STI cases are surging, especially among teens and young women in the South.

Daily Living

There are often no symptoms; ask your doctor for testing.

Page Leggett

Contributing Writer

Published Aug. 25, 2023

It's always helpful when an illness announces itself. But what about illnesses that don't have symptoms? That's a trickier issue.

Up to 75% of sexually transmitted infections (STIs) can be asymptomatic. So, it's important that young women who are sexually active – and men, too – are diligent about getting screened. Young women's bodies are biologically more prone to STIs, according to the U.S. Centers for Disease Control and Prevention (CDC).

All STIs have been on the rise since 2017. By 2021, cases in the U.S. reached 2.5 million, according to the CDC.

It's an "epidemic" that "shows no signs of slowing" said Dr. Leandro Mena, director of the CDC's Division of STD Prevention. (STIs were once known as STDs.)

In 2021, new chlamydia cases comprised 65% of new STI cases, with the highest incidence occurring in the South. The highest chlamydia rates are among women ages 20 to 24, followed by those who are 15 to 19.

The World Health Organization (WHO) lays out the risks of leaving an STI untreated: If untreated, they can lead to serious consequences, including:

Neurological and cardiovascular disease.
Pelvic inflammatory disease (PID).
Infertility or ectopic pregnancy (when a fertilized egg grows outside the uterus).
Stillbirths.
Increased risk of Human Immunodeficiency Virus (HIV).

While most 16- and 17-year-old girls aren't hoping to become parents anytime soon, the possibility of fertility issues later looms large for those with a history of PID. Approximately one in eight women who've had PID may experience difficulties getting pregnant.

Becky DeCamillis, a Winston-Salem based physician assistant (PA) with Novant Health Infectious Disease Specialists and APP medical director for the Novant Health Institute of Safety & Quality, wants to increase awareness of the prevalence of chlamydia and other STIs – and erase any stigma associated with them.

"Thinking 'it can't happen to me' is a dangerous attitude," she said. "And contrary to what some may think, contracting an STI is not a moral failure. The fact is: If you're sexually active, you can contract an STI such as chlamydia. So, if you choose to be sexually active, getting screened for STIs is just another item to add to the checklist to keep you healthy. Be forthright with your health care provider so they can make sure they're including all the tests you need."

Having 'the talk' with your teen

Talking with your teen about sex should include talking openly about sexually transmitted infections (STIs).

Knowing about their prevalence – and how to prevent their spread – is part of having safe sex. Getting tested – and treated, if necessary – is the responsible thing to do. And if your teen should test positive, he or she will need to tell their partner (or partners) so they can get tested, too.

Being sexually active comes with responsibility, and your teen should be aware of that. Teens should also know that all forms of sex – vaginal, anal and oral – can lead to transmission of STIs. Some 38% of high school students report having sex, a drop of 15% from the early 1990s.

More than half of STI cases in the United States happen in people ages 15 to 24. Teens are at a higher risk than adults of getting STIs because they may not be aware of them, may not use condoms correctly or at all and may have contact with multiple partners.

On its website, the U.S. Department of Health and Human Services offers fact sheets and tips for parents on initiating the conversation, including:

Think about what you want to say ahead of time.
Try not to give your teen too much information at once.
Talk while you're doing something together.

Testing and treatment

Since such a high percentage of people with chlamydia don't have symptoms, everyone who's sexually active should get tested annually, DeCamillis said. Those in high-risk categories, including people under the age of 25, those with multiple partners and those who don't use barrier protection such as condoms, might consider getting tested more frequently.

Talk to your doctor

Getting tested is easy. Your health care clinician – a primary care provider, OB/GYN or pediatrician – can do it. Other testing sites include urgent care centers or your county's health department. The CDC's "Get Tested" website allows people to input their ZIP code and find a free and anonymous testing site in their area. Visit gettested.cdc.gov to learn more.

"Typically, you can be tested for chlamydia with a urine sample," DeCamillis said. "For girls and women, a swab can be collected at the time of your yearly pelvic exam."

Symptoms may not be present

In girls and women, STI symptoms, which aren't present in about 25% of cases, include vaginal or urethral discharge, genital ulcers and lower abdominal pain. If you have any of these symptoms, you should see your doctor or make an appointment at the county health department to be tested – and, if positive – treated.

Highly treatable

Fortunately, chlamydia, unlike some STIs, is highly treatable. The preferred treatment is an antibiotic: Doxycycline 100 mg twice daily for seven days. You should abstain from intercourse until you and your partner have completed your course of antibiotics.

An alternative treatment – and one used for women who are pregnant – is a single dose of Azithromycin (1 gram). It should be noted that a pregnant woman can pass an STI on to her baby during childbirth.

Inform your partner

People diagnosed with chlamydia should tell their recent sex partners (within the last two months) so they can seek treatment. "It's important that both partners be treated so the infection isn't retransmitted after completing treatment," DeCamillis said.

Condoms reduce risk

What's led to the spike in STI cases? The CDC suggests that the COVID pandemic led some people to delay getting tested. Or to forego it entirely. But cases of STIs were rising even before COVID hit; other contributing factors include a decrease in condom use and decrease in prevention and testing efforts.

"The only way to completely eliminate the risk of getting or transmitting chlamydia – or any STI – is to abstain from sex," DeCamillis said. "Being in a long-term, mutually monogamous relationship with a partner who has tested negative for chlamydia also reduces the risk. Condoms, when used correctly and at every sexual encounter, can also reduce the risk of transmission."

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