Cases of chlamydia, gonorrhea and syphilis hit an all-time high nationally in the most recent Centers for Disease Control and Prevention annual report that documented 2 million cases of sexually transmitted disease.
The bulk of those cases — 1.6 million — were chlamydia, with young women accounting for more than half of the diagnoses in 2016, the last year for which the data were available. Syphilis rates also rose nearly 18 percent over the previous year. And while the majority of those cases occur among men, there was a 36 percent increase in syphilis rates among women and a 28 percent increase in syphilis among newborns, known as congenital syphilis.
Amy Kelley, M.D., an obstetrician and gynecologist at Sanford Health Midtown Family Planning Clinic in Sioux Falls, South Dakota, said she suspects a big reason for the surge is that some states have done away with sex education standards, so some schools don’t offer anything.
“I would say that’s largely why, along with things like Tinder and more of a hookup culture,” she said. “By far the highest rates are ages 16 to 25 and then it goes way down, and then there’s a tiny bump in early 40s and 50s.”
Midtown operates in cooperation with the South Dakota Department of Health to provide free or discounted services based on family size and income to male and female patients:
- Exams and screenings
- Sexually transmitted infection testing
- Treatment and education
- Birth control
- Pregnancy testing
- Free community education
Because it’s a federally funded family planning clinic, it can provide birth control to minors, which is otherwise against South Dakota law.
“So if you have a teenager who can’t talk to their parents or needs STD testing and does not want their parents involved, they can go there and it’s very low cost and confidential,” Dr. Kelley said. “I don’t think kids should go behind their parents’ backs. But some are afraid, and they should get some information rather than no information at all.”
Thomas Looby, M.D., who practiced at midtown from 1972 until his retirement in 2013, said it provides services that otherwise might not be available to people with inadequate or no medical insurance.
“It was always intended to be a state-supported service for indigent care, just a low-cost approach for women’s care. Eventually we expanded to where we were taking care of men patients as well,” he said. “These guys were going to be able to get knowledgeable and therapeutic care for the disease that they were suspected of harboring.”
Looby said it’s a rewarding place to practice.
“The key requirement was to let go of judgmental care — if somebody comes in to see you and you want to change their attitude about something,” he said.
Birth control options
The birth control pill remains popular, but long-acting reversible contraceptives (LARC) like an IUD or implant offer a far lower failure rate, Dr. Kelley said.
But none of those options protects against sexually transmitted disease, so a condom should still be used, especially in a hookup society, she said.
“The best defense against STDs is having one partner, and hopefully that one partner has one partner as well. But you only have control over yourself. You have to protect yourself. It’s OK to trust people, but verify. You use condoms a long time to make sure that you’re in a monogamous relationship,” she said.
‘8 is great’
Besides practicing at midtown, Dr. Kelley also gives lectures about sex education and teaches sexuality. Morals and the emotional side of sex and relationships should be part of it, she said.
“What we and national experts say is 8 is great, 9 is fine and 10 is too late,” she said of the recommended age to start talking to children about sex.
“That’s not to say your kids should know everything. But by 8 they should know where babies come from and the real names for their anatomy and what sex is — the mechanics of it and the fact that it’s between adults. Otherwise, they’ll find out from someone on the playground or an older sibling and they don’t get good information,” Dr. Kelley said.
The average age of sex abuse is 9, so having those conversations with kids helps them know what’s appropriate.
“The way you can help them prevent being abused is by telling them this is what sex is and this is only what sex is. Only adults do this. Or only married people do this, depending on your values,” she said.
“You add, ‘This is what our family believes’ and how you can protect yourself both physically from pregnancy and disease but also emotionally. The mechanics and science is important. But I also think it should include, ‘How do you treat somebody that you are involved with?’ As a woman, ‘How should you expect to be treated?’ There’s so much abuse. It’s important to teach your kids about consent and what a healthy relationship looks like.”
Tips for parents
Dr. Kelley offers these suggestions to parents about how to have regular and open-ended conversations about sex and relationships with their children:
- Don’t freak out. That doesn’t mean there aren’t consequences for breaking rules or doing things outside of a family’s expectations. If you over-react, they won’t come to you again because they’ll think you can’t handle it.
- Start talking to kids when they’re 8 to 10 years old. It’s going to be uncomfortable, but younger children don’t feel as embarrassed as teens.
- Talk in the car. You don’t have to look at each other, but kids are also a captive audience.
- Talk at night. If you’re putting them to bed, you can turn off the lights and don’t have to look at each other.
- Practice what to say. “I tell parents that if you’re uncomfortable, your kids will be uncomfortable. If you have to stand in front of the mirror and say ‘penis’ or ‘vagina’ five times without getting embarrassed, it will really help,” she said.
- If you’ve laid the groundwork from 8 to 10 about what sex is, you then use teachable moments. For example, if they hear about some older cousin getting pregnant, you can ask, “Did you know you can prevent pregnancy? We can talk about it.”
- By 12, kids should know almost everything. They should know ways to prevent pregnancy and that they get diseases from sex. You don’t have to go into tons of detail.
“It’s not just about sex,” she said. “It’s about teaching your kids about a normal relationship.”
Some resources Dr. Kelley recommends:
- Bedsider.org has information on birth control options and sexually transmitted infections
- Sexetc.org is a website for teens by teens and covers multiple issues, including substance use, safety, sexuality, healthy relationships and consent
- Youngwomenshealth.org is run by Boston Children’s Hospital and offers general and reproductive health information for teens and young women