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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 behavioral
factors. 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

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