Adolescent health brief
Acquisition of Sexually Transmitted Infections in Adolescents
Attending an Urban, General HMO Teen Clinic
Cherrie B. Boyer, Ph.D.
*, Nadew S. Sebro, M.D.
, Charles Wibbelsman, M.D.
Mary-Ann Shafer, M.D.
Department of Pediatrics, University of California, San Francisco, San Francisco, California
Department of Pediatrics, Kaiser Permanente Medical Center, San Francisco, California
Manuscript received June 2, 2005; manuscript accepted December 7, 2005
Abstract: To determine association between acquisition of sexually transmitted infections (STIs) over a
nine-month period among sexually experienced adolescents attending an urban, general HMO teen
clinic and African American race, use of marijuana more than once or twice a week, and having had
relationships with a sexual partner who is more than four years older. © 2006 Society for Adolescent
Medicine. All rights reserved.
Keywords: Sexually transmitted infections; Acquisition; Risk factors; Adolescents; Marijuana use; Sexual partner
Sexually transmitted infections (STIs) are prevalent
among sexually experienced adolescents in the United
States . These infections pose serious health concerns for
young women, in particular, because of their association
with adverse reproductive health outcomes, including pelvic
inﬂammatory disease, tubal infertility, ectopic pregnancy,
and increased risk of exposure to human immunodeﬁciency
virus (HIV) . Adolescents’ exposure to STIs is the result
of complex and interrelated sociodemographic markers and
behavioral risk factors. Much of what is known about these
factors is based on national surveillance data reported from
sexually transmitted disease and family planning clinics,
providing limited opportunities for understanding factors
associated with STI acquisition among adolescents. More-
over, many studies of STIs in adolescents are cross-sec-
tional and some include population-based surveys that uti-
lize self-reported histories of STIs . However, a few
recent studies have reported on factors associated with the
incidence of clinically diagnosed Chlamydia trachomatis
[4,5], Neisseria gonorrhoeae , and Trichomonas vagina-
lis [5,6] in adolescents. These studies did not focus primar-
ily on sociodemographic and behavioral risk factors asso-
ciated with STI acquisition. Therefore, in an effort to
contribute to this growing body of literature, the present
study prospectively assessed the association of sociodemo-
graphic markers and behavioral risk factors with a clinical
diagnosis of STIs in adolescents attending a general teen
Study sample and procedures
A convenience sample of adolescents seeking health care
at an urban, general, Health Maintenance Organization
(HMO) teen clinic was recruited to participate in this lon-
gitudinal study. Adolescents were included if they were
sexually experienced, aged 13–21 years, or had not taken a
course of antibiotics in the two weeks prior to the study.
Seventy-ﬁve percent of all eligible adolescents agreed to
participate, which required only informed written consent of
participants in accordance with guidelines and approval of
our institutional review boards. At baseline, and again at
nine months, participants completed a self-administered
questionnaire and were screened for STIs because previous
research suggested that STIs in adolescents are more likely
to recur within this timeframe .
*Address correspondence to: Dr. Cherrie B. Boyer, Department of
Pediatrics, Division of Adolescent Medicine, University of California, San
Francisco, 3333 California Street, Suite 245, San Francisco, CA 94143-
E-mail address: firstname.lastname@example.org
Journal of Adolescent Health 39 (2006) 287–290
1054-139X/06/$ – see front matter © 2006 Society for Adolescent Medicine. All rights reserved.