Trends should be examined over longer period

EDITOR—Nicoll and colleagues report large percentage increases between 1995 and 1996 in indicators of sexual health in English teenagers.1 This is clearly of concern given the potential for serious health and social consequences. But it is important to look at trends in these various indicators over a longer period in order to obtain an accurate picture and to be aware of the impact on these of other, sometimes transient, factors.

Scottish publications routinely include data on teenage sexual health.2^–4 We have examined the trends in indicators of sexual health among Scottish teenagers between 1993 and 1997 in some detail The only indicators which convincingly show an increasing trend between 1993 and 1997 are genital chlamydia and genital warts in females; the data on pregnancies are less convincing (figure).

There are several factors which contribute to the increasing trend, including increased “unsafe sex.” Nicoll and colleagues point out that increased attendance by teenagers at genitourinary medicine clinics may have contributed to the increased rates of diagnosis of gonorrhoea and genital chlamydia in these clinics. They also refer to the importance of gonorrhoea in young men who have sex with men within the total infections in teenagers. Increased awareness and the introduction of more sensitive methods of diagnosis of Chlamydia trachomatis infection in recent years has led to increased screening and diagnosis of this largely asymptomatic infection in teenagers, among whom the highest prevalence of infection is found There are also data to indicate that the “pill scare” in 1995 led to increased conception and termination rates among teenagers in the first two quarters of 1996.5

Our data do not negate the need to ensure that appropriate and effective health promotion …