel uncomfortable talking about STIs, imagine that at this age everything changes in your life, you form new relationships, the group takes on more meaning… The main thing is to create zones of trust where your teenager can feel comfortable explaining to you what they are doing. worries her,” he said.

One feature of the health care system that does not help at this point is that adolescents stop seeing their pediatrician throughout their lives at age 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 for participation could be lost. They usually have some sort of “hidden agenda”. They come for something else and, if it suits them, they ask what really interests them: this itching, a kind of discharge…” explains Notario.

Early age of access to pornography is another factor highlighted by experts. “Research shows that pornography is the number one sex educator for our young people. And it shows very specific patterns, usually violent and sexist, where the woman is the object and condoms are not used either. It also does not promote the visibility of erotic practices through which we can protect ourselves and obtain pleasure,” laments José García, coordinator of the sex education program. Neither ogres nor princesses government of Asturias.

According to this expert, “many things have been going wrong for a long time” in terms of sex education. For 17 years, Spanish law has required all students to take courses in this subject, which in practice is very irregular. “This is a problem that continues to cause social divisions, and that doesn't help. Sometimes this happens for electoral reasons, sometimes for ideological reasons. There are people who oppose sex education because it shows a diverse reality in which not everyone feels comfortable. The problem, after all, is that adolescents often do not receive adequate training,” he concludes.