The Centers for Disease Control and Prevention (CDC) estimates that there
are approximately 19 million new STD infections each year—almost half of them
among young people ages 15 to 24. The cost of STDs to the U.S. health care
system is estimated to be as much as $15.9 billion annually. Because many cases
of STDs go undiagnosed—and some common viral infections, such as human
papillomavirus (HPV) and genital herpes, are not reported to CDC at all—the
reported cases of chlamydia, gonorrhea, and syphilis represent only a fraction
of the true burden of STDs in the United States.
Untreated STDs can lead to serious long-term health consequences, especially
for adolescent girls and young women. CDC estimates that undiagnosed and
untreated STDs cause at least 24,000 women in the United States each year to
become infertile.
Understanding Sexually Transmitted Diseases
Several factors contribute to the spread of STDs.Biological Factors
STDs are acquired during unprotected sex with an infected partner.Biological
factors that affect the spread of STDs include:
- Asymptomatic nature of STDs. The majority of STDs either do not produce any
symptoms or signs, or they produce symptoms so mild that they are
unnoticed; consequently, many infected persons do not know that they need
medical care. - Gender disparities. Women suffer more frequent and more serious STD
complications than men do. Among the most serious STD complications are
pelvic inflammatory disease, ectopic pregnancy (pregnancy outside of the
uterus), infertility, and chronic pelvic pain. - Age disparities. Compared to older adults, sexually active
adolescents ages 15 to 19 and young adults ages 20 to 24 are at higher
risk for getting STDs. - Lag time between infection and
complications. Often, a long
interval, sometimes years, occurs between acquiring an STD and recognizing
a clinically significant health problem.
Social, Economic, and Behavioral Factors
The spread of STDs is directly affected by social, economic, and behavioralfactors. Such factors may cause serious obstacles to STD prevention due to
their influence on social and sexual networks, access to and provision of care,
willingness to seek care, and social norms regarding sex and sexuality. Among
certain vulnerable populations, historical experience with segregation and
discrimination exacerbates the influence of these factors.
Social, economic, and behavioral factors that affect the spread of STDs
include:
- Racial and ethnic disparities. Certain racial and ethnic groups (mainly African
American, Hispanic, and American Indian/Alaska Native populations) have
high rates of STDs, compared with rates for whites. Race and ethnicity in
the United States are correlated with other determinants of health status,
such as poverty, limited access to health care, fewer attempts to get
medical treatment, and living in communities with high rates of STDs. - Poverty and marginalization. STDs disproportionately affect disenfranchised
people and people in social networks where high-risk sexual behavior is
common, and either access to care or health-seeking behavior is
compromised. - Access to health care. Access to high-quality health care is essential
for early detection, treatment, and behavior-change counseling for STDs.
Groups with the highest rates of STDs are often the same groups for whom
access to or use of health services is most limited. - Substance abuse. Many studies document the association of
substance abuse with STDs. The introduction of new illicit substances into
communities often can alter sexual behavior drastically in high-risk
sexual networks, leading to the epidemic spread of STDs. - Sexuality and secrecy. Perhaps the most important social factors
contributing to the spread of STDs in the United States are the stigma associated
with STDs and the general discomfort of discussing intimate aspects of
life, especially those related to sex. These social factors separate the
United States from industrialized countries with low rates of STDs. - Sexual networks. Sexual networks refer to groups of people who
can be considered “linked” by sequential or concurrent sexual partners. A
person may have only 1 sex partner, but if that partner is a member of a
risky sexual network, then the person is at higher risk for STDs than a
similar individual from a nonrisky network.
Emerging Issues in Sexually Transmitted Diseases
There are several emerging issues in STD prevention:- Each State needs to address system-level barriers
to the implementation of expedited partner therapy for the treatment of
chlamydia and gonorrheal infections. - Enhanced data collection on demographic and
behavioral variables, such as the sex of an infected person’s sex
partner(s), is essential to understanding the epidemiology of STDs and to
guiding prevention efforts. - Innovative communication strategies are critical
for addressing issues of disparities, facilitating HPV vaccine uptake, and
normalizing perceptions of sexual health and STD prevention, particularly
as they help reduce health disparities. - It is necessary to coordinate STD prevention
efforts with the health care delivery system to leverage new developments
provided by health reform legislation.
References
1United Nations. Report of the International Conference on Population andDevelopment, Cairo, Egypt, September 5–13, 1994. New York: United Nations;
1995.
2St. Louis ME, Wasserheit JN, Gayle HD, editors. Janus considers the HIV
pandemic: Harnessing recent advances to enhance AIDS prevention. Am J Public
Health. 1997;87:10-12.
3Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among
American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod
Health. 2004 Jan–Feb;36(1):6-10.
4Chesson HW, Blandford JM, Gift TL, et al. The estimated direct medical cost
of sexually transmitted diseases among American youth, 2000. Perspect Sex
Reprod Health. 2004 Jan–Feb;36(1):11-9. [Review].
5Centers for Disease Control and Prevention. Unpublished estimate.
6Institute of Medicine. The hidden epidemic: Confronting sexually
transmitted diseases. Eng TR, Butler, WT, editors. Washington: National
Academies Press; 1997.
7Chandra A, Stephen EH. Impaired fecundity in the United States: 1982–1995.
Fam Plann Perspect. 1998 Jan–Feb;30(1):34-42.
8Centers for Disease Control and Prevention (CDC). Sexually transmitted
disease surveillance, 2008. Atlanta: CDC; 2009 Nov.
9Krieger N, Waterman PD, Chen JT, et al. Monitoring socioeconomic
inequalities in sexually transmitted infections, tuberculosis and violence:
Geocoding and choice of area-based socioeconomic measures. Public Health Rep.
2003 May–Jun;118(3):240-60.
10Geisler WM, Chyu L, Kusunoki Y, et al. Health insurance coverage,
health-care-seeking behaviors, and genital chlamydia infection prevalence in
sexually active young adults. Sex Transm Dis. 2006 Jun;33(6):389-96.
11Institute of Medicine. Unequal treatment: Confronting racial and ethnic
disparities in health care. Washington: National Academies Press; 2002.
12Beltrami J, Wright-DeAguero L, Fullilove M, et al. Substance abuse and the
spread of sexually transmitted diseases. [Commissioned paper for the IOM
Committee on Prevention and Control of STDs]. Washington: Institute of
Medicine; 1997.
13Marx R, Aral SO, Rolfs RT, et al. Crack, sex, and STDs. Sex Transm Dis.
1991 Apr–Jun;18(2):92-101. [Review].
14Brandt, A. No magic bullet: A social history of venereal disease in the
United States since 1880. New York: Oxford University Press; 1985.
