Over the past few years, there has been a surge in sexually transmitted infection (STI) incidence that has predominantly affected adolescents aged 15 to 24 years. The CDC estimates that over half of all new sexually transmitted infections occur in this young age group, with research suggesting that one in every four sexually active girls between the ages of 14 and 19 is living with an STI. According to the AAP, schools hold a strategic position in mitigating the risk of STIs among teenagers by offering comprehensive sexual health education, access to sexual health services, and fostering safe, supportive environments. In this critical mission, school nurses stand at the forefront.

The CDC defines sexually transmitted infections (STIs) as "a virus, bacteria, fungus, or parasite that has infected a person's body via sexual contact, whereas the term sexually transmitted disease (STD) refers to a recognizable disease state that has developed from an STI." The most prevalent pathogens responsible for STIs in adolescents include human papillomavirus (HPV), chlamydia, gonorrhea, herpes simplex virus (HSV), and trichomoniasis. When not identified early and treated appropriately, STIs have the potential to bring about severe health repercussions. Conditions such as pelvic inflammatory disease (PID), chronic abdominal pain, infertility issues, ectopic pregnancies, miscarriages, infant mortality, and congenital disabilities are significant risks that underscore the gravity of untreated STIs. Specific STIs, including chlamydia, gonorrhea, and syphilis, notably heighten the risk of acquiring HIV, presenting a complex interplay between different infections that magnify health vulnerabilities - in 2020, 20% of new HIV cases were in young people aged 13-24.

Elevated instances of sexually transmitted infections (STIs) among young people are primarily attributed to a few key factors:

• There is a general shortfall in the understanding of these conditions.
• Engagement in behaviors that heighten risks.
• The significant obstacle of not having sufficient entry points to programs and services dedicated to sexual health.

An effective school health education program, when enriched with a comprehensive sexual health curriculum, focuses on equipping students with essential knowledge and practical skills to nurture positive health behaviors and sidestep potential risks. Central to this approach is the explicit inclusion and emphasis on skill-building within sexual health education. Years of research have consistently shown that comprehensive sex education not only plays a vital role in lowering the incidence of STIs but also in equipping young people with a broad spectrum of understanding and competencies that foster social-emotional growth, improve communication abilities, and encourage the formation of positive relationships.

In the U.S., school-based sex education content demonstrates considerable diversity, with markedly differing curricular components established at the state level, directly impacting the resources and information available to schools and school nurses for student guidance. Get more information on your state's policies around sex education - including requirements for instruction time, instructor credentials and professional development, parental involvement, specific topics to cover, and more - HERE. Additionally, NASN has a Sexual Health Toolkit available for school nurses seeking resources to help reduce rates of STIs in adolescents and foster supportive school environments.

In 2023, the U.S. Department of Health and Human Services released a groundbreaking STI Federal Implementation Plan "to reduce the burden and attempt to reverse the dramatic rise of STIs in the United States." In it, they stress the importance of "a non-stigmatizing, comprehensive approach to sexual health education and sexual wellbeing, especially in adolescents and young adults, that promotes healthy sexual development and relationships and includes both risk-avoidance and risk-reduction messaging at the community level in schools…".

Despite school nurses' crucial role in delivering health education, their insights and contributions often remain underutilized, leaving their valuable perspectives out of essential policy dialogues. As pivotal links between health and education policies, and considering their commitment to student welfare and frontline advocacy, the involvement of school nurses in shaping and implementing sexual health education policies is essential for ensuring their effectiveness in schools.