April is STD Awareness Month
Dr. Katharine O. White, above, is chief of general obstetrics and gynecology at Baystate Medical Center.
ÂWhen you think about sexually transmitted diseases, most people don’t always think about human papillomavirus, which can cause cervical cancer. I can’t think of any better way to observe STD Awareness Month than for parents to consider getting their child the Gardasil vaccine to prevent them against the human papillomavirus,” said Dr. Katharine O. White, chief of general obstetrics and gynecology at Baystate Medical Center, in a hospital release
Human papillomavirus, 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 (or STIs – sexually transmitted infections, as they are increasingly referred to) in the United States today, and more than half of sexually active men and women will become infected at some time in their lives.
“While the vaccine is recommended for both girls and boys ages 9 to 11, studies tell us that women up to age 26 will also benefit from being vaccinated, which is covered by insurance up to that age,” White said.
April is STD Awareness Month, an opportunity for individuals, doctors, and community-based organizations to address ways to prevent some of the nearly 20 million new sexually-transmitted diseases – some of the most common being chlamydia, herpes and gonorrhea – that occur in the United States each year.
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 figures from the Centers for Disease Control and Prevention.
A new CDC analysis released in March – which included eight common STIs: chlamydia, gonorrhea, hepatitis B virus (HBV), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV), human papillomavirus (HPV), syphilis and trichomoniasis – noted some one-half of all new infections each year occur among young people ages 15 to 24.
“While this age group is the most vulnerable, anyone with a new partner or with multiple partners is also vulnerable,” White said.
Dr. Patricia Bailey-Sarnelli is director of pediatric and adolescent gynecologic services at Baystate Medical Center
Those numbers, especially among the young, highlight the need for prevention, noted Dr. Patricia Bailey-Sarnelli, director of pediatric and adolescent gynecologic services at Baystate.
Bailey-Sarnelli, who sees many adolescent girls in her practice, said a part of the problem has to do with normal adolescent psychological development.
“Adolescents go through a phase of magical thinking where, basically, they have a sense of invulnerability, that nothing can hurt them. For that reason, they tend to be less consistent about condom use, so that puts them at greater risk,” Bailey-Sarnelli said.
The Baystate ob-gyn noted the other issue is a lack of knowledge and general understanding of the risks of STDs. She noted in one study, 25 percent of urban adolescent females developed an STI within one year of first intercourse.
Also, the CDC cites stigma, inconsistent or incorrect condom use, limited access to health care, and a combination of other factors as contributing to higher rates of STDs among teens and young adults.
Bailey-Sarnelli said she believes parents and schools are doing a better job about informing youth about sex and its consequences, including discussing abstinence, reducing their number of sexual partners, and how to correctly use a condom.
“I find the girls 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 the results cut across all socioeconomic and racial boundaries, that kids whose parents have spoken with them about sex tend to make better decisions,” she said.
The concern among doctors is that while most of these infections are treatable – in fact, many are curable – some can result in serious health consequences if left undiagnosed and not treated early.
The March analysis of STDs released last month by the CDC noted while the consequences of untreated STDs are often worse for young women, the annual number of new infections is about the same between young 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, notes the CDC. 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 United States die with AIDS each year.
“Herpes, for example, 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,” Bailey-Sarnelli said.
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,” Bailey-Sarnelli said.
Helen Caulton-Harris is director of the Springfield Department of Health and Human Services.
When speaking about sexually transmitted diseases, Helen R. Caulton-Harris, director of the Springfield Department of Health and Human Services, said they are now using the newer term of STI – sexually transmitted infection.
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 also is a belief among some that talking about an infection, rather than a disease, has less of a stigma attached to it and is therefore less embarrassing to talk about.
“The city of Springfield is actively combating sexually transmitted infections in both our adolescent and adult populations. We recognize that STIs in our city have historically been a concern, particularly among the 13 to 19 age group. As a result, we are attempting through our health center on Worthington Street and our adolescent health center on 11 Wilbraham Road, along with the help of our health educators, to bring further awareness to STIs and to examine and treat patients as our capacity allows,” Caulton-Harris said.
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.
Bailey-Sarnelli said she offers the following advice to her younger patients.
“I always like to 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, to their partners, their family, and community – and part of that includes using protection against sexually transmitted diseases,” Bailey-Sarnelli said.
STI TESTING
If you are sexually active, be sure to talk to your healthcare provider about STI testing and which tests may be right for you.
All adults and adolescents should be tested at least once for HIV.
Annual chlamydia screening for all sexually active women age 25 and under, as well as older women with risk factors such as new or multiple sex partners.
Yearly gonorrhea screening for at-risk sexually active women (that is, those with new or multiple sex partners, and women who live in communities with a high burden of disease).
Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women at the first prenatal visit, to protect the health of mothers and their infants.
Trichomoniasis screening should be conducted at least annually for all HIV-infected women.
Screening at least once a year for syphilis, chlamydia, gonorrhea, and HIV for all sexually active gay men, bisexual men, and other men who have sex with men, or MSM.
MSM who have multiple or anonymous partners should be screened more frequently for STIs (for example, at 3 to 6 month intervals). In addition, MSM who have sex in conjunction with illicit drug use (particularly methamphetamine use) or whose sex partners participate in these activities should be screened more frequently.