Chlamydia in Teens
Health experts warn that an epidemic of chlamydia may cause a wave of infertility in young Australians.1
The past decade has seen a steady rise in sexually transmitted infections (STIs) in Australia.2 Professor David Wilson, from the Kirby Institute estimates that rates of chlamydia have tripled over a ten-year period.3 Chlamydia is the most frequently notified infection in Australia with almost 83,000 cases diagnosed in 2012. The rise in chlamydia diagnosis is partly due to increased testing however, the Kirby Institute estimate that one in twenty young Australians have chlamydia and many don’t even know they have it.
The Burnet Institute recently reported that the group who have the highest percentage of positive test results are girls aged 12-15 years (13%) compared with females 16-19 years (12 %) and 20-24 years (8%).4 In males, the highest percentage of positive chlamydia tests were in those aged 16-19 years (15%) followed by 20-24 year olds (13%) and 12 to 15 year olds (9%).4 These figures may come as a surprise, but according to Carol El-Hayek, 12 to 15 year olds are definitely sexually active – and many of this age group are practising unsafe sex. Add to this the confounding factor that around 70% of females and 50% of males with chlamydia have no symptoms, so may pass on infection without knowing.5
For information about chlamydia symptoms, testing and treatment see What is Chlamydia?
Getting more Teens to Screen
Clearly, Australian teenagers as young as 12 years old are vulnerable to STIs, and the younger they are, the less likely they are to be tested. This age group are more likely to seek a test only after symptoms appear, or if they are identified as being at risk of unprotected sex by their GP, parent/carer or school counsellor.3
Chlamydia & Cyberspace
What’s also clear, is that young people are getting much of their health information from cyberspace. The internet plays a vital role in educating young people about STIs in a way that is familiar, non-judgemental and easily accessible. So how effective is cyberspace in reducing the rates of chlamydia in young people?
A recent study by Melissa Kang and colleagues from the University of Sydney GP Medical School, used the internet to engage sexually active young Australians aged 16-25 years in confidential, email interactions with a sexual health nurse or doctor. The goal was to educate and facilitate access to chlamydia testing services for young people. Subjects were invited to visit a specifically designed website to discuss chlamydia and the importance of testing.6
Young people were more likely to report having a chlamydia test after 6 months of email interaction with a clinician than those who were not offered such contact. The authors concluded that the internet and eTechnology may be useful in promoting chlamydia testing and healthcare seeking behaviour in young people.6
It goes without saying that cyberspace is a good place to start when designing public health messages about STIs for young people. There remain gaping research holes, sure to be filled over the next few years with studies on the extent and efficacy of internet-based education programs for young people. At this stage, and with little evidence to back up social media and internet-based programs, the most effective way to change behaviour are the still traditional methods of school-based programs, community health centres
In July 2013, The Australian Research Centre in Sex, Health & Society issued a report outlining the most effective (and ineffective) methods of delivering STI education programs.7
- Comprehensive one-on-one counselling with sexually active young people has shown to be effective in changing behaviour and reducing risky sexual practices;
- Generally, interactive internet-based programs are comparable to face-to-face counselling for increasing sexual health knowledge and improving attitudes towards practising safe sex
- Targeted outreach screening in community health settings and non-GP health services show high acceptance and participation in STI screening;
- Sexual health education via the internet and social media may improve young people’s sexual health knowledge and attitudes;
- Programs for Aboriginal and Torres Strait Islander youth that follow good cultural practices such as community consultation and ownership, collaborative development and engagement using multidisciplinary and interagency approaches are effective;
- Peer-led programs and youth development with at-risk young people and minority youth are effective in increasing knowledge and improving attitudes and motivations.
And what isn’t…
Programs focusing on abstinence were ineffective in reducing risk or delaying sexual behaviour. There is also indicative evidence that abstinence based programs may increase STI risk.7
There has been minimal success in increasing STI screening rates in general practice contexts, in particular for chlamydia. However, young people will respond positively to an offer from a clinician or GP for an STI test and many would prefer this to having to initiate the request.7
Take-home message for health practitioners:
- Offer confidential STI screening to young people.
- Make sure a list of sexual health clinics and youth health centres is available for young people from the age of 12 years.
- Avoid talk of abstinence. Young people are sexually active and need support not judgement.
- Keep up to speed on culturally appropriate, locally relevant, interactive sexual health education sites, apps and community programs.
In the meantime, there are plenty of informative, locally relevant websites, campaigns and Twitter feeds:
Red Aware YEAH is a youth driven health promotion organisation aimed at empowering youth to become involved in improving sexual health awareness in their local communities.
Get The Facts is a youth focused website about sexual health (Department of Health, WA).
Could I Have It? is a comprehensive site all about Chlamydia with information for young people and travellers. It even features online Chlamydia self-assessment and testing (WA based).
Better to Know is a website for Aboriginal and Torres Strait Islander people with information on STIs, how and where to test for STIs and how to tell a partner that you have an STI.
1. Brewster, K. Chlamydia epidemic may cause a rise in infertility among young Australians – experts warn. ABC News 24 October, 2013
2. Australian Bureau of Statistics ABS June 2012
3. Hagan, K. Chlamydia rates rise for younger girls. The Age, 24 October 2013
4. Somerville, C. Burnet Institute News, 24 October 2013
5. Better Health Channel: Chlamydia
6. Kang M, Rochford, A, Skinner R. et al. Facilitating chlamydia testing among young people: a randomised controlled trial in cyberspace. Sex Trans Infect. 2012;88:568-573.
7. Brown G, Croy S, Johnston K, Pitts, M., & Lewis, V. (2013). Rapid Review: Reducing sexually transmissible infections in young people. Melbourne: Australian Institute for Primary Care & Ageing (AIPCA) and Australian Research Centre in Sex, Health & Society (ARCSHS), La Trobe University.