Something is not working in the prevention of sexually transmitted infections (STIs) in Spain and the youngest people are paying much of the consequences. This is evidenced by a work by researchers at the Basurto Hospital (Bilbao)—a reference for these ailments in the province of Bizkaia—which reveals that adolescents between 14 and 18 years old suffer from a high prevalence of STIs (especially women), They use condoms less than older people and go to health services less frequently.
“These data describe only the tip of the iceberg, under which a growing epidemic of unknown dimensions is hidden,” conclude the authors of the work, titled The hidden epidemic of sexually transmitted infections in adolescents and presented at the congress of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) recently held in Zaragoza.
Joana de Miguel, main researcher, tells how the idea to carry out the work arose. “We realized that we saw few teenagers. This group only accounted for 2% of consultations, when their weight in the population is much greater and we know that they are especially vulnerable. ‘Where are they?’, we asked ourselves. We will hardly be able to know what is happening to them and help them prevent it if they do not come to our services,” she reasons.
To resolve these questions, the researchers compiled all the information from patients treated for bacterial STIs at the Bombero Etxániz health center—attached to the Basurto Hospital—between 2014 and 2023 and focused on the age group of 14 to 18 years. . The first revealing fact is that the prevalence of STIs among adolescents is notably higher than among people aged 19 or older.
The rate of gonorrhea is 15.5% among patients aged 14 to 18, while this percentage among older patients is reduced to 10.3%. The difference is much more pronounced among women (15.5% and 5.3%, respectively). In chlamydia, the prevalence is 25.3% in adolescents and 14.2% in older people (29.3% and 15.2% in women). Only in syphilis, although barely, do adolescents present a lower percentage (2.1% by 3.4%), although if we look at women, among adolescents it is more than double that among those 19 years or older ( 1.4% by 0.6%).
To interpret these data, however, two factors must be taken into account. The first is that, if five-year age groups are compared—and not that of 14 to 18 years of age with that of all adults—some incidences may be higher in other groups (such as those of 20 to 24 years of age or 25 to 29, depending on the infection), as shown by data from the Carlos III Health Institute. The second is that older people go to the doctor more often for preventive reasons—tests and consultations when a contact has tested positive…—, while adolescents tend to go only when they have symptoms, which introduces a bias in the samples.
In any case, for the authors, the results reveal relevant and worrying issues. “The first is that, in reality, we do not know the real magnitude of the problem. Several STIs can remain latent and one can be an asymptomatic carrier, but transmit the infection. If minors only come when they have symptoms, all the other cases are missing us,” warns De Miguel. Adolescents, the authors highlight, hardly go to the centers on their own to take a test for prevention. “Only 15% come on their own initiative. The majority are referred by their family doctor,” adds this specialist.
This limited knowledge about the phenomenon is also observed in the scarcity of studies focused on minors. “We have only found one similar one, with similar results, done at the Sandoval Center in Madrid,” also specialized in sexual health, explains the researcher.
The second point that the research highlights is that there continue to be “barriers” that make it difficult to access specialized services. “Teenagers come less. It’s probably because of shame, because they don’t know the available healthcare resources well, because they fear what others think… Adolescence is a time when you feel vulnerable. The serious thing is that this prevents or delays diagnosis and treatment,” adds De Miguel. The authors of the study warn of the consequences that this may have in the future, especially for them: “An untreated or late-treated STI increases the risk of infertility, chronic pelvic pain…”.
This lack of information, the authors highlight, affects adolescents precisely when they need it most. “There are some anatomical characteristics (less production of cervical mucus and greater cervical ectopia) that make patients of this age more susceptible to suffering from STIs. There are also behavioral factors: they have more contacts than adults, something that is favored by new technological applications, and despite this they use condoms less,” says De Miguel.
The conclusions of the research coincide with the warning messages that have been repeated in recent years, in which a sustained increase in STIs has been recorded in the population as a whole. All the sources consulted insist, however, that the problem has its own characteristics in adolescents that require specific strategies.
“Access barriers continue to be a major pending issue,” warns Cristina Espalza, pediatrician at Hospital 12 de Octubre (Madrid) and member of the Spanish Society of Periatric Infectology (SAIP) and GeSIDA. This expert gives Madrid as an example, where there is only one center especially aimed at this group – dependent on the City Council – that seeks to better adapt to their characteristics. “It is open to everyone, you are not asked for a card, the city councils have all the means available, they are dedicated to informing…” she says.
Better treatments than recipes
Another barrier is money. “Many times we prefer to give treatments instead of prescriptions, which then you never know if they will really buy. This also applies to condoms: they have to be very accessible and free,” adds Espalza.
This expert insists on an idea: “Today’s adolescents are tomorrow’s adults. If we don’t get it right now, we will pay for it in the future, just as this bad data shows that something was not done right in the past. We must promote an education that affects knowing and living sexuality in a healthy way, respect, accepting oneself… If we achieve that, it will be the most natural thing for adolescents to go to sexual health services when they think they need it.” .
Félix Notario, president of the Spanish Society of Adolescent Medicine (SEMA) – which is part of the Spanish Association of Pediatrics (AEP) – emphasizes the importance of adapting to the special needs of adolescence. “If many people find it uncomfortable to talk about an STI, imagine at those ages when everything changes in your life, you establish new relationships, the group acquires great relevance… It is key to create areas of trust in which the adolescent can feel comfortable to explain to you what worries him,” he says.
A characteristic of the health system that does not help at this point is that adolescents stop having their lifelong pediatrician when they turn 15 and begin to be treated by a family doctor. “The pediatrician has been a reference for these children since they were children and with the change a very important space of complicity may be lost. They usually have a kind of ‘hidden agenda’. They come for something else and, if they are comfortable, they ask you what really interests them: those itches, some secretions…”, says Notario.
The early age of access to pornography is another factor pointed out by experts. “Studies say that pornography is the first sexual educator of our young people. And very specific patterns are shown there, which are usually violent and sexist, where the woman is an object, and condoms are not used either. That also does not contribute to making visible erotic practices in which you can protect yourself and enjoy yourself,” laments José García, coordinator of the sexual education program. Neither ogres nor princesses of the Government of Asturias.
For this expert “many things have been failing for a long time” in terms of sexual education. As much as 17 years, a time since Spanish legislation establishes that all students should receive classes in this subject, something that in practice has had a very irregular deployment. “It is an issue that continues to cause social controversy and this does not help. Sometimes it is for electoral reasons, other times for ideological positions. There are people who are against sexual education because it shows a diverse reality in which not everyone feels comfortable. The problem, in the end, is that adolescents often do not receive the training they should,” he concludes.