Prevent Cervical Cancer with the Right Test at the Right Time

Screening tests can find abnormal cells so they can be treated before they turn into cancer.

• The Pap test looks for changes in cells on the cervix that could turn into cancer if left untreated.
• The human papillomavirus (HPV) test looks for the virus that causes these cell changes.

The only cancer the Pap test screens for is cervical.

HPV is the main cause of cervical cancer. HPV is a very common virus, passed from one person to another during sex. Most people get it, but it usually goes away on its own. If HPV doesn’t go away, it can cause cancer.

Most women don’t need a Pap test every year!

Have your first Pap test when you’re 21. If your test results are normal, you can wait 3 years for your next Pap test. HPV tests aren’t recommended for screening women under 30.

When you turn 30, you have a choice:

• If your test results are normal, get a Pap test every 3 years. OR
• Get both a Pap test and an HPV test every 5 years.

You can stop getting screened if:

• You’re older than 65 and have had normal Pap test results for many years.
• Your cervix was removed during surgery for a non-cancerous condition like fibroids.

The cervix is the lower, narrow end of the uterus (womb) that connects the uterus to the vagina (birth canal). A diagram of the female reproductive system shows the ovaries, Fallopian tubes, cervix, uterus, vagina, and vulva.

Knowing your status doesn’t have to be scary. Find out which test you need, how often you need it, and if it actually involves peeing in a cup.

Herpes is a common sexually transmitted disease (STD) that any sexually active person can get. Most people with the virus don’t have symptoms. It is important to know that even without signs of the disease, it can still spread to sexual partners.

Genital herpes is an STD caused by two types of viruses. The viruses are called herpes simplex type 1 and herpes simplex type 2.

How common is genital herpes?

Genital herpes is common in the United States. In the United States, about one out of every six people aged 14 to 49 years have genital herpes.

How is genital herpes spread?

You can get herpes by having vaginal, anal, or oral sex with someone who has the disease.

Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. You can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected because the virus can be released through your skin and spread the infection to your sex partner(s).

How can I reduce my risk of getting herpes?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting herpes:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

Herpes symptoms can occur in both male and female genital areas that are covered by a latex condom. However, outbreaks can also occur in areas that are not covered by a condom so condoms may not fully protect you from getting herpes.

I’m pregnant. How could genital herpes affect my baby?

If you are pregnant and have genital herpes, it is even more important for you to go to prenatal care visits. You need to tell your doctor if you have ever had symptoms of, been exposed to, or been diagnosed with genital herpes. Sometimes genital herpes infection can lead to miscarriage. It can also make it more likely for you to deliver your baby too early. Herpes infection can be passed from you to your unborn child and cause a potentially deadly infection (neonatal herpes). It is important that you avoid getting herpes during pregnancy.

If you are pregnant and have genital herpes, you may be offered herpes medicine towards the end of your pregnancy to reduce the risk of having any symptoms and passing the disease to your baby. At the time of delivery your doctor should carefully examine you for symptoms. If you have herpes symptoms at delivery, a ‘C-section’ is usually performed.

How do I know if I have genital herpes?

Most people who have herpes have no, or very mild symptoms. You may not notice mild symptoms or you may mistake them for another skin condition, such as a pimple or ingrown hair. Because of this, most people who have herpes do not know it.

Genital herpes sores usually appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take weeks to heal. These symptoms are sometimes called “having an outbreak.†The first time someone has an outbreak they may also have flu-like symptoms such as fever, body aches, or swollen glands.

Repeat outbreaks of genital herpes are common, especially during the first year after infection. Repeat outbreaks are usually shorter and less severe than the first outbreak. Although the infection can stay in the body for the rest of your life, the number of outbreaks tends to decrease over a period of years.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or, for women specifically, bleeding between periods.

How will my doctor know if I have herpes?

Often times, your healthcare provider can diagnose genital herpes by simply looking at your symptoms. Providers can also take a sample from the sore(s) and test it. Have an honest and open talk with your health care provider and ask whether you should be tested for herpes or other STDs.

Can herpes be cured?

There is no cure for herpes. However, there are medicines that can prevent or shorten outbreaks. One of these herpes medicines can be taken daily, and makes it less likely that you will pass the infection on to your sex partner(s).

What happens if I don’t get treated?

Genital herpes can cause painful genital sores and can be severe in people with suppressed immune systems. If you touch your sores or the fluids from the sores, you may transfer herpes to another part of your body, such as your eyes. Do not touch the sores or fluids to avoid spreading herpes to another part of your body. If you touch the sores or fluids, immediately wash your hands thoroughly to help avoid spreading your infection.

Some people who get genital herpes have concerns about how it will impact their overall health, sex life, and relationships. It is best for you to talk to a health care provider about those concerns, but it also is important to recognize that while herpes is not curable, it can be managed. Since a genital herpes diagnosis may affect how you will feel about current or future sexual relationships, it is important to understand how to talk to sexual partners about STDs. You can find one resource here: GYT Campaign.

If you are pregnant, there can be problems for you and your unborn child. See “I’m pregnant. How could genital herpes affect my baby?†above for information about this.

Can I still have sex if I have herpes?

If you have herpes, you should tell your sex partner(s) and let him or her know that you do and the risk involved. Using condoms may help lower this risk but it will not get rid of the risk completely. Having sores or other symptoms of herpes can increase your risk of spreading the disease. Even if you do not have any symptoms, you can still infect your sex partners.

What is the link between genital herpes and HIV?

Genital herpes can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum. The genital sores caused by herpes can bleed easily. When the sores come into contact with the mouth, vagina, or rectum during sex, they increase the risk of giving or getting HIV if you or your partner has HIV.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention

Personal health inquiries and information about STDs:

CDC-INFO Contact Center
1-800-CDC-INFO1-800-CDC-INFO FREE (1-800-232-46361-800-232-4636 FREE)
TTY: (888) 232-6348
Contact CDC-INFO

Resources:

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

American Sexual Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-98771-800-783-9877 FREE

In recent years, there has been a reduction in rates of teen pregnancy, births, and abortions.  Similarly there has been a drop off in the share of adolescents engaging in sexual activity. Despite this shift, recent data indicate that the rates of unintended pregnancy and sexually transmitted infections (STIs) among teens and young adults remain higher in the U.S. than in other developed nations and are considerably higher among certain racial and ethnic minorities and in different geographic regions in the nation. This fact sheet provides key data on sexual activity, contraceptive use, pregnancy, prevalence of STIs, and access to reproductive health services among teenagers and young adults in the U.S.

Sexual Activity

• Nearly half (47%) of all high school students report ever having had sexual intercourse in 2013, a decline from 54% in 1991. A similar share of male and female students report ever having had sex (48% vs. 46%).¹
• There are racial and ethnic differences in sexual activity rates. Black high school students are more likely to have had intercourse (60%) compared to White (44%) and Hispanic students (49%).  A higher share of Black high school students (14%) and Hispanic students (6%) initiated sex before age 13 compared to White students (3%).²
• More than one in ten (13%) female teens and one in six (17%) male teens had more than four sexual partners in their lives. The percentage of high school students who report having had four or more sexual partners declined from 18% in 1995 to 15% in 2013.³
• One-third (34%) of high school students are currently sexually active, defined as having had sexual intercourse with at least one person in the previous three months. Almost one-quarter (22%) of these students reported using alcohol or drugs during their most recent sexual encounter. More males reported using alcohol or drugs (26%) compared to females (19%), and White males (28%) had higher rates than Black males (19%).⁴
• One in ten high school students who dated or went out with someone within the previous 12 months reported having experienced dating violence. More than 10% of students reported experiencing physical violence, and 10% of students reported experiencing sexual dating violence. Seven percent of students have been physically forced to have sexual intercourse, with more females (11%) than males (4%) reporting this experience.⁵  One in four women ages 15 to 24 report that they have talked with a health care provider about dating violence.⁶
• Young women experience the highest rates of rape and sexual assault among all age groups. More than 1 in 5 (22%) college women have been victims of physical abuse, sexual abuse, or threats of physical violence.⁷ Among women who have ever been raped, 30% were raped when they were between the ages of 11 and 17 and 37% were raped between the ages of 18 and 24.⁸
• “Sexting” is the exchange of explicit sexual messages or images by mobile phone. More than one in ten (13%) 14 to 24 year olds report having shared a naked photo or video of themselves via digital communication such as the internet or text messaging.⁹
• Twice as many young adults identify as lesbian, gay, bisexual, or transgender (LGBT) compared to older adults. A 2013 survey found 6.4% of adults ages 18 to 29 identified as LGBT compared to 3.2% of 30 to 49 year olds.¹⁰

Contraception

• Three quarters (74%) of teen girls reported learning about birth control in school.¹¹ Half (50%) of teen girls ages 15 to 18 discussed contraception with a health care provider, compared to 77% of young adult women (ages 19 to 24).¹² Among adolescents, 53% of females and 45% of males talked about contraception or STIs with their partner before their first time having sex.¹³
• 22% of teen females and 14% of teen males reported they did not use contraception at first intercourse.¹⁴ Research has shown that those who reported condom use at their sexual debut were more likely to engage in protective behaviors than those who did not report condom use at first intercourse.¹⁵
• Two thirds (66%) of sexually active teen males and half (53%) of teen females said they had used a condom at last sexual intercourse (Table 1).¹⁶

Table 1: Types of contraceptives used by teens or by teen’s partner during last sexual intercourse, among teens ages 15-19
Type of contraceptive	All teens, ages 15-19	White, Non-Hispanic	Black, Non-Hispanic	Hispanic	Males	Females
Condom	59.1%	57.1%	64.7%	58.3%	65.8%	53.1%
Birth Control Pills	19%	25.9%	8.2%	9.0%	15.1%	22.4%
IUD/Implant	1.6%	1.9%	1.1%	1.3%	1.3%	1.8%
Shot/Patch/Ring	4.7%	4.8%	5.7%	4.3%	3.7%	5.6%
NOTE: Totals do not round to 100% because some teens may use more than one method and other teens do not use any methods. SOURCE: CDC. Youth Risk Behavior Surveillance System: US, 2013. MMWR, 63(-4). 2014.

• 19% of currently sexually active high school students report that they or their partner used birth control pills to prevent pregnancy at last sexual intercourse. ¹⁷ White students (26%) were more likely to use birth control pills compared to Black (8%) and Hispanic (9%).¹⁸ Approximately 9% of teens used both condoms and one other method of contraceptive during last sexual intercourse.
• Emergency contraceptive (EC) pills can prevent pregnancy when taken within a few days of unprotected intercourse. One type of EC pill, Plan B, is available without a prescription in-front-of-the-counter without age restrictions. Other ECs, such as ella, are available with a prescription. Most teen girls age 15 to 18 (78%) report that they have heard of EC pills.¹⁹ From 2006 through 2010, 14% of female teens who had ever had sex had ever used EC pills.²⁰
• The American Congress of Obstetricians and Gynecologists (ACOG) formally recommends long-acting reversible contraceptives (LARCs), such as intra-uterine devices (IUDs), for adolescents.²¹ LARCs are considered among the most effective forms of reversible contraception.  However, utilization rates have been increasing. Approximately 7.4% of women aged 15 to 19 used a LARC in 2013, including an IUD, contraceptive patch, contraceptive implants, vaginal ring or injection.²²
• IUDs have historically had high up-front costs with insertion and supplies typically costing between $500 and $1,000. The Affordable Care Act (ACA) requires most new private plans to cover many preventive services important for sexual health without cost sharing, including FDA approved prescribed contraceptive services and supplies for women.²³ When financial barriers are removed, studies have shown a majority of women will choose LARCs which have the highest effectiveness rate.²⁴

Pregnancy

• The pregnancy rate among female teens ages 15 to 19 in 2010 was 57.4 per 1,000, a drop of more than 50% since the peak in 1990.²⁵ Despite the decline in this rate over the past decade, the U.S. continues to have among the highest teen pregnancy, birth, and abortion rates in the developed world.²⁶
• The teen birth rate has decreased significantly over the past decades, falling to 27 births per 1,000 females ages 15 to 19 in 2013 from 62 births per 1,000 females in 1991 (Figure 1).²⁷
• Although birth rates have fallen for teens of all races and ethnicities, the rates for African American, Hispanic and Native American teens are over twice the rates of White and Asian American youth (Figure 2).
• There are also geographic differences in teen birth rates across the nation. In 2012, teen birth rates were highest in South Central states and lowest in the Northeast (Figure 3).  The range varied considerably by state with New Mexico having the highest rate (47.5 births per thousand females 15 to 19) compared to a low in New Hampshire (13.8 births per thousand females 15 to 19).²⁸ Teen birth rates have been declining in rural areas, but not as quickly as in suburban and urban areas.²⁹
• The vast majority (82%) of teen pregnancies are unplanned compared to less than half of women above age 25.³⁰ These teen pregnancies comprise more than one sixth of total unintended pregnancies annually in the U.S. and 36% of these unintended pregnancies end in abortion.³¹  Approximately 18% of women having abortions in the U.S. are teens and 33% are between the ages of 20 and 24.³²  Women ages 15 to 19 comprised 17% of women of reproductive age (ages 15 to 44) in 2008.³³

Sexually Transmitted Infections (STIs) and HIV/AIDS

• Compared to older adults, sexually active teens and young adults are at higher risk for acquiring STIs, due to a combination of behavioral, biological and cultural factors (Figure 4). Though they make up 25% of the sexually active population, they account for nearly half of new STI cases.³⁴

• HPV is the most common STI among teens, with some estimates reaching an infection rate of 35% of 14 to 19 year olds.³⁵ Currently, there are two vaccines (Gardasil and Cervarix) that protect against strains of HPV associated with cervical cancer and genital warts. The CDC recommends that all girls and women up to age 26 receive the 3 dose course of HPV vaccinations, as well as all boys up to age 21.³⁶ These vaccines are now covered by private insurance without cost sharing, along with counseling on and screening for sexually transmitted infections, by the ACA’s policy for coverage of preventive services.³⁷
• Teens ages 15 to 19 and young adults ages 20 to 24 accounted for the most reported cases of Chlamydia and Gonorrhea in 2012. Females are at greater risk than men of acquiring sexually transmitted infections, and the consequences include pelvic inflammatory disease, pregnancy complications, and infertility.³⁸
• Despite the high rates of infection, many young women do not receive provider counseling on STIs. One-third of teen girls and almost half (45%) of young adult women ages 19 to 25 report that they have discussed STIs with their providers in the past three years.³⁹
• Research has found that STI screening rates vary among youth. One study estimates that 37% of young men and 70% of young women ages 15 to 24 had an STI test in the past year.⁴⁰ However, in another recent survey,  more than half (56%) of young women who reported having an STI test incorrectly assumed it was a routine part of the exam, which is often not the case.⁴¹
• Over 34,000 young people, ages 13 to 24, were estimated to be living with HIV in the U.S in 2009.⁴² This age group accounts for 26% of new HIV infections.  Most young people with HIV/AIDS were infected through sexual contact.⁴³
• In 2013, 85% of high school students reported that they had been taught about AIDS or HIV infection in school.⁴⁴ However, there are still gaps in knowledge about HIV/AIDS. One-third of teens ages 12-17 do not know that HIV is an STI.⁴⁵

Access to Services

• Health insurance coverage and the ability to pay for services affect teens’ access to reproductive health care. Prior to many of the ACA insurance coverage benefits taking effect, approximately 25% of young adults 19 to 25 years old were uninsured and 15% were covered by Medicaid in 2012. Six in ten (61%) young adults lived in a low-income household (below 200% of the federal poverty level).⁴⁶ After the initial insurance enrollment period in 2014, the uninsured rate among young adults ages 18 to 25 has declined to 18.7%.⁴⁷
• Confidentiality is a priority for teens and young adults. In a national survey, 70% of women 19 to 24 rated confidentiality about use of health care such as family planning or mental health services as “important”; however, the majority of girls and women were not aware that insurers may send an explanation of benefits (EOB) that documents use of medical services that have been used to the principal policy holder, who may be a parent (Figure 5).⁴⁸
• The Federal Title X program provides confidential contraceptive services and STI screening and treatment for low-income teens and young adults by funding approximately 4,400 clinics, public health departments and hospitals, available in 72% of US counties.⁴⁹
• Currently, Medicaid funds 75% of publicly funded family planning services in the U.S.⁵⁰ Family planning is a mandatory service under Medicaid and states are not permitted to charge cost-sharing for family planning services.
• Today, 21 states and DC have policies that explicitly allow minors to consent to contraceptive services, 25 allow consent in certain circumstances, and 4 have no explicit policy.⁵¹
• 38 states require some level of parental involvement in a minor’s decision to have an abortion, up from 18 states in 1991. 21 states require that teens obtain parental consent for the procedure, 12 require parental notification, and 5 require both.⁵²
• Teen girls ages 15 to 19 seek information about sexual and reproductive health issues from a variety of sources, primarily family and friends (36%), websites (28%), or health care providers (21%) (Figure 6).⁵³

If you are sexually active, getting tested for STDs is one of the most important things you can do to protect your health. Make sure to have an open and honest conversation with your doctor about your sexual history and STD testing. A recent study found that one-third of teens didn’t talk about issues of sex and sexuality during their annual health visits.

If you are not comfortable talking with your regular health care provider about STDs, there are many clinics that provide confidential and free or low-cost testing. It is also important that you find and visit a doctor or other medical provider who stays current on STD and HIV testing recommendations.