Italians called it “the Spanish disease.” The French dubbed it “the English disease.” Among Russians, it was known as “the Polish disease.” Among Arabs? “The disease of Christians.”
No one wanted to claim it, and with good reason. The disease, syphilis, begins by causing crusty sores in private places. After hiding out in the body for years, it can emerge to drive people insane and then kill them.
Syphilis is just one of more than a dozen nasty sexually transmitted diseases, or STDs, that take advantage of the joy of sex to spread their special misery. Along with gonorrhea, chlamydia, genital herpes, human papillomavirus (HPV), and HIV/AIDS, syphilis is one of the six most common STDs. Despite tremendous advances in understanding and controlling STDs — or sexually transmitted infections (STIs), as they are sometimes called — they’re still out there spoiling the party.
Here’s the latest information on some of the most common or worrisome STDs — and on the effectiveness of condoms to prevent them.
By far the most dreaded sexually transmitted disease, the number of infections of HIV/AIDS has been falling slowly but surely. The latest numbers from the CDC, which tracks rates of reportable sexually transmitted infections, put the rate of new HIV/AIDS infections among Americans at 38,730 a year — half of what they were in 1992, when the epidemic peaked.
That’s still far too many for a disease that’s largely preventable, experts say. An estimated 44% of new cases are among men who have sex with men, and 34% are among heterosexuals. Injection drug use accounts for 17% of new cases.
Generally, the highest risk of HIV/AIDS infection is among black men. Among new cases diagnosed between 2001 and 2004, 51% were among blacks, who were seven times more likely to become infected than white men.
Early signs of HIV/AIDS infection can include flu-like symptoms, unexplained rashes, fungal infections in the throat, and unusual tiredness. As the disease progresses and the immune system is compromised, cancers and life-threatening infections such as cytomegalovirus can occur. Often, however, early infection with HIV/AIDS has no symptoms. An estimated one-quarter of Americans who carry the virus — 250,000 in all — don’t know they are infected. That’s why being tested is so important. If you are sexually active with more than one partner — or have any reason to think you might have been exposed to HIV in the past — go in for screening.
Thanks to the new antiviral medicine “cocktails,” many people are surviving HIV/AIDS and living active lives. But the drugs have unpleasant side effects, such as muscle wasting. And the disease can still be lethal. In 2005, more than 16,000 people died of HIV/AIDS, according to the CDC.
Gonorrhea is an STD that just won’t go away — it remains the second most commonly reported infectious disease in the United States. In 2005, 339,593 new cases of gonorrhea were reported; experts say the true number of new infections was approximately twice that.
In men, the symptoms of gonorrhea include pus-like discharge from the urethra, with frequent, burning urination. Untreated, gonorrhea can lead to epididymitis, a painful condition of the testicles that can cause infertility. In women, gonorrhea is a major cause of pelvic inflammatory disease and, like chlamydia, can lead to infertility. Having a case of gonorrhea makes you three to five times more likely to acquire HIV if you’re exposed to the HIV virus.
Gonorrhea can be treated with antibiotics. But researchers at the CDC are tracking a worrisome rise in drug-resistant strains. As a result, the treatment options are becoming more limited than in the past — one more good reason to avoid this bug.
About 2.2% of adult Americans are believed to carry chlamydia. Among sexually active men, the number is much higher. A 2003 study of young men entering a national job-training program found that 8.2% were infected with chlamydia. Among those aged 20 to 24 — the most likely to be whooping it up — the prevalence was even higher.
Although often symptomless in men, chlamydia can cause inflammation of the testicles, prostate and urethra. The consequences for women are more serious. Untreated infections are a leading cause of pelvic inflammatory disease, ectopic pregnancies, and sometimes infertility.
Thanks to expanded screening for this easy-to-get bacterial infection, more people who carry the bug are being diagnosed and treated with antibiotics. That should help reduce transmission of chlamydia. But many people with the infection still don’t know they have it. Although almost a million U.S. cases of chlamydia were diagnosed in 2005, experts estimate that there are actually 2.8 million new infections each year.
That means almost two out of three people infected with this bug don’t know they have it — and go can go on spreading it.Experts are especially concerned that men who are unaware they carry chlamydia are infecting and sometimes re-infecting their female partners. A recent study found that one in eight women treated for chlamydia becomes re-infected within a year.
Herpes Simplex Virus-2 (HSV-2)
Good news on this bad guy: Herpes simplex virus-2, which can cause genital herpes sores, is on the decline, according to the latest numbers. Its presence, as measured in blood tests of adults age 49 and younger, has fallen a dramatic 19% in the past 10 years.
Several antiviral drugs are used to treat herpes simplex virus. A vaccine is currently being tested in a large nationwide study by the National Institutes of Health.
Human Papillomavirus (HPV)
Experts are most concerned about women getting HPV because the virus is known to cause cervical cancer. But HPV is also known to cause genital warts and to increase the risk of cancers of the penis, anus and rectum in men. What’s more, millions of men carry the virus and risk giving it to their sexual partners. According to the CDC, more than six million Americans are infected with HPV every year. In recent surveys, as many as 48% of men showing up in STI clinics tested positive for HPV. The number is about 8% among the general male population.
A new vaccine has proven remarkably effective in preventing HPV infection. In 2006, the CDC recommended that the vaccine be routinely given to girls when they are 11 to 12 years old. The Advisory Committee on Immunization Practices (ACIP)recommendation allows for vaccination of girls beginning at nine years old as well as vaccination of girls and women 13 to 26 years old. That recommendation has sparked controversy, of course. But it could well save lives. HPV is the leading cause of cervical cancer in women.
Fortunately, modern medicine has found effective drugs to treat the scourge of syphilis. Preventing the disease hasn’t proved as easy, however. Through the 1990s, rates of syphilis fell, reaching an all-time low in 2000. Since then, they’ve been climbing again. “Syphilis rates have increased for five consecutive years,” says Jennifer Ruth, spokesperson for the CDC. Between 2004 and 2005 alone, the national syphilis rate jumped more than 11%. Among men, the risk has soared 70% in the past five years.
That’s scary for plenty of reasons. Untreated syphilis can damage the brain, cardiovascular system and many organs in the body. What’s more, having syphilis increases the danger of being infected with HIV/AIDS at least two- to five-fold.
The ABCs of STD Prevention
You’d think advice on how to prevent sexually transmitted diseases would be noncontroversial, right? Wrong. Like so much else these days, STD prevention advice is a political hot potato. Some sides want to focus exclusively on abstinence and monogamy in marriage. Others say more should be done to promote condoms.
To keep everyone happy, public health officials have latched on to an easy-to-remember acronym for prevention: “ABC.” A is for “abstinence.” B is for “be faithful.” C is for “condom.”
Obviously, the only foolproof way to prevent STDs is to avoid sex. The second most effective way is to settle down and live happily — and faithfully — ever after with a sexual partner who is free of infections. That’s great if you can manage it. But let’s face it — plenty of people these days are sexually active, with more than one partner. In that case, especially if you aren’t sure whether you or your partner may have an STD, using a condom is critical.
How Well Do Condoms Prevent STDs?
That question has been devilishly hard for scientists to answer, says Markus Steiner, PhD, senior epidemiologist with Family Health International, a nonprofit group that focuses on STDs. “People aren’t lab animals that can be carefully manipulated,” Steiner says. “When it comes to asking people what they do in their bedrooms, they’re often likely to tell you what they think you want to hear“ — a problem called “social desirability bias.”
What’s more, people who use condoms are typically people having “high-risk” sex, meaning with a variety of partners, for instance, or in settings where the risk of encountering an infected person is higher, such as in gay sex clubs. Those who don’t use condoms are more likely to be in monogamous relationships. “So if you simply ask about condom use and then measure rates of sexually transmitted diseases, these two problems can lead condoms to appear less effective than they really are.”
New Evidence on Condom Effectiveness
Until recently, in fact, there was little evidence one way or the other on how well condoms lowered the risk for specific STDs. Anti-condom forces used that fact to argue that condoms don’t protect. But lately, important new findings show that condom use can lower the risk of infection — not only of HIV/AIDS, but of many other STDs. A 2006 study by University of Washington researchers found that women whose partners consistently used condoms were half as likely to be infected with human papilloma virus. For HIV/AIDS, consistent and careful condom use can lower risk of infection by a whopping 90%. When researchers from the National Center for Chronic Disease Prevention reviewed results from 45 studies looking at gonorrhea and chlamydia infection, they found solid evidence that condoms reduce the risk of these two STDs as well.
Do pro-condom messages promote risky sex? For years, that’s been the worry of groups that promote abstinence. But a review of 174 programs that encouraged condom use found no increase in unsafe sexual behavior.
The bottom line: Condoms don’t offer 100% protection, but they can certainly lower your risk — and the risk of your partner.
Source: Peter Jaret, WebMD