Magazine article Drug Topics

Chlamydia: The Silent STD

Magazine article Drug Topics

Chlamydia: The Silent STD

Article excerpt

According to the Centers for Disease Control & Prevention (CDC), an estimated 333 million new cases of curable sexually transmitted diseases (STDs) occur throughout the world each year among adults. While much progress has been made in STD prevention, the United States still has the highest incidence of STDs in the industrialized world. It is easily 50 to 100 times higher, although the occurrence of gonorrhea and syphilis has recently been brought to historic lows.

The CDC reports that STDs now account for more than 85% of the most common infectious diseases in this country. In addition, there are an estimated 15 million new cases of STDs in the United States annually, approximately two-thirds of which occur in persons under 25 years of age (Table 1).

STDs affect men and women of all backgrounds and economic levels, with the highest prevalence among teens and young adults. Some contributing factors in the overall rise of STDs include societal changes-young people becoming sexually active earlier, divorce being more common, and the sexually active being more likely to have multiple partners. STDs disproportionately affect women, minorities, infants, and the young. In women, STDs can lead to pelvic inflammatory disease (PID), infertility, potentially fatal ectopic pregnancies, and cancer of the reproductive tract. STDs can also result in irreparable lifetime damage for infants infected by their mothers during gestation or birth. Such exposure can result in blindness, bone deformities, mental retardation, and even death. Early detection and treatment can be hindered, since many STDs initially show few or no symptoms, especially in women. When symptoms do develop, they may be confused with those of other diseases that are not transmitted through sexual contact. Since STDs can still be transmitted by an asymptomatic carrier, an infected individual can unknowingly become an STD "Typhoid Mary" Other factors that contribute to the uncontrolled spread of STDs include a lack of widespread routine STD screening programs, the social stigma associated with these diseases, and a lack of public awareness concerning STDs. Unfortunately, most STDs remain undiagnosed.

Only three STDs have been classified as nationally reportable diseases: gonorrhea, syphilis, and chlamydia. Health-care providers are required to report each diagnosed case to state health departments and the CDC. There are no national reporting requirements for any of the other five major STDs: genital herpes, human papillomavirus (HPV), hepatitis B, HIV, and trichomoniasis.

The major STDs can be divided into two groups-- those that are bacterial in origin and those that are viral in origin (Table 2). Treatment of bacterial STDs most often results in a cure, with the course of therapy limited and relatively inexpensive. Unfortunately, viral STDs are incurable and often require extended treatment. The greatest costs associated with STDs are those resulting from complications of untreated chlamydia and gonorrhea, those resulting from treatment of precancerous cervical lesions in HPV infection, and treatment of HIV/AIDS (Table 2).

In a 1998 Kaiser Family Foundation/Glamour magazine survey, it was shown that most men and women of reproductive age (18 to 44 years old) seriously underestimate how common STDs are as well as their personal risk for getting an STD. While an estimated one in four Americans will get an STD in their lifetime, the majority of men (74%) and women (69%) fl-think the rate is one in 10 Americans or fewer. Only 14% of men and 8% of women said they think they are at risk for STDs. Twothirds of single men and women said they do not "always" use condoms. In addition, only one in five teens said they think they are at risk of getting a STD. In a 1995 Gallup Organization poll, over half of adults and over one-third of teens said their health-care providers spend "no time at all" discussing STDs with them. The estimated incidence and costs associated with STDs indicates the great need for general public educational awareness on the topic of sexual health. …

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