Sexual health of teenagers in England and Wales: analysis of national data

Sexual health is an essential component of general health and includes the avoidance of unintended pregnancies and sexually transmitted infections. Unintended pregnancies are associated with increased risk of poor social, economic, and health outcomes for mother and child,¹ and important sequelae of sexually transmitted infections include pelvic inflammatory disease and infertility, cervical cancer, and increased susceptibility to HIV infection. For some of these factors teenagers are at greater risk than older women.¹,²

Subjects, methods, and results

We reviewed all national routine data pertaining to sexual ill health among teenagers in England and Wales; birth and termination statistics from the Office for National Statistics; and reports from sexually transmitted disease clinics.³ We analysed data for 1996 and made comparisons with 1995.

In 1996 there were 86 174 conceptions in females under age 20 years, of which 30 296 were terminated and 55 878 led to a maternity (still or live birth). Rates of termination of pregnancy among teenagers rose in 1996 compared with 1995, by 14.5% in under 16s and 12.5% in 16-19 year olds. Maternity rates also rose in the two age groups by 6.7% and 4.6% respectively (table). The rises took place in all health regions and reversed previously declining trends in the early 1990s. When data were combined for 1995-6 and analysed by health district for females under age 16 (a Health of the Nation indicator) we found substantial inequalities. Termination rates varied from 2.2 to 10.5 per 1000 and live births from 1.1 to 9.9 per 1000, the highest rates being in urban districts. Teenage birth rates in England and Wales were the highest in western Europe (see BMJ’s website for data).

In 1996, there were 2272 cases of gonorrhoea diagnosed and reported among teenagers aged 16-19 years attending sexually transmitted disease clinics in England and Wales. The numbers increased by 34% in women and 30% in men from those of 1995 (table). The rises occurred in every region apart from Anglia and Oxford and followed a smaller rise between 1994 and 1995. Rates of gonorrhoea had consistently fallen from 1991 to 1994. Widespread rises were also seen for genital chlamydial infection and warts but not for genital herpes simplex.

Comment

In 1996, teenage females accounted for 20% of all terminations but only 9% of births, and teenage females had the second highest termination rate after 20-24 year olds. Older female teenagers (age 16-19) had the highest rates of gonorrhoea, genital chlamydial infection, and warts and the second highest (after 20-24 year old women) rate of genital herpes simplex.³ Incidence of gonorrhoea has been identified as a sensitive indicator of trends in sexual behaviour. Older age groups were also affected by the rise in 1994-6, but the rises in numbers and rates among both sexes were greater among 16-19 year olds than any other age group.³ Overall attendances at sexually transmitted disease clinics have gradually risen since 1988, and increased use of services may have accounted for some of the 1994-6 rises, which continued into 1997.⁴ However, it seems unlikely that the pronounced rise could be attributed solely to a sudden widespread increase in clinic use.

There is substantial sexual ill health among teenagers in England and Wales. This is distributed inequitably, and recent data are consistent with a worsening trend. The potential for health gain through primary behavioural prevention is considerable, and the United States, which has even worse teenage rates than the United Kingdom, has recently shown such an improvement.⁵ Sexual health should be a priority for coordinated national and local health promotion among young people.

Table.

Sexual health indices among teenagers in England and Wales, 1995-6

	1995			1996		% rate increase 1995-6 (95% CI)
	No	Rate per 1000		No	Rate per 1000
Terminations of pregnancy*
<16 year olds†	3999	4.3		4550	4.8	14.5%‡ (9.7 to 19.4)
16-19 year olds†	30 296	20.6		34 752	23.2	12.5%‡ (10.8 to 14.2)
Maternities*
<16 year olds†	4035	4.3		4279	4.6	6.7%‡ (2.2 to 11.4)
<16-19 year olds†	55 878	38.0		59 612	39.8	4.6%‡ (3.4 to 5.8)
New diagnoses at sexually transmitted disease clinics (16-19 year olds)§
Women:
Gonorrhoea (uncomplicated)	1024	0.79		1377	1.07	34.5‡ (24.0 to 45.8)
Chlamydia (uncomplicated)	4940	3.82		5753	4.45	16.5‡ (12.1 to 21.0)
Genital herpes (first attack)	1622	1.25		1646	1.39	1.5 (−5.2 to 8.7)
Genital warts (first attack)	6737	5.21		7561	5.84	12.2‡ (8.6 to 16.0)
Men:
Gonorrhoea (uncomplicated)	687	0.56		895¶	0.71	31.3‡ (19.2 to 44.7)
Chlamydia (uncomplicated)	1197	0.97		1411	1.15	17.9‡ (9.1 to 27.3)
Genital herpes (first attack)	274	0.22		269	0.22	−2.5 (−17.6 to 15.3)
Genital warts (first attack)	1821	1.49		2054	1.68	12.8‡ (5.9 to 20.1)

^*All conceptions of women resident in England and Wales leading to a termination of pregnancy in England and Wales and live or stillbirth (maternities) registered in England and Wales. 

^†Age at time of conception of pregnancy. 

^‡Significant rate increase, P<0.001. Analyses for termination and birth data involved calculating confidence intervals for rate ratios which were subsequently converted to percentage rate increase in 1996 compared with 1995. Analyses of data on sexually transmitted disease used Poisson linear regression with allowance for region effects. 

^§Aggregate data on new diagnoses of sexually transmitted infections diagnosed and reported to the Department of Health and Public Health Laboratory Service by 30 September 1998. 

^¶Numbers of cases of gonorrhoea diagnosed in 16-19 year old men that were attributed to homosexual transmission rose from 31 to 60. 

Editorial by McKee