Why are young people at risk from sexually transmitted infections?

According to the World Health Organization (WHO), the highest reported rates of STIs are found among 15–24 year olds, while about half of all of the people infected with HIV and 60% of all new HIV infections are also in that age group.

The most widely known STIs are gonorrhoea, syphilis and HIV – but there are more than 30 STIs and disease syndromes that result from STIs. It is important to note that certain STIs substantially increase the risk of transmission of HIV for both men and women. HIV, in its turn, facilitates the transmission of some STIs and worsens the complications of STIs because it weakens the immune system.

Biological factors:

• Young women are biologically more susceptible to STIs than older women. This is because their vaginal mucosa and cervical tissue are immature, and this makes these tissues more vulnerable to STIs.
• Boys and girls may have immune systems that have not previously been challenged and have not mobilised defences against STIs and HIV.
• Young people may also be more prone to infection because of anaemia or malnutrition.

Another biological factor, though not exclusive to young people, is that women often do not show symptoms of chlamydia and gonorrhoea (the most common STIs), so they do not seek treatment. For example, up to 70% of women and 30% of men infected with chlamydia have no symptoms. Similarly, up to 80% of women and 10% of men infected with gonorrhoea also have no symptoms.

Psychosocial factors:

• Adolescents often lack basic information concerning their sexual health, or the symptoms, transmission and treatment of STIs.
• Often there is poor communication between young people and their elders, and there are few learning materials (books, magazines) designed for young people.
• Sexual intercourse is often unplanned and spontaneous among young people.
• They often have multiple, short-term sexual relationships and do not consistently use condoms.
• Young people may feel peer pressure to have sex before they are emotionally ready to be sexually active and they often confuse sex with love and engage in sex before they are ready in the name of 'love' .
• Young men sometimes have a need to prove their sexual powers. Young men may have their first sexual experiences with prostitutes (commercial sex workers), while young women may have their first sexual experiences with older men, both of which increase the chance of getting STIs including HIV.
• Sexual violence and exploitation, lack of formal education (including sex education), inability to negotiate with partners about sexual decisions (in some cultures, girls are not empowered to say 'No') and lack of access to reproductive health services together put young women at especially high risk.
• Some adolescents are subject to early marriage, forced sex, trafficking and poverty, and may engage in sex work for money or favours.
• Substance abuse or experimentation with drugs and alcohol is common among young people, which often leads to their making irresponsible decisions such as having unprotected sex.

Even when young people realise that they are infected they may be afraid to seek treatment for STIs and so go on to infect others unnecessarily.