A Prescription for Sexually Transmitted Diseases

By Donovan, Patricia | Issues in Science and Technology, Summer 1993 | Go to article overview

A Prescription for Sexually Transmitted Diseases


Donovan, Patricia, Issues in Science and Technology


Sexually transmitted diseases (STDs) pose a growing threat to America's public health. Twelve million new cases occur each year; in addition, an estimated 56 million Americans are infected with incurable viral STDs other than AIDS. At current rates, at least one in four Americans will contract an STD at some point in his or her life.

The country's STD rates are among the highest in the industrialized world. In most industrialized countries, syphilis and gonorrhea have virtually disappeared. In the United States, however, infectious syphilis is at its highest level in 40 years. The incidence of other STDs has increased even more dramatically: Chlamydia, which was relatively unknown a decade ago, has become the nation's most common STD, with 4 million new cases per year. Doctor visits for treatment of genital herpes and genital warts have also risen sharply since the mid-1960s.

Some of the most common STDs are not curable: Herpes, human papilloma virus (HPV), which causes genital warts, and hepatitis B are, like AIDS, caused by viruses and can result in chronic infection. Bacterial infections, which include syphilis, gonorrhea, chlamydia, and trichomoniasis, can be cured once they are detected; the problem is that all too often they go undetected until serious symptoms develop. Thus, bacterial as well as viral STDs can have serious, even life-threatening complications, including infertility, ectopic pregnancy, several types of cancer, liver disease, and recurrent or chronic pain. Some can also significantly increase an individual's risk of becoming infected with HIV if he or she is exposed to the virus.

In addition to taking a toll in human suffering, STDs cost society more than $5 billion per year in direct and indirect expenses. Clearly, prevention of STDs, early diagnosis, and treatment are major public health imperatives.

Yet the federal program designed to combat the spread of STDs does not adequately address many of these needs. The program targets resources to historically prevalent STDs, when other infections have become far more common. It focuses on treating infected individuals and notifying their sexual partners, rather than helping people avoid infection in the first place. It allocates resources in a way that fails to reach many women, who are far more likely than men to suffer serious problems if an STD is not diagnosed and treated early. Finally, the program lacks sufficient funding to effectively combat the current array of serious infections.

In light of the dramatically expanded spectrum of STDs in recent years, Congress and the STD program's administrator, the Centers for Disease Control (CDC), should reassess strategies, priorities, and funding, with a view toward making the program more effective in addressing today's problems.

Widespread risk

Until the early 1980s, the roster of recognized STDs included only five infections: syphilis, gonorrhea, chancroid, lymphogranuloma venereum, and granuloma inguinale. Today, more than 50 organisms and syndromes are known to be transmitted sexually, and some STDs have become extremely common. Whereas certain diseases, especially syphilis and gonorrhea, are particularly widespread among low-income racial and ethnic minority populations, other infections, including chlamydia, HPV, and genital herpes, are diffused throughout the population. The assumption that STDs are confined to prostitutes, immigrants, the urban poor, and--with the advent of AIDS--drug addicts and homosexuals, is simply wrong.

Studies have found, for example, that up to 5 percent of middle-class pregnant women and 8 percent of female college students are infected with chlamydia. Several small studies of female college students seeking routine gynecological services indicate that anywhere from 17 percent to 46 percent have HPV. Many of these young women are infected with a strain of the virus strongly associated with cervical cancer and other genital cancers. …

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