Adolescent pregnancy rates are increasing in Peru. Although the Ministry of Health collects data about adolescent pregnancies, little is known about the knowledge and practices of youth in rural areas to inform design of educational interventions. In 2014, 315 students in two secondary schools in the city of Chota, Cajamarca Peru completed a cross-sectional self-administered anonymous survey related to reproductive health knowledge, attitudes and practices. Of these students, approximately 25% report having already initiated sexual activity, with much higher rates among boys than girls, and in specific schools. Bivariate statistics revealed that teachers are the most frequently cited source of sexual health information, and regression models showed that students who speak to teachers have significantly higher knowledge in reproductive health but report little difference in sexual behavior. Results provide evidence for a comprehensive approach to sexual health for adolescents in Chota, taking into account the low knowledge levels and the reality that some adolescents are already engaging in potentially risky sexual behavior.