Sexual Behavior and STDs: Some NC teens are taking big risks

Editor’s Note: The following story contains information that is graphic and sexual in nature. Please note that it is intended for adult readers.

On the national front, Americans appear to be winning some battles against sexually transmitted diseases (STDs). Rates of HIV, syphilis, gonorrhea and chlamydia — the four STDs most systematically reported — have decreased across all age groups over the last decade. Yet a recent study shows that when all STDs are taken into account, the infection rate is actually on the rise, up 26 percent between 1996 and 2000. Even more alarming, young people are by far the most vulnerable population. The study, sponsored by the Centers for Disease Control and Prevention (CDC), estimates that youth ages 15-24 contracted nearly half of all new sexually-transmitted diseases, though they make up only one quarter of the sexually-active population.

Three STDs — human papillomavirus (HPV), trichomoniasis and chlamydia — account for 88 percent of these infections. CDC researchers also calculate that at least 11 percent of young people have genital herpes, which they qualified as a “minimum estimate” because it ignores all type-1 infections of genital herpes, which tend to produce fewer, less-painful lesions.

In North Carolina, statistics from the State Laboratory of Public Health in Raleigh, which collects samples from women who visit public health clinics, tell a similar story. In 2003, nearly 10 percent of girls in the 10-14 age group, and 9 percent of girls ages 15-19 tested positive for chlamydia, the most common STD tracked by the state. Researchers say that determining rates among boys is difficult because they don’t show symptoms and rarely visit clinics.

The vulnerability of teen-agers to STDs has not escaped the army of educators and health-care workers who counsel kids about the perils of premarital sex. In North Carolina, most school districts offer health education courses that present abstinence until marriage as the best way to avoid STDs, which are thoroughly described and discussed. According to data from the Youth Risk Behavior Surveillance System (YRBS) — an ongoing project managed by the Centers for Disease Control and Prevention to monitor the health risk behaviors that contribute markedly to the leading causes of death, disability and social problems among youth in the United States — young people appear to be getting the message. Fewer today report having sexual intercourse than 10 years ago, and those who do have sex are more likely to wear condoms and less likely to risk more than one partner.

So why are adolescents contracting more STDs than the rest of the population? One reason may be that kids are defining and practicing sexual behavior in ways that make them believe — often incorrectly — that they are not at risk for STDs. And they’re doing it at younger ages than ever before.

Risky Behavior at Younger Ages

The most reliable, comprehensive data about teen-age sex comes from the YRBS. Since 1991, the system has partnered with thousands of U.S. high schools every two years to ask students if they’ve had “sexual intercourse” and if they used a condom. And therein lie two limitations of the survey. First, it asks specifically about “sexual intercourse,” ignoring oral sex and other kinds of skin-to-skin contact that spread STDs. Second, it targets high school students exclusively. Only a handful of states have surveyed sexual behavior among middle school students, which means that health workers and educators nationwide know very little about this group beyond what they hear and see in clinics and schools. Presumably, there aren’t enough sexually active middle schoolers to justify the time and expense of large-scale surveys.

That’s what the Alabama state school board thought until health department officials convinced them to administer the questionnaire to 7th- and 8th-graders for the first time in 1993. The results shocked a group of educators, lawyers, physicians and agency heads, according to Martha Holloway, the state school nurse consultant in charge of directing the project. Thirty percent of the kids reported having had sexual intercourse, and 13.3 percent reported having had three or more partners.

North Carolina does not currently administer the YRBS to middle schoolers, but some health workers and educators in the region suspect that many younger kids are sexually active here, too. And the sooner sexual activity begins, the greater the risk of eventually contracting an STD through exposure to a greater number of partners.

Pediatrician Michelle Bailey used to ask her adolescent patients, mostly from Durham and Chapel Hill, about their sexual activity beginning at age 12, but two years ago she began raising the question when they turned 10. Around that time, a preteen patient surprised Bailey by mentioning that she and other kids at West Lake Middle School in Apex were wearing color-coded wrist bands signaling what type of sexual act that they were willing to perform. “For example, it could be oral sex or it could just be a kiss,” Bailey explains.

Since then, West Lake and other schools in the state have banned the bracelets. But the practice became so widespread nationally that “Oprah” featured the bracelets on a 2004 show. Some parents believe that the talk-show host exaggerated the sexual implications of the bands, but Bailey and other doctors report a rising level of sexual activity among younger teens and preteens.

A guidance counselor at West Lake agrees. Out of 110 middle school students that she counsels yearly, Jennifer Clifton estimates that between 30 and 40 talk to her about issues related to having sex. “A lot of people would be surprised how many risks they are taking.”

“It Isn’t Really Sex”

Teen-age sexual behavior isn’t anything new, but a growing trend among adolescents to substitute oral sex and genital-to-genital contact for intercourse may be.

Hope Siedel, a pediatrician in Cary, says oral sex is popular among kids who know their parents don’t want them to have sex and those who want to “save themselves for marriage.”

“Adolescents are very literal in their definition of sex,” notes Siedel, who believes that most young people think that if they aren’t having intercourse, they aren’t having sex. Approximately 20 percent of all her adolescent patients admit to sexual activity, she says. In the past three years, at least 10 patients younger than 15 told her that they’ve experienced more than one partner. Not asking a 13-year old about sex, she says, would be irresponsible on her part: “The equivalent of not bringing up car seats to the parent of a toddler.”

Heather Staley, a 2002 graduate of an Asheboro public high school, remembers that oral sex was “way more prevalent” than intercourse at her alma mater. “A lot of people that you heard about were doing that and other forms of pre-sex stuff,” she says.

Similarly, Rebecca*, currently a sophomore at Chapel Hill High, says that she and members of her close group of friends are all “still virgins.” But when asked about oral sex, she replies: “Oral sex isn’t sex, really.”

It is exactly this attitude that worries Carol Moseley, an STD prevention manager with the Guilford County Health Department. Especially when it comes to young people and STDs. “It’s been my experience from working with teens that they are more likely to be having oral and anal sex than vaginal sex,” she says. “While having only anal or oral sex can significantly reduce the risk of pregnancy, they are both very risky for STDs.”

Is Popular Culture to Blame?

When speculating about why some kids are becoming sexually active at younger ages, experts point to a culture saturated with pro-sex messages. Teen magazines and TV shows, instant messaging (IM) and online chat rooms, song lyrics and erotic fashions for girls are a few things that they mention. The October 2004 issue of YM, for example, featured an article titled “Friends with Benefits,” which discussed the merits of “casual hookups” that involve little emotional attachment. Catch phrases like these may signal changing attitudes about sex among young people. Karen Sommers, vice principal of West Lake for the last five years, believes that promiscuity comes in waves. “Right now,” she says, “being sexually active is cool.”

Sommers worries in particular about kids’ online behavior. The overtly sexual nature of the screen names that kids use to identify themselves online, are shocking, she says. The idea is to appear as sexy as possible so others will respond to an IM or e-mail query, she explains. At a popular Web site called, for example, 13- and 14-year-olds from towns and cities across North Carolina list the following screen names in their profiles:





Kids’ participation in the virtual meat market makes Sommers and Clifton very uncomfortable. From online profiles that include sexual turn-ons and provocative photos to explicit IM chatting and text messaging, the high-tech youth culture is extremely sexual.

These erotic online identities often extend to the personas kids project at school through fashion, say educators troubled by the parallel trends. “I look down the hall sometimes and I wonder if they really understand what kind of impression they make by what they wear,” says Clifton. Their choices reflect the popular culture, which they imitate almost reflexively, she laments. “They are so focused on wearing what the trendy stores sell and what the popular kids are wearing. They copy each other and what they see on TV. They don’t have the ability yet to think critically,” she says, “which is why talking to them about their choices is so important.”

*Names were changed to protect the child.

D’Ann George is a free-lance writer living in Chapel Hill. As part of this special assignment for Charlotte Parent, she spent two months talking with educators, physicians, parents, teens and health officials statewide about teen sex and the risks.