Knowledge Is Power
With STDs, Information Is Often the Key to Prevention
By DR. PATRICIA BAILEY-SARNELLI
Or that a new Centers for Disease Control and Prevention (CDC) analysis released in March — which included eight common STDs: chlamydia, gonorrhea, hepatitis B virus (HBV), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV), human papilloma virus (HPV), syphilis, and trichomoniasis — noted that about half of all new infections each year occur among young people ages 15 to 24?
Those numbers, especially among our youth, highlight the critical need for prevention. I see many adolescent girls in my practice, and a part of the problem has to do with their normal adolescent psychological development.
Adolescents go through a phase of magical thinking where they have a sense of invulnerability, that nothing can hurt them. For that reason, they tend to be less consistent about condom use, and that puts them at greater risk. The other part of the problem is their lack of knowledge and general understanding of the risks of STDs. In one study, for example, 25% of urban adolescent females developed an STI (sexually transmitted infection) within one year of first intercourse.
While the terms STD and STI are often used interchangeably, there is a difference, and STI is now being used more often in the public-health sector. The difference can be found in the terminology used to refer to an infection versus disease. You can have an infection spread through sexual contact that may or may not lead to symptoms and a future medical problem, but when it does, the result is a disease. In other words, STDs are preceded by STIs, but not all STIs result in the development of an STD. There is also a belief among some that referring to an infection, rather than a disease, has less of a stigma attached to it and is therefore less embarrassing to talk about.
Also, the CDC cites stigma, inconsistent or incorrect condom use, limited access to healthcare, and a combination of other factors as contributing to higher rates of STDs among teens and young adults.
Despite the challenges remaining, parents and schools are doing a better job about informing young people about sex and its consequences, including discussions about abstinence, reducing their number of sexual partners, and how to correctly use a condom.
The girls that I am seeing now are somewhat better-informed, and most talk about learning about sex in their health class at school. It’s also very important for parents to have a frank discussion with their children about sex and its risks. Literature shows that the results cut across all socioeconomic and racial boundaries, that kids whose parents have spoken with them about sex tend to make better decisions.
When it comes to talking to my young patients about STDs, I tell them that we are all sexual beings, and that the most important part of that is being a responsible sexual being — responsible to themselves, their partners, their family, and their community — and part of that includes using protection against sexually transmitted diseases.
The concern among clinicians is that, while most of these infections are treatable — many are curable — some can result in serious health consequences if left undiagnosed and not treated early. Also, the CDC’s March analysis noted that, while the consequences of untreated STDs are often worse for young women, the annual number of new infections is about the same between women and men.
According to the CDC, four of the STDs included in the analysis are easily treated and cured if diagnosed early: chlamydia, gonorrhea, syphilis, and trichomoniasis.
Because they often have no symptoms, many of these infections go undetected. However, even STDs with no symptoms can seriously affect one’s health. Undiagnosed and untreated chlamydia or gonorrhea can put a woman at increased risk of chronic pelvic pain and life-threatening ectopic pregnancy, and can also increase a woman’s chance of infertility.
But while gonorrhea and chlamydia can be treated with antibiotics and cured, other STDs are lifelong, affecting both the physical and social health of an individual.
HSV-2, HBV, and HIV are lifelong infections that together account for nearly one-quarter of all prevalent infections. HSV-2 can lead to painful chronic infection, miscarriage or premature birth, and fatal infections in newborns. HBV can lead to cirrhosis, a life-threatening liver disease. And HIV damages a person’s immune system over time, increasing an infected person’s susceptibility to a number of diseases. Additionally, nearly 18,000 people in the U.S. die of AIDS each year.
Herpes, which will affect you for the rest of your life, is a very individual disease process. Some will experience a single outbreak, then may go for years without another. Others will have an outbreak every month. As for the psychological and social repercussions, those with herpes must make the responsible decision to tell a new partner and face the consequences of how they will react to the news. This can have enormous consequences and seriously affect one’s ability to connect with others throughout their life.
Also, when you think about sexually transmitted diseases, most people don’t always think of human papillomavirus (HPV), which can cause cervical cancer. HPV, for which there is no treatment, is the second-leading cause of cancer deaths among women worldwide. The virus accounts for the majority of prevalent STDs in the U.S. today, and more than half of sexually active men and women will become infected at some time in their lives.
While there is no cure for HPV infection, there is a vaccine that parents can have administered to their sons and daughters to protect them from certain HPV-related diseases. In fact, the CDC recommends routine vaccinations with Gardasil for boys and girls ages 11 or 12. Gardasil is given as three injections over a six-month period.
Based on information from the gardasil.com website, the vaccine helps protect against four types of HPV. In girls and young women ages 9 to 26, Gardasil helps protect against two types of HPV that cause about 75% of cervical cancer cases, and two more types that cause about 90% of genital warts cases. In boys and young men ages 9 to 26, Gardasil helps protect against approximately 90% of genital warts cases. Gardasil also helps protect girls and young women ages 9 to 26 against approximately 70% of vaginal cancer cases and up to 50% of vulvar cancer cases.
As importantly noted on the website, “Gardasil may not fully protect everyone, nor will it protect against diseases caused by other HPV types or against diseases not caused by HPV. Gardasil does not prevent all types of cervical cancer, so it’s important for women to continue routine cervical cancer screenings.”
In addition to the severe human burden STDs place on individuals, STDs also cost an already-stressed American healthcare system nearly $16 billion in direct medical costs alone, according to CDC figures.
Baystate Medical Center’s two community health clinics — Baystate Brightwood Health Center and Baystate Mason Square Neighborhood Health Center — offer both free testing and treatment of sexually transmitted diseases. STD testing is available Monday through Friday from 8 a.m. to 4 p.m., including rapid HIV testing, as well as testing for gonorrhea, chlamydia, syphilis, and hepatitis C. Nurse practitioner Rebecca Reed also provides exams and treatment at Brightwood Health Center on Tuesday and Mason Square Neighborhood Health Center on Wednesday from 8 a.m. to 4:30 p.m. She is also at Brightwood on Friday from 8 a.m. to noon and at Mason Square from 1 to 4:30 p.m.
Dr. Patricia Bailey-Sarnelli is director of Pediatric and Adolescent Gynecologic Services at Baystate Medical Center.