Since the sexual revolution in the twentieth century, teenagers have been participating in sexual intercourse outside marriage and with multiple partners. The emerged sexual freedom and consistently decreasing level of parents’ involvement in the private life of young people contributed to the increased sexual activity among the youth. Various measures for preventing negative consequences of such behavior were invented. Although contraception is relatively available in the U.S., teenagers tend to disregard these safety tools. Hence, sexually transmitted diseases (STDs), like gonorrhea or chlamydia, became common among youth. This research project aims to study the lack of examination for gonorrhea and chlamydia among high school students in the U.S. Unfortunately, not every teenager with these illnesses knows about these infections because they do not often get tested.
Research Questions
Students that participate in sexual intercourse and potentially have STDs can belong to various categories and yet not visit clinicians for this cause. Numerous factors might affect the decision not to take tests for chlamydia or gonorrhea. The first question is, does age affect the lack of testing? The second question is, does gender affect the lack of testing? The third question is, does the race of the teenagers affect the lack of testing?
Study Rationale
Studying the lack of visiting clinicians for testing for STDs like chlamydia or gonorrhea is helpful for further study of the reason for this phenomenon. Moreover, it can be insightful about the ways of popularizing the screening. The methods for testing are numerous; some of them are brief and effective, like the Point-of-Care test (Pol et al., 2020). Therefore, it is helpful to determine the population ignoring the testing to prevent the spread of the diseases and enhance their treatment.
Literature Review
STDs are an enormous burden for the healthcare system because it affects many young people. Despite the availability of contraception methods, the rates of chlamydia and gonorrhea infections are increasing among youth (Pol et al., 2020). Notably, young people often refuse to get tested for STI and are usually diagnosed accidentally when admitted to EDs for different reasons. Therefore, this study explores if such factors as age, gender, and race influence the probability of not being tested for these infections. This literature review will discuss aspects that cause low referral for these STIs and potential solutions for this problem.
Youth is at greater risk for acquiring such STIs as chlamydia and gonorrhea. Indeed, U.S. Preventive Services Task Force (2021) reports that more than half of all gonococcal infections were revealed in females aged 15-24. This data may be subjective because women tend to go to hospitals more often than men, and males are usually asymptomatic. Still, Dretler et al. (2020) also found that women are less likely to get checked. Moreover, Francisco-Natanauan et al. (2021) claim that youth refuse to test for STIs. Therefore, screening recommendations may be applicable for both genders among young population.
Race and socioeconomic status seem to play a crucial role in the incidence of STDs. Marotta (2017) found that most infections are clustered in the southern states, poor urban areas, and regions where African Americans prevail. It appears that race and income level play a significant role in the propensity to get infected. However, this paper does not discuss if these factors influence the testing rate. Dretler et al. (2020) confirmed that the black population has a greater chance of being infected. The study is limited because it was conducted only in one emergency department. Lastly, since many young people refuse testing in hospitals, alternative methods should be suggested. For example, Pol et al. (2020) proposed a rapid assay to detect gonococcal infections. In fact, this point-of-care test demonstrated high sensitivity and specificity.
In summary, gonorrhea and chlamydia infections became increasingly prevalent among youth because they refused contraception use and testing. Adolescents and young African Americans living in poor urban regions of the southern states are more prone to get these STIs. However, many reviewed studies collected data from one hospital or did not adjust for confounding factors. Therefore, future research should focus on adjusting for these variables.
Present Study
- Hypothesis 1: Youth is less likely to get tested for gonorrhea and chlamydia.
- Hypothesis 2: Females are more likely to be tested and diagnosed with these infections than males.
- Hypothesis 3: African Americans are at greater risk of not being tested for these STIs.
Methods
Data and Sample
The participants of the survey will be high-school students across the United States. Data collection among adolescents aged 15-19 will be done with parental consent. This survey is a computer-based one-hour-long questionnaire that will be conducted anonymously.
Measures
Dependent Variables (Centers for Disease Control and Prevention, 2019):
Which of the following best describes you?
- Heterosexual (straight),
- gay or lesbian,
- bisexual, or
- not sure
During your life, with whom have you had sexual contact?
- I have never had sexual contact,
- females,
- males, or
- females and males
What is your sex?
- Male or
- female
What is your race?
- White,
- African American,
- Asian American,
- American Indian, or
- Native Hawaiian
Independent Variables:
What is your age range?
- 15-16
- 17-18
- 19-20
Have you ever been tested positive for STIs?
- Yes,
- No
How many times did you go for a check for STIs in the last two years?
- Never,
- 1-4,
- 5-9,
- more than 10
If checked, how many times were you tested positive?
- None,
- 1-4,
- 5-9,
- more than 10
Annotated Bibliography
Dretler, A. W., Trolard, A., Bergquist, E. P., Cooper, B., Liang, S. Y., Stoner, B. P., & Reno, H. (2020). The influence of race and sex on gonorrhea and chlamydia treatment in the emergency department.The American Journal of Emergency Medicine, 38(3), 566-570. Web.
The authors of this paper state that urban areas of St. Louis, Missouri, have the highest rates of chlamydia and gonorrhea. They explore different causes that affect high infection and low treatment rates among people admitted to the emergency department (ED). The authors developed their claim based on previous reports about the prevalence of sexually transmitted infections (STIs) among the asymptomatic young population. In this study, data was extracted from ED visits, where a rapid test for these infections was done to patients of different ages, gender, and race from 2012 to 2014 (Dretler et al., 2020). They found that women were at greater risk of not receiving testing and treatment. This manuscript is related to my topic because I plan to examine the effect of age, gender, and race on the lack of testing for STDs.
Francisco-Natanauan, P., Leatherman-Arkus, N., & Pantell, R. H. (2021). Chlamydia and gonorrhea prevalence and treatment in detained youths: Strategies for improvement.Journal of Adolescent Health, 68(1), 65-70. Web.
This article claims that gonorrhea and chlamydia infections have the highest prevalence among adolescents compared to other illnesses. The authors base their theory on the recent statistics from the state of Hawaii. The study reviewed charts of young people in correctional facilities of Hawaii and who were tested for STIs from 2014 to 2018 (Francisco-Natanauan et al., 2021). The authors reported that 62% of adolescents refused to be tested for chlamydia and gonorrhea (Francisco-Natanauan et al., 2021). This paper is relevant to my project because it explores factors associated with the lack of testing and treatment of STDs among adolescents.
Marotta, P. (2017). Assessing spatial relationships between race, inequality, crime, and gonorrhea and chlamydia in the United States.Journal of Urban Health, 94(5), 683-698. Web.
The author of this manuscript claims that the rates of gonorrhea and chlamydia are unequally distributed across the U.S. The main reasons for such nonuniformity are the difference in socioeconomic status, urban environment, and race (Marotta, 2017). The data for this study was obtained from public sources of the southern states. This study found that African Americans were at greater risk of testing positive for STIs. This article pertains to my topic because I also want to explore if race contributes to the risk of not being tested.
Pol, B., Taylor, S. N., Mena, L., Lebed, J., McNeil, C. J., Crane, L., Ermel, A., Sukhija-Cohen, A., & Gaydos, C. A. (2020). Evaluation of the performance of a point-of-care test for chlamydia and gonorrhea.JAMA Network Open, 3(5), 1-10. Web.
The authors state that the point-of-care test is needed for early diagnosis and timely treatment of gonococcal infections. They built this theory on the fact that the STI rate is growing despite the development of molecular diagnostic techniques. The study compared the rapid point-of-care assay and three other commercial tests for detecting gonorrhea and chlamydia. The results showed higher than 90% sensitivity and specificity for the new detection method of these infections (Pol et al., 2020). This article pertains to my topic because I also want to suggest a solution for patients to receive rapid at-home testing for STIs.
U.S. Preventive Services Task Force. (2021). Screening for chlamydia and gonorrhea: U.S. preventive services task force recommendation statement.JAMA, 326(10), 949–956. Web.
The authors suggest that screening young women for chlamydia and gonorrhea is beneficial for preventing further complications. Their theory was developed because more than 50% of these infections in 2018-2019 were found in individuals aged 15-24 (U.S. Preventive Services Task Force, 2021). The group conducted a systematic review on this issue to update existing recommendations. They found that screening of this cohort has a moderate benefit. This article pertains to my project because my central claim is that young people do not go for STD testing frequently; hence, screening is a better approach.