A Closer Look: Sexual Health in Young Adults in Cleveland



Special Thanks to the Following for their Authorship on this Report:

Julia Kosco, MPH Candidate          Case Western Reserve University

Vino Sundaram, MPH                     Cleveland Department of Public Health

What is Sexual Health?

Sexual Health can have many different meanings. According to ACT for Youth, it encompasses:
1) Comfort with body and sexuality
2) Understanding the body and how it functions
3) Effective communication with peers, family, and partners
4) Understanding risks, responsibilities, and consequences of sexual behavior
5) Recognizing risks and how to reduce them
6) Knowing how to access and use healthcare services and information
7) Having the ability to set boundaries with sexual partner(s)
8) Remaining strong to personal values
9) Having the ability to build healthy relationships



source: www.huffingtonpost.co.uk

What are the national trends in sexual health among youth?

source: searchengineland.com

According to the National Coalition for Sexual Health, the United States ranks poorly on many indicators of sexual health compared to other developed nations. 

Positive Trends

Waiting longer to initiate sex, increased condom usage, decreased number of sexual partners, decreased teen pregnancy/birth rates, more open communication with sexual partners and parents, better access to reproductive healthcare services

Negative Trends

Prevalence of STIs and HIV, unplanned pregnancies, sexual violence, drug/alcohol use before or during sex

Reasons why these negative trends are persisting

Many youth lack adequate understanding of sexual health. They do not know where to go for information, or they are misguided. The result is confusion or complete lack of knowledge about personal risk, safe sex, contraceptives, available reproductive healthcare services, and effective communication skills. 

Who is at risk of getting a Sexually Transmitted Infection (STI)?

According to the Centers for Disease Control and Prevention (CDC), adolescents and young adults are at increased risk. This especially applies to those who start having sex at a young age, live in detention facilities, use injection drugs, and men who have sex with men (MSM). 

Factors contributing to increased risk

Having multiple sexual partners around the same time
Not using protection consistently or correctly
Not having access to healthcare services


Reasons preventing access to needed and recommended reproductive healthcare services

According to the National Coalition for Sexual Health
Services referring to:STI and HIV screening, behavioral/contraceptive counseling, vaccination, etc.


1) Stigma
2) Cost
3) Transportation
4) Perceived lack of confidentiality
5) Lack of knowledge

source: termcoord.wordpress.com

What is Chlamydia?

Chlamydia is the most commonly reported STI in the United States. It is spread through vaginal, anal, or oral sex. Pregnant women can infect their children during childbirth. It affects both men and women. 

Possible Symptoms

Men may notice discharge from the penis, a burning sensation when urinating, or pain/swelling in the testicles. If untreated, it can spread to the tube that carries sperm from the testicles, causing pain and fever. It rarely affects fertility. 

Women may notice abnormal vaginal discharge or a burning sensation when urinating. If untreated, it can spread to the uterus and fallopian tubes, causing pelvic inflammatory disease (PID). This often does not have symptoms, but it can cause permanent damage to the reproductive system and lead to long term pelvic pain, infertility, or fatal ectopic pregnancy (the embryo implants outside of the uterus).

Men or women who had anal sex may notice rectal pain, discharge, or bleeding. 


source: www.cdc.gov


Diagnosis & Treatment 

It is diagnosed through lab tests or cotton swabs

It is cured with antibiotics, although they do not undo the permanent damage already done. 

When getting treated, abstain from sexual activity for 1 week after single dose antibiotics or until completion of 7 day course of antibiotics. 

Both men and women should be retested 3 months after treatment of initial infection in order to ensure that treatment was successful. 

Re-infection is possible. 

What is Gonorrhea?

Gonorrhea is a very common STI, especially among those aged 15-24 years old. It is spread through vaginal, anal, or oral sex. Pregnant women can infect their children during childbirth. It affects both men and women. 

Possible Symptoms

Men may notice a burning sensation when urinating, a white/green/yellow discharge from the penis, or pain/swelling in the testicles. If untreated, it can cause a painful condition in the tubes attached to the testicles, which may cause sterility. It can also spread to the blood or joints, which may be fatal. 

Women often do not have symptoms, but if they are present they are usually mild and can be mistaken for a bladder or vaginal infection. Noticeable symptoms are still possible, however, and include: a painful/burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. If untreated, scar tissue may form that blocks the fallopian tubes, or it can cause ectopic pregnancy, infertility, or long term pelvic/abdominal pain. It can also spread to the blood or joints, which may be fatal. 

Men or women who had anal sex may notice discharge, anal itching, soreness, bleeding, or painful bowel movements. 


source: www.cdc.gov

Diagnosis & Treatment

It is diagnosed through a urine sample or swab. 

It is cured with antibiotics, although they do not undo the permanent damage already done. 

When getting treated, wait 1 week after finishing all medications before having sex. 

Re-infection is possible. 

What is Human Immunodeficiency Virus (HIV)?

HIV is the disease that leads to AIDS if untreated. It is spread through blood, semen, pre-seminal fluid, rectal fluid, vaginal fluids, and breast milk. These fluids must come in contact with a mucous membrane or damaged tissue, or must be directly injected, in order for transmission to occur. Some people are more at risk due to sex partners, risk behaviors, or where they live. 

What does HIV do?

It weakens the immune system by destroying cells called T cells (specifically CD4 cells) that fight off disease and infection. Opportunistic infections or cancers take advance of the weak immune system and indicate that the person has AIDS. 



source: plainsmenpost.com

What are the stages of HIV?

Stage 1: Acute HIV Infection

Within 2-4 weeks of initial infection, flu-like symptoms occur that may last for weeks.There are high viral loads, making the person extremely contagious. It often goes unnoticed.

Stage 2: Clinical latency (HIV inactivity or dormancy)

HIV is inactive but reproduces at low levels. There may be no symptoms, but the person is still contagious.At the end stage, the viral load increases and the T cell count decreases. It may last a decade or more.

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

This is the most severe phase and survival is about 3 years if untreated. The immune system is so badly damaged that the person can get several severe illnesses. Symptoms include: chills, fever, sweats, swollen lymph glands, weakness, and weight loss.There are high viral loads, making the person extremely contagious.

How is HIV connected to other STIs?

STIs can cause irritation of the skin, causing breaks or sores that make it easier for HIV to enter the body during sexual contact.

STIs that do not cause breaks or open sores still increase the risk of HIV due to inflammation, as increased numbers of cells can act as targets for HIV. 

There is an increased concentration of HIV in semen and other genital fluids of HIV positive people who are also infected with another STI. 

Diagnosis & Treatment

HIV is diagnosed by testing blood or saliva for antibodies or antigens. 

AIDS is diagnosed when the T cell count drops below 200 cells/mm or if certain illnesses develop. 

There is no effective cure, but antiretroviral therapy can prolong life through viral repression.

What is Syphilis?

Syphilis is a very common STI, especially among those 30 years old and younger. It is spread through direct contact with a sore during vaginal, anal, or oral sex. Pregnant women can infect their children during childbirth. It affects both men and women, and high risk groups include: pregnant women, MSM, and those with an HIV infection. 

primary syphilis - source: Society of Syphilitis (walnet.org)

secondary syphilis - source: www.healthlifemedia.com


What are the stages of syphilis?

Stage 1: Primary stage

Sores are present in the vagina, anus, rectum, or on the lips. They are usually firm, round, and painless and typically appear 2-10 weeks after initial exposure. They last 3-6 weeks and heal regardless of treatment. 

Stage 2: Secondary stage

Skin rash and/or sores are present. The rash appears when sore(s) are in the healing process, or several weeks after the last sore has disappeared (can be anywhere from 6-12 weeks). The rash is rough, red, or reddish brown and shows up as spots on the palms of hands and/or the bottoms of feet. It does not itch and can be very faint. It typically lasts 2-6 weeks. Other possible symptoms: fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. 

Stages 3 & 4: Early latent and late latent stages

All previous symptoms have disappeared. If treatment was never sought, syphilis can remain in the body for years without exhibiting signs or symptoms. It can cause difficulty coordinating muscle movements, paralysis, numbness, blindness, dementia, or damage to organs which can lead to death. 

Diagnosis & Treatment

It is diagnosed through blood tests or sore fluid tests. It is cured with antibiotics, although they do not undo the permanent damage already done. Those receiving treatment cannot have sexual contact until sores are completely healed. 

What are the trends of these STIs in Cleveland among young adults?

Chlamydia

Most chlamydia cases in Cleveland were female, making up 71.27%. 

Those of a non-Hispanic/non-Latino ethnicity made up the majority of cases at 79.84%. 

Blacks were the overwhelming majority compared to other races at 76.74%. 

Gonorrhea

Most gonorrhea cases in Cleveland were female, making up 59.63%

Those of a non-Hispanic/non-Latino ethnicity made up the majority of cases at 81.92%. 

Blacks were the overwhelming majority compared to other races at 83.45%. 

Human Immunodeficiency Virus (HIV)



Most HIV cases in Cleveland were male, making up 91.58%. 

Those of a non-Hispanic/non-Latino ethnicity made up the majority of cases at 92.57%. 

Blacks were the overwhelming majority compared to other races at 83.66%. 

Syphilis



Most syphilis cases in Cleveland were male, making up 91.14%.

Those of a non-Hispanic/non-Latino ethnicity made up the majority of cases at 93.67%

Blacks were the overwhelming majority compared to other races at 86.07%. 

Sources of Sexual Health Information

It is very important for youth to get sexual health information from reliable sources. Below are the top sources youth reported they use (not ranked in any specific order) according to the National Coalition for Sexual Health & the CDC. 

School
Family
Friends
Health professionals
Internet
Television



source: www.patheos.com

Recommended Reproductive Healthcare Services

according to the National Coalition for Sexual Health

Chlamydia and gonorrhea screening for sexually active females 25 years old and younger

HIV testing at least once for all sexually active youth

High intensity behavioral counseling to reduce STI risk for those engaging in unsafe behavior

Contraceptive counseling

Domestic and interpersonal violence screening and counseling

Hepatitis B and HPV vaccination for all youth

Pap smears for female youth within 3 years of having sex for the first time or by 21 (whichever comes first)

Prenatal screening for chlamydia, syphilis, HIV, and Hepatitis B

source: www.americanprogress.org

source: www.azoospermia.info

Action Steps to Improve Sexual Health Among Youth

according to the National Coalition for Sexual Health

1) Educate youth about their bodies
2) Educate youth about how to build healthy relationships
3) Promote open and positive communication about sex and sexual health
4) Encourage youth to value themselves and their morals
5) Teach about and encourage use of reproductive healthcare services