STD’S: America’s Hidden Epidemic

STDs have always been a taboo subject. As a result, the prevalence of STDs among Americans is much more pervasive than many of us think. In fact, the U.S. rate of STD infections, 117 per 100,000 people, is six times the goal rate of the U.S. Department of Health and Human Services (“Quicker Treatments Fight STD Spread,” 2005. 2). This is problematic in a number of ways. First, due to lack of education on the subject, sexually active people don’t prioritize safe sex as much as they should.

Secondly, those who contract an STD may not know they have it for quite some time; symptoms can emerge after years, when the person may have transmitted the disease to others.

The consequences of living with an untreated or incurable STD can be very serious and include chronic pelvic pain, life-threatening pregnancy situations, infertility and even death. Underscoring just how widespread and serious the problem is, one source provided these statistics: One American in four will acquire an STD in the course of a lifetime.

One in five has genital herpes, but 90 percent of those infected are not aware of it. More than 15 million people become infected every year, including about a third with human papilloma virus (HPV), the most common STD.

Two thirds of those who get STDs are under 25, and the majority are women. At least 15 percent of female infertility problems stem from tubal damage caused by pelvic inflammatory disease (PID), the result of an untreated STD (Lippman, 2001, 5).

SIGNIFICANCE OF PROBLEM

Some researchers call the spread of STDs across civilized nations a “hidden epidemic,” simply because many people are not aware of the serious consequences of the diseases.

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STDs should concern Americans because STDs can cause such serious consequences as cervical cancer, infertility, infection of offspring, and death. Most people are unaware that: An estimated 100,000 to 150,000 women become infertile each year as a result of an STD; Half of the 88,000 ectopic pregnancies that occur each year are due to a preexisting STD infection; 4,500 American women die each year from cervical cancer, which is almost always caused by an STD called the human papilloma virus (HPV) (Hsu, 1998, 56).

Perhaps if more people were aware of these real life threatening consequences, they would be more likely to take preventative actions to avoid or reduce risk. Even those who may know, especially naïve young adults, who may take the “It will never happen to me,” approach to the subject, should be continually reminded.The problem is compounded by the fact that some STDs don’t show symptoms right away so carriers aren’t aware that they have the disease. Seventy-five percent of women with chlamydia don’t have any symptoms. They don’t know until 5 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 (Hsu, 1998, 56).

If this disease, and other non-virals like gonorrhea, syphilis and trichomoniasis, were caught at the beginning stages, they would be cured without risk of further transmission. But even if patients do receive treatment, they may return two months later with a similar infection, since their partners fail to receive treatment. At one hospital, the treated member comes back reinfected two months later 40% of the time (“Meet ‘Joe Partner’,” 2001, 3).

It can turn into a vicious cycle if all parties are not treated right away.More problematic, however, are those STDs that are viral infections and do not have a cure. These include HPV, genital herpes, sexually transmitted hepatitis B, and the human immunodeficiency virus, or HIV, which is responsible for 90,000 cases of AIDS annually, a figure that was dramatically expanded in 1993 over previous years due to an official redefinition of AIDS (Hsu, 1998, 56).

Instead of a cure, people who contract these diseases are subject to years of medical treatment in the form of costly and inconvenient exams, as well as life long medication to stifle the symptoms of the disease. Unfortunately, not everyone can afford this treatment and some even continue to have unprotected sex, spreading the disease to others.Those who don’t receive the education about these issues in school may never receive it unless they are confronted with symptoms.

One case summarizes the ignorance of some (otherwise educated) adults about the subject: Highlighting the widespread ignorance about these disease, Kathleen Toomey, director of the division of public health, Georgia Department of Human Resources-and one of the panelists at the conference session-recalled: “When I testified before the Georgia General Assembly about the scope and impact of sexually transmitted diseases, several legislators thought chlamydia was a flower being proposed to represent the state (Lippman, 2001, 3).”

Perhaps these people may be more likely to learn about STDs if the problem were placed in the context of monetary loss. For instance, new data shows that a treatable STD like bacterial vaginosis can lead to premature delivery and infant mortality and exorbitant costs. A single complicated delivery and newborn requiring intensive care can run up a tab of anywhere from $20,000 to more than $1 million (Lippman, 2001, 8).

Those with lower incomes or no medical insurance may be less likely to seek treatment; once they do, the cost may be much more than they can pay. They will be unable to pay their bills, forcing the cost on healthcare providers and tax payers. They may also be forced to take time off of work for illness and to go to the doctor, which places low productivity costs on the employer.

SOCIAL IMPLICATIONS

In today’s society, there is an embarrassing stigma associated with having an STD. The person may be perceived as one who sleeps around or has unclean hygienic habits. This stigma leads to shame, an intense negative emotion that results from a person experiencing failure in relation to personal or other people’s standards, feeling responsible for that failure, and believing that the failure reflects an inadequate self (Cunningham, 2002, 1).

If a person with an STD experiences the combination of stigma and shame, he or she may be less likely to disclose sexual behaviors when seeking treatment. Stigma as a barrier to communication with clinicians could potentially pose an important barrier to care (Cunningham, 2002, 1).Women, in particular, are subject to the obstacles of stigmatization. If it is true that sexual behavior of women is subject to greater social controls, and if women are seen to have more responsibility for sexual activity and its consequences, social attribution theory suggests that women would perceive more stigma associated with STDs. There is also evidence that females may be more likely than males to develop a shame prone affective style (Cunningham, 2002, 4).

This is problematic because studies show that women, specifically adolescent females, may be at a higher risk of STDs than males. This is for a number of reasons: Young women are typically in relationships with partners two or more years older than themselves and older partners are more likely to be infected than partners who are their own age. Age and power differences may lesson a young woman’s ability to initiate or insist on condom use – studies show that female adolescents are less likely than males of the same age to report condom use (Panchaud, 2000, 4).

Another troubling perception is that young people are the only ones at risk. With large numbers of people divorcing and re-entering the dating scene, “The risk of infection among older folks is higher than most people want to admit,” according to Linda Alexander, president and CEO of the American Social Health Association. ASHA’s hotlines get calls from 40-year-olds getting herpes and 30-year-olds becoming infected with HIV, she said (Lippman, 2001, 5). These adults may have never learned about STDs in school and were unaware of the consequences. Additionally, there is more shame involved with the admission of a disease since society may perceive the action of unprotected sex as irresponsible, especially for an adult.

SOCIETAL RESPONSES

Given the serious consequences, why aren’t we taught about the consequences of STDs from the time we become sexually active? In some cases, STDs carry the same weight as an average urban legend, with symptoms perceived as “rumors” rather than facts. This is the fault of the American government and the school systems, who have yet to develop and enforce a consistent STD education plan within classrooms. Teachers remained relatively close mouthed about the subject for fear of offending students’ parents, who may be offended by the course material.

Depending on their value systems, some families believe the subject to be private, not for public discussion. Others fear that open discussion will lead to promiscuity and worsen the problem.America’s two political groups sit on different sides of the fence when it comes to STD education in schools. To many conservatives, America’s STD epidemic is really a problem of promiscuity, a symptom of society’s moral decline, which began with the 1960s sexual revolution (Hsu, 1998, 56).

This group strives to reinstate traditional perspectives, such as abstinence before marriage, in order to reduce the chance of STDs. Generally, this push to abstinence is led by a drive for higher moral values and good character traits, rather than using education. Conservatives believe that young people will behave at the level of greatest expectation and if your expectation of young people is that they will engage in sexual activity, you aren’t teaching them appropriate restraints (Hsu, 1998, 56).

Thus, a typical discussion about sexual activity would lean more toward the positive rewards for good moral behavior than the negative consequences for sexual behavior.This easily offendable audience has helped muddy the waters to the point that many women at healthcare facilities aren’t even aware that they’re being tested for STDs. The tests must be phrased in “politically palatable terms.” Thus, chlamydia screening is coined infertility prevention. A Pap smear is called a test for cervical cancer, and few women realize they’re actually tested for HPV. The same is true for the Hepatitis B vaccine. Two thirds of new cases are transmitted sexually, but since some would be offended that Hepatitis B is an STD, so physicians talk to them about liver cancer instead (Lippman, 2001, 3).

The inability of doctors to talk with their patients about STDs only reinforces the existing stigma that STDs are unacceptable for people who have “good morals.”The fact of the matter is that promiscuity does exist throughout all ages, classes and races. Those who choose to be sexually active outside of marriage have a right to know the risks involved. Instead, our conservative government, the Bush administration, has been increasing grants to the states for abstinence-only sex education in public schools, crowding out funds for more comprehensive programs that include abstinence along with discussions of contraception (Apuzzo, 2005, 3).

They take this approach even though data shows that the most popular abstinence programs do not work.Teens who pledge to remain virgins until marriage are more likely to take chances with other kinds of sex that increase the risk of sexually transmitted diseases, a study of 12,000 adolescents suggests. Last year, the same research team found that 88 percent of teens who pledge abstinence end up having sex before marriage, compared with 99 percent of teens who do not make a pledge.  (Apuzzo, 2005, 3).

On the other side of the coin, many liberals believe that the expectations for abstinence are too high and that preventing promiscuity is an unrealistic, undesirable goal. Instead, they envision a culture where people are open and comfortable with their sexuality so each person would be able to negotiate with his sexual partner about what he wants or doesn’t want from sex. Preventing promiscuity, therefore, is not the goal; preventing unprotected intercourse is (Hsu, 1998, 56).

This strategy is focused on education and providing factual sex education that emphasizes the importance of using a condom. Groups like Planned Parenthood are especially consistent with this message. They sum it up in this way, “Talk with your partners before the heat of passion, and use a condom every time (Hsu, 1998, 56)” In schools, however, this direct discussion may be watered down, if not avoided at all, due to the fact that the conservative groups think that talking explicitly about sexuality piques curiosity and increases the likelihood of sexual experimentation.

TREATMENT

Due to the fact that STDs can be, and have been, spreading at a frightening rate, new treatments are being developed to help slow the epidemic. One recent study claimed that, if antibiotics were given to the partners of people with STDs, the treatment process would be faster and more effective, reducing the chance for new cases. The study of 1,800 women and heterosexual men at the University of Washington Seattle found faster antibiotic treatment of the partners of people diagnosed with STDs reduced re-infections for gonorrhea by 68 percent and Chlamydia by 18 percent (UPI NewsTrack, 2005, 1).

This study recommended that the partners who receive the medication should be allowed to do so without first seeing a doctor, which reflects convenience and a respect for privacy. Thus far, it is only allowed in just two states – California and Tennessee (“Quicker Treatments Fight STD Spread,” 2005, 1). California has been experimenting with this approach for about 5 years, when the California Senate Bill 648, dubbed the “Ortiz Bill” after its sponsor, Sen. Deborah Ortiz of Sacramento, was enacted. This bill authorizes providers who diagnose chlamydia in a patient to prescribe or provide prescription antibiotic drugs to that patient’s sex partner or partners without prior examination (“Meet ‘Joe Partner’,” 2001, 2).

This is a brave step that was controversial and, in some ways, problematic. Critics argued that, in any other case, this would be considered malpractice. Additionally, the extra prescriptions were difficult to track and that women were often hesitant to identify their partners. The proponents for the plan offered a solution by the name of “Joe Partner.” Providers can write two prescriptions, one for the patient and one for the unseen partner with the name “Partner Rx” on the prescription form. By being able to see the number of “Joe Partner” prescriptions, the plan will have a clearer picture of partner treatment (“Meet ‘Joe Partner’,” 2001, 4).

The program is promoted through managed care settings to doctors who would screen for chlamydia.While the above noted strategy is one of the more bold progressions in STD treatment programs, there have been other advances that are significant. The healthcare industry has begun to recognize that the social stigma and lack of information on the subject presents problems that need creative solutions. Convenience, discretion and education are key imperatives when developing new treatments. This realization has led to the development of single-dose treatment protocols for diseases such as chlamydia and gonorrhea and easier treatments for genital warts. Improved testing methods have made widespread STD screening more practical (STD treatment guidelines: questions and answers, 1998, 1).

The 1990’s was an important decade for the improvement of STD testing, prevention and treatment programs. Some late decade developments included:Improved treatments for herpes and human papilloma (HPV) that makes it easier to administer therapy when symptoms reduce the emotional stress associated with viral STDs and possibly reduce transmissions. The introduction of a simple urine test that makes it easier to diagnose and treat chlamydia in clinical and nonclinical settings; A hepatitis A and hepatitis B vaccination for sexually active youth; Improved treatments of STDs in pregnancy that produce fewer side effects and reduce the number of infants born prematurely (STD treatment guidelines: questions and answers, 1998, 1).

These new therapies may significantly increase the number of people who can receive treatment fast enough to be cured and reduce the chance of transmitting it to others. They are more feasible and less uncomfortable than awkward methods of the past that required multiple visits to the doctor and unpleasant testing procedures.

CONCLUSIONE

ducation must first begin with the adolescent audience. We must stop sugarcoating reality by dropping euphemistic, compromised messages. Data proves that young adults, even the majority of those who promise abstinence before marriage, are having sexual relations that put them at risk for STDs. STDs have serious consequences and therefore, the topic deserves an open discussion regarding the significant health consequences and prevention options. These comprehensive discussions should occur in a school or health care setting, with public service marketing reinforcing the message.These public service messages will also hit home with an adult population who may be unaware of the consequences of STDs as well. This message should be underscored in health care facilities.

Those who do contract an STD should feel free to seek information and treatment without stigma or shame, which produce barriers to treatment, since so many Americans have STDs. Patients should be educated about the treatments that should be made as convenient and inexpensive as possible to effectively serve the population as a whole. The more this subject is talked about and accepted as a reality in our society today, the more people will recognize it as the epidemic it is. As a result, we can significantly slow the spread of STDs and save thousands of people from symptoms that range from discomfort and embarrassment to severe, lifelong health problems.