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These estimates emphasize the toll that STDs have on American youth. More representative data are needed to help monitor efforts at lowering the burden of these infections.

CONTEXT: In the United States, young people aged 15-24 represent 25% of the sexually experienced population. However, the incidence and prevalence of sexually transmitted diseases (STDs) among this age-group are unknown. METHODS:Data from a variety of sources were used to estimate the incidence and prevalence of STDs among 15-24year-olds in the United States in 2000. The quality and reliability of the estimates were categorized as good, fair or poor, depending on the quality of the data source. RESULTS: Approximately 18.9 million new cases of STD occurred in 2000, of which 9.1 million (48%) were among persons aged 15-24. Three STDs (human papillomavirus, trichomoniasis and chlamydia) accounted for 88% of all new cases of STD among 15-24-year-olds.CONCLUSIONS: These estimates emphasize the toll that STDs have on American youth. More representative data are needed to help monitor efforts at lowering the burden of these infections.

Objectives:The objective of this trial was to investigate the safety and preliminary effectiveness of a daily dose of 300 mg of tenofovir disoproxil fumarate (TDF) versus placebo in preventing HIV infection in women.Design:This was a phase 2, randomized, double-blind, placebo-controlled trial.Setting:The study was conducted between June 2004 and March 2006 in Tema, Ghana; Douala, Cameroon; and Ibadan, Nigeria.Participants:We enrolled 936 HIV-negative women at high risk of HIV infection into this study.Intervention:Participants were randomized 1:1 to once daily use of 300 mg of TDF or placebo.Outcome measures:The primary safety endpoints were grade 2 or higher serum creatinine elevations (>2.0 mg/dl) for renal function, grade 3 or 4 aspartate aminotransferase or alanine aminotransferase elevations (>170 U/l) for hepatic function, and grade 3 or 4 phosphorus abnormalities (<1.5 mg/dl). The effectiveness endpoint was infection with HIV-1 or HIV-2.Results:Study participants contributed 428 person-years of laboratory testing to the primary safety analysis. No significant differences emerged between treatment groups in clinical or laboratory safety outcomes. Study participants contributed 476 person-years of HIV testing to the primary effectiveness analysis, during which time eight seroconversions occurred. Two were diagnosed in participants randomized to TDF (0.86 per 100 person-years) and six in participants receiving placebo (2.48 per 100 person-years), yielding a rate ratio of 0.35 (95% confidence interval = 0.03–1.93), which did not achieve statistical significance. Owing to premature closures of the Cameroon and Nigeria study sites, the planned person-years of follow-up and study power could not be achieved.Conclusion:Daily oral use of TDF in HIV-uninfected women was not associated with increased clinical or laboratory adverse events. Effectiveness could not be conclusively evaluated because of the small number of HIV infections observed during the study.

Large numbers of new STDs continue to occur each year in the United States, with serious health and economic consequences. More than two thirds of our current estimate of 15 million STDs annually consists of two infections--trichomoniasis and human papillomavirus--for which we have only level III surveillance data. As the quality of our surveillance data improves, we can further refine the precision of our national estimates.

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