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Background Levels of STIs and teenage pregnancy among Aboriginal and Torres Strait Islander populations are significantly higher than among non-Indigenous populations. However, recent research has shown few differences in the sexual behaviour of young Indigenous and non-Indigenous Australians. We conducted a systematic review to examine the multi-dimensional and socially constructed nature of adolescent sexuality with a view to developing meaningful STI and pregnancy reduction programmes for young Indigenous Australians. Methods Following standard guidelines for systematic reviews we searched eight relevant databases for published studies. We focused on publications since January 2003 using search terms: adolescent, youth, sexual, Australia, Indigenous, Aboriginal and Torres Strait. Given the limited amount of literature available we included all study designs and studies of broader age ranges or populations, but where Indigenous and adolescent populations were disaggregated in study results. Results We identified an initial 2,718 citations through the database search. After removing duplicates and citations that were not peer-reviewed or research articles, we screened 2,266 articles and excluded 2,158. The remaining 180 articles were reviewed in full: 93 did not meet inclusion criteria. Our review finally comprised 15 research papers, representing eleven distinct studies.Across the literature included in the review a number of key social determinants of poor sexual health were identified. These included alcohol, poverty, gender inequalities, intergenerational trauma, limited access to education and employment, shame, constrained adult role models and aspirations and restricted access to (sexual) health services. We examine the role of these factors with regard to adolescent Indigenous sexual health. Conclusions International research argues that promoting good sexual health requires a broader focus on sexuality. The sociocultural and historical contexts of Indigenous communities suggest that focusing on strengths-based approaches to sexual health with peer or community facilitation might be acceptable and effective for young Indigenous Australians.

After chlamydia became a nationally notifiable condition in the United States, reported case rates increased steadily, likely a result of more complete reporting, expanded screening efforts, and use of more sensitive diagnostic tests. Reported case rates of chlamydia are highest among young women, a consequence of high prevalence in this population (as evidenced by estimates from national population-based surveys) and of targeted screening efforts (current guidelines in the United States recommend screening for all sexually active females aged <25 years). However, after a decade of increasing reported case rates, case rates have recently declined among adolescent women aged 15-19 years: during 2001-2011, case rates increased 49.8% (2,327 to 3,485 per 100,000 females) and then decreased 15.1% during 2011-2014 (3,485 to 2,960 per 100,000 females). We explored possible reasons for decreases in chlamydia case rates among adolescent females using available national data and highlight how decreases in screening coverage among key populations may be impacting reported case rate trends.