COLUMN ONE : America’s Silent Epidemic : Despite publicity about AIDS, sexually transmitted diseases are flourishing among the young. Experts blame ignorance, double standards and a lack of honest discussion.

Carrie knew all about safe sex. And she was cautious. When her friends began having sex in high school, she steadfastly refused.

But, at 18, she fell in love and decided it was OK because this boyfriend seemed so nice, so safe. They didn’t even discuss condoms.

Later, as the relationship faltered and Carrie learned more about her boyfriend’s past, she decided to get tested for sexually transmitted diseases. After the exam, a clinic counselor told the tearful adolescent that she had chlamydia, the most prevalent sexually transmitted disease in the country, which often produces no symptoms in women but can cause sterility if left untreated.

“He was my first partner. He supposedly loved and cared about me. I guess I thought love would protect me,” she says.

What’s disconcerting to health experts is that, even in the age of AIDS, there apparently are so many young Americans like Carrie: naive about the hazards of sex in the ‘90s--and greatly at risk.

Sexually transmitted diseases, or STDs, are flourishing in the United States. Several are thought to be at their highest rates ever.

But what alarms health officials most is that teen-agers and young adults are now the primary victims of STDs. And STD infections, in turn, boost the risk of contracting the human immunodeficiency virus, becoming infertile or giving birth to babies with health problems. (Most HIV-infected people contract the virus in their late teens and early 20s, according to statistics.)

Teen-age girls in particular have become more promiscuous in the last two decades, experts say. The problem stems in part, they say, from a dearth of educational materials and treatment programs for teen-agers and a reluctance by parents and doctors to deal honestly with young people regarding the do’s and don’ts of sex.

The infection rates--from age-old gonorrhea to newer scourges such as chlamydia and human papilloma virus--are highest among Americans ages 15 to 25, and show little signs of abating.

Of the 12 million new STD infections each year, two-thirds occur among people under 25.

And since young people are generally more promiscuous, less likely to use condoms, less likely to see a doctor and, among females, more biologically prone to STDs, they are the generation of Americans who stand to suffer the greatest consequences, experts say.

Particularly puzzling is that this is happening when AIDS and safe sex are universal discussion topics for all ages. But the message clearly is not getting through, particularly to teen-agers.

It is a predicament so disturbing to health officials that many are pleading for a restructuring of the nation’s approach to controlling STDs to focus more on young people and sex education in addition to a consistent public-health effort to prevent disease.

Experts note that, historically, when the federal government has pumped money into syphilis and gonorrhea prevention, infection rates have dropped. But when the funds are reduced, they rage back.

Federal funds have mainly targeted these two diseases, which largely affect adults, while STDs that affect younger people have received little attention from the government. According to experts, new tactics are long overdue.

“The AIDS epidemic is as bad as it is because we, as a culture, have not been good at dealing with sexuality,” says Peggy Clarke, president of the American Social Health Assn., the only non-government organization devoted to fighting STDs. “Our rate of STDs is a national embarrassment. We are the only industrialized country in the world with so big a problem.”

The inadequate response can be traced to every sector, from the government to health professionals to educators to parents, according to a 1993 report from The Alan Guttmacher Institute, a nonprofit corporation for research in policy specializing in reproductive health.

“How can this be happening in the age of AIDS?” asks Patricia Donovan, a senior associate at Guttmacher who wrote the report.

Experts point to several factors that include:

* An increasingly promiscuous society in which people begin having unprotected sex younger and have more partners during their “unattached” period--often 10 to 20 years--before they commit to one monogamous relationship.

* Americans’ inability to talk about sexuality and provide factual sex education in the home, schools and health care settings, even though the culture is highly sexualized.

* An antiquated approach to STDs by governments, health organizations and schools, which makes it difficult for youths to get treatment, screening--or even basic information.

“I’m afraid . . . that people are not aware of the problem or don’t believe it will happen to them,” Donovan says. “Teens, who are a particularly strong risk group, often make the judgment that their partner is clean even though they have no way in the world of knowing that.”

A look at statistics shows high infection rates for young people in every STD category. For the first time, teen-age girls have the highest gonorrhea rates in the nation; teen-age boys rank second. The rate in adolescent girls is 20 times higher than in women over 30, according to the U.S. Centers for Disease Control and Prevention. At least 10% of sexually active teen-age girls have had gonorrhea.

“That teen-age girls are now the harbingers of this disease is amazing,” says Deborah Howard, program coordinator of the STD/HIV Prevention Training Center in Long Beach, a joint federal, state and city program to educate health professionals about STDs. This is particularly scary, she says, because many girls in the 15 to 19 age bracket do not come in for treatment--meaning the incidence is probably greatly underreported.

Adolescent rates for chlamydia, which can lead to pelvic inflammatory disease as well as infertility, range from 15% to 37% in females and are around 10% in males.

And, in several studies, 32% to 46% of sexually active teen-age girls were found to be infected with human papilloma virus, most of them carrying a strain that can cause cervical cancer.

Nationwide, one in four sexually active adolescents will become infected with an STD by age 19, says Dr. Adele Dellenbaugh Hofmann, a professor of adolescent medicine at UC Irvine.

Human papilloma virus, which is difficult to treat and can become chronic, is not a disease that must be reported in the United States, and the federal government has no program to deal with it. Health officials in some states have only recently been asked to report chlamydia cases, but there are few programs to control the disease.

“We have a large number of youths who are sexually active, and we still have a large percentage of youths who are not using condoms. I don’t see this problem as diminishing significantly,” Hofmann says.

One in five adult Americans carries some type of viral STD, such as herpes, which are not curable, according to the Guttmacher report. When the curable, bacterial STDs--such as syphilis, gonorrhea and chlamydia--are included, Americans have at least a one in four lifetime chance of contracting an STD.

But the price of sexual freedom is more profound for 15- to 19-year-olds than for their parents because of the widening pool of infections in that age group.

About one in five reported AIDS cases is diagnosed among people in their 20s. But since the virus has a long incubation period--about 10 years--most were adolescents when they were infected, according to the CDC.

That fact is particularly alarming because many STDs act in synergy with HIV to enhance the transmission of both, experts say. Having an STD, such as gonorrhea, increases by as much as 100 times the chance of contracting HIV from an infected partner, according to some estimates.

“As time goes on, we’re seeing more and more of a connection between HIV and syphilis and gonorrhea,” says Sylvia Drew Ivie, director of T.H.E. Clinic, in Los Angeles, which treats underserved families and has a large teen-age clientele. “I think the fact that (syphilis and gonorrhea rates) are high is not only alarming by itself but by their connection to hidden HIV infection. One of the indicators of HIV are these other diseases.”

Although HIV has helped raise awareness about all STDs, there is a common misperception that, other than HIV, the diseases are easily cured and cause no lasting harm. That is not true, Donovan says. As infections slink through the population they lay a minefield of future reproductive problems, such as infertility, ectopic pregnancy and miscarriage.

“I don’t think people understand how common some of these serious consequences are, particularly infertility,” Donovan says. “That has a major impact on the lives of millions of women who would like to have children.”

In addition, STDs often attack women silently, without symptoms. But this crucial bit of information rarely reaches young people. For example, one 1990 study of college students in Canada found almost half didn’t know STDs can be asymptomatic.

“Seventy-five per cent of women with chlamydia don’t have any symptoms,” Donovan says. “They don’t know until five years later, when they have serious pelvic pain, or 10 years later, when they can’t get pregnant, that they had this STD that would have been easily curable.”

Teen-agers are sexually active younger and have more partners than did previous generations. According to a new national poll of more than 11,000 high school-aged youths, 54% said they were sexually active, compared to 29% in 1970. The portion of 15-year-olds having sex has risen from 4.6% in 1970 to 26%. Almost one-fifth of the sexually active teens say they have had four or more partners.

In addition to being less likely to use condoms, young people are more likely to use drugs and alcohol, which often leads to unwise decisions about sex.

In the national study, published in July’s American Journal of Public Health, over half of the sexually active teens said that they had not used a condom when they last had intercourse. Among students who used illicit drugs, one-third said that they had multiple partners and did not use condoms when they last had sex.

“Sexual behavior is putting a sizable portion of high school students at risk,” says Dr. Richard Lowry, a CDC adolescent health expert and lead author of the report. Having several partners is especially dangerous for teen-age girls because, studies show, they often have an immature cervix which may be more easily infected.

But the biggest problem among young people--male or female--may be that they don’t perceive themselves at risk for STDs--until it happens, experts say.

Widespread efforts to promote safe sex because of the HIV threat have helped reach some, but far from all, young people.

“We’ve used HIV as the ‘great bad outcome’ to encourage people to undertake precautions,” says Dr. Stuart Berman, of the CDC’s Division of STD/HIV Prevention.

Armando, now 20, started having sex years ago but didn’t bother to use condoms.

Then his aunt died of AIDS. “That changed me,” he says, sitting in a clinic where he works part-time as a peer counselor to youths seeking treatment for an STD. “I used to think if a girl looks clean she was probably clean. I didn’t know there were so many diseases.” Armando himself was treated for an STD and says he now always uses condoms.

But although the HIV threat may be convincing some high school and college students to practice safe sex, says UCI’s Hofmann, “There is no evidence that the HIV threat or anything else has affected the behavior of the alienated youth population, such as the kids who drop out of school.”

And the HIV threat message may miss some adolescents who simply don’t think about sex or its repercussions until it’s too late. When adolescents were asked in one study why they do not use protection, 65% said it was because sex was unexpected. Youths may avoid using condoms because it indicates they “planned” to have sex, Hofmann says.

Few people, adult or adolescent, understand that having sex with one person may mean being exposed to the diseases of many others, says Laura Brannon, an Ohio State University researcher who has studied what she calls “the phantom sex partner.”

This fact may be especially true for teen-agers, among whom STD rates are extremely high and condom use low. For example, one study in Atlanta found that 24% of teen-aged women with only one sexual partner had chlamydia.

Tricia, a 20-year-old from the Westside, learned that lesson the hard way. She recently contracted gonorrhea from her longtime boyfriend after he returned from a six-month military tour.

“It was so upsetting because I had always used protection when I was dating other people,” Tricia says. “This was the one person that, for three years, I had never questioned. When you get something from someone you care about, just think what you could get from strangers who will tell you anything.”

Condoms are very effective in preventing disease if used correctly every time, Donovan says. “But just giving people condoms is not enough. You have to educate people on their risks. I think one of the real shortcomings (of the nation’s attempt to control STDs) is the refusal of television networks to air condom ads.”

Many sex educators criticize what they say is a deadly double standard: Sex education for children and teen-agers is restrained at the same time that young people are bombarded by sexuality on TV and in movies and song lyrics.

Guilt, shame and fear that their parents will discover their sexual activity prevents many adolescents from seeking health care when they do suspect they have an STD, Hofmann says.

In California, children 12 and older can seek STD treatment on their own. But, she says: “These kids still don’t know where to go.”

Few school-based health clinics offer such services, experts say. As for government-sponsored STD clinics, many are clearly marked units in urban health departments where adults line up for appointments early in the morning and wait for hours, noted one expert, who added: “Teen-agers wouldn’t be caught dead there.”

And it would take a gutsy child to raise the issue of sex with a pediatrician or the family doctor. In one report on college freshmen published in the journal Pediatrics, 79% said they had never been counseled about STDs by a physician. Only one-third of sexually active females ages 15 to 19 are screened for an STD each year, according to another study.

“Either the doctors themselves have no idea of the prevalence of STDs or they don’t want to offend their patients by suggesting they may have one of these diseases,” Donovan says.

That is beginning to change. The American Medical Assn. in 1992 issued a report on adolescent health advising doctors to regularly counsel their teen patients about responsible sexual behavior and to make condoms and contraceptives available. The report also called for routine STD screening for sexually active youths.

To prevent STDs in young people, experts say, more sex education has to occur in doctors’ offices, family planning clinics, health centers, schools and homes.

“We educate our young children early not to get in a car with a stranger. I don’t see how we cannot educate our kids in regard to sexual decision-making,” Hofmann says. “Sure, it would be a lot easier if kids weren’t sexually active, but that ain’t the fact. If we are going to have a permissive society, we have to equip our kids for it. We can’t just say, ‘Just say no.’ ”

The Teen Factor

About 55% of U.S. adolescents are sexually active. Members of this group have higher rates of sexually transmitted disease than any other age group, according to health experts.

Here are the percentages of sexually active teen-agers infected with:

Men Women Gonorrhea 6% 10% Chiamydia 10% 22% Trichomoniasis* - 21% Human papilloma virus 15% 39%

* Does not usually appear in men

Note: These averages represent ranges of infection as reported by several studies.

Terms to Know

Gonorrhea and syphilis have been around for ages, but several other sexually transmitted diseases have been identified only in the past two decades.

Chlamydia: Bacterial. Often produces no symptoms in women. Men may experience discharge and burning sensation. Curable.

Genital Herpes: Viral. Symptoms are often mild but can include itching or burning sensation and pain in legs or genital area. Blisters or painful sores may appear and recur any time. Incurable, but a drug is available to reduce symptoms.

Gonorrhea: Bacterial. Symptoms often absent but can include discharge, burning sensation and itching. Curable.

Hepatitis B: Viral. No symptoms present in one-third of all cases but can cause fever, headache, muscle ache, vomiting and diarrhea. Infections often clear up themselves, but some people become chronically infected. A vaccine is available to prevent infection.

HIV: Viral. Often asymptomatic for many years. Later symptoms include immune system deterioration. Symptoms can be treated but infection is otherwise incurable.

Human Papilloma Virus: Viral. Produces painless fleshy warts. Warts can be removed but infection often reappears.

Syphilis: Bacterial. Produces painless sores in early stages. Curable.

Trichomoniasis: Parasitic infection. Women may have vaginal discharge and odor. Curable.

Sources: Dr. Adele D. Hofmann; U.S. Office of Technology Assessment, “Adolescent Health, Vol. II”; the Alan Guttmacher Institute.