Sexually Transmitted Diseases: A Major Public Health Problem.In the last century, infectious diseases in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. have been largely conquered. Devastating diseases such as diphtheria diphtheria (dĭfthēr`ēə), acute contagious disease caused by Corynebacterium diphtheriae (Klebs-Loffler bacillus) bacteria that have been infected by a bacteriophage. It begins as a soreness of the throat with fever. , typhoid typhoidor typhoid fever Acute infectious disease resembling typhus (and distinguished from it only in the 19th century). Salmonella typhi, usually ingested in food or water, multiplies in the intestinal wall and then enters the bloodstream, causing , measles and polio have been brought under control, if not virtually eradicated. (1,2) Yet, in stark contrast to these successes, the country has been unable to stem the spread of sexually transmitted diseases Sexually transmitted diseases Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely (STDs). Twelve million sexually transmitted infections occur every year. (3) At current rates, it is estimated that at least one in four--and perhaps as many as one in two--Americans will contract an STD (Subscriber Trunk Dialing) Long distance dialing outside of the U.S. that does not require operator intervention. STD prefix codes are required and billing is based on call units, which are a fixed amount of money in the currency of that country. at some point in their lives. (4) No person who is sexually active--whether he or she is married or single, white or black, rich or poor, heterosexual or homosexual, young or old--is immune from the risk of infection. The country's STD rates are among the highest in the industrialized in·dus·tri·al·ize v. in·dus·tri·al·ized, in·dus·tri·al·iz·ing, in·dus·tri·al·iz·es v.tr. 1. To develop industry in (a country or society, for example). 2. world, and in some areas, rates approach those found in developing countries. (5) Inmost in·most adj. Farthest within; innermost. inmost Adjective same as innermost Adj. 1. industrialized countries, syphilis and gonorrhea gonorrhea (gŏnərē`ə), common infectious disease caused by a bacterium (Neisseria gonorrhoeae), involving chiefly the mucous membranes of the genitourinary tract. have virtually disappeared, (6) but in the United States, infectious syphilis is at its highest levels in 40 years, (7) and gonorrhea is the country's most commonly reported communicable disease communicable disease n. A disease that is transmitted through direct contact with an infected individual or indirectly through a vector. Also called contagious disease. . (2) Meanwhile, an estimated four million cases of chlamydia chlamydia (kləmĭd`ēə), genus of microorganisms that cause a variety of diseases in humans and other animals. Psittacosis, or parrot fever, caused by the species Chlamydia psittaci, occur each year--nearly four times the number of cases of gonorrhea. (3) And AIDS, which burst on the scene just a dozen years ago, has already claimed the lives of more than 170,000 Americans (8) and has become a leading cause of death among persons aged 25-44. (9) Young people are hit hardest by these infections. Two-thirds of persons who contract STDs are under age 25; (3) one-quarter are teenagers. (3) Many of these young people suffer long-term health problems as a consequence of their infection. Refuting Misperceptions The AIDS epidemic has increased public awareness of other STDs, but a widespread misperception mis·per·ceive tr.v. mis·per·ceived, mis·per·ceiv·ing, mis·per·ceives To perceive incorrectly; misunderstand. mis persists that, with the exception of AIDS, STDs are easily cured and cause no serious or irreversible problems. (10) The facts tell a different story. * At least 56 million people--more than one in five Americans--are believed to be infected with a viral STD other than AIDS. (3,11,12) These incurable incurable /in·cur·a·ble/ (in-kur´ah-b'l) 1. not susceptible of being cured. 2. a person with a disease which cannot be cured. in·cur·a·ble adj. diseases--such as genital herpes Genital Herpes Definition Genital herpes is a sexually transmitted disease caused by a herpes virus. The disease is characterized by the formation of fluid-filled, painful blisters in the genital area. , human papillomavirus human papillomavirus (HPV), any of a family of more than 60 viruses that cause various growths, including plantar warts and genital warts, a sexually transmitted disease. Detectable warts can be or removed, usually by chemicals, freezing, or laser, but often recur. (HPV HPV human papillomavirus. HPV abbr. human papilloma virus Human papilloma virus (HPV) ) and hepatitis B--have consequences ranging from recurrent painful outbreaks to chronic liver disease Chronic liver disease is a liver disease of slow process and persisting over a long period of time, resulting in a progressive destruction of the liver. It includes amongst others:
* STDs caused by bacteria, such as chlamydia and gonorrhea, can usually be cured--if they are diagnosed early. Often, however, these infections produce mild symptoms, or none at all, and therefore are not detected and treated until serious, even life-threatening problems develop. (10,13) * Infection with certain STDs--both those that cause sores or ulcers (such as syphilis, herpes and chancroid chancroid: see sexually transmitted disease. ) and common nonulcerative diseases (for example, chlamydia, gonorrhea and trichononiasis)--significantly increases a person's risk of contracting the human immunodeficiency virus human immunodeficiency virus n. HIV. Human immunodeficiency virus (HIV) A transmissible retrovirus that causes AIDS in humans. (HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. ), which causes AIDS, upon exposure to that virus. (16) * The costs associated with just three STDs--chlamydia, gonorrhea and herpes--are estimated to be over $5 billion annually. (17,18,19) The portion of the medical costs covered by public payment sources appears to be increasing. (17) Impact on Women STDs have a disproportionate impact on women because they are more easily transmitted to and more difficult to diagnose in women than in men. (20) Moreover, complications of undiagnosed infections are far more common and severe in women. (11,13) More than one million women suffer an episode of pelvic inflammatory disease pelvic inflammatory disease (PID), infection of the female reproductive organs, usually resulting from infection with the bacteria that cause chlamydia or gonorrhea. (PID (1) (Process IDentifier) A temporary number assigned by the operating system to a process or service. (2) (Proportional-Integral-Derivative) The most common control methodology in process control. ) each year, most as a consequence of an undetected STD. (21) In addition, as many as 150,000 women may become infertile in·fer·tile adj. Not capable of initiating, sustaining, or supporting reproduction. infertile, adj unable to produce offspring. , and 45,000 may experience a life-endangering ectopic pregnancy ectopic pregnancy or extrauterine pregnancy Condition in which a fertilized egg is imbedded outside the uterus (see fertilization). Early on, it may resemble a normal pregnancy, with hormonal changes, amenorrhea, and development of a placenta. as a result of a previous STD infection. More than 4,500 women die annually of cervical cancer Cervical Cancer Definition Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. , which is strongly associated with several common strains of HPV. (13) Furthermore, infected women can transmit an STD to their offspring during pregnancy or childbirth, sometimes with devastating results. Perinatal perinatal /peri·na·tal/ (-na´t'l) relating to the period shortly before and after birth; from the twentieth to twenty-ninth week of gestation to one to four weeks after birth. per·i·na·tal adj. and neonatal infections can cause spontaneous abortion spon·ta·ne·ous abortion n. A naturally occurring termination of a pregnancy. Also called miscarriage. spontaneous abortion , stillbirth, infant death Noun 1. infant death - sudden and unexpected death of an apparently healthy infant during sleep cot death, crib death, SIDS, sudden infant death syndrome , premature delivery premature delivery n. The birth of a premature baby. Premature delivery The birth of a live baby when a pregnancy ends spontaneously after the twentieth week. Mentioned in: Stillbirth and low birth weight, chronic respiratory problems, blindness and mental retardation mental retardation, below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. . (10,11,13) "New" STDs Until the early 1980s, the scope of recognized STDs included only five traditional infections: syphilis, gonorrhea, chancroid, lymphogranuloma venereum lymphogranuloma venereum: see sexually transmitted disease. and granuloma inguinale granuloma inguinale: see sexually transmitted disease. . Today, more than 50 organisms and syndromes are known to be transmitted sexually. (13) With the possible exception of AIDS, the STDs on this expanded list are not "new"; the diseases or their manifestations have been recognized for decades, even centuries. However, recent advances in medical technology permit more accurate diagnosis of many of these infections and have contributed to a greater understanding of their sexual transmissibility. (13,22) Even so, there have been large increases in the incidence of a number of STDs in recent years; some of these increases are occurring at alarming rates. (13,23) Changes in sexual mores, together with trends in marriage and divorce, have helped to fuel these increases. (24) Earlier initiation of sexual intercourse sexual intercourse or coitus or copulation Act in which the male reproductive organ enters the female reproductive tract (see reproductive system). ,(25,26) and greater acceptance of sex among unmarried persons have combined with later age at marriage and more widespread divorce (27,28) to increase the amount of time that individuals are sexually active and unmarried. During periods when they are not married, many sexually active persons have several sexual partners, which raises their chances of encountering someone who is infected with an STD. (29) At the same time, most individuals with multiple partners do not use condoms consistently, (29,30) even though condoms can substantially reduce the risk of infection. (31) Growing use of drugs, especially crack cocaine, has also contributed to the increase in STDs, chiefly through its effect on the number of sexual partners an individual may have. (13) Among some cocaine users, for example, it has become common to trade sex for drugs or money to support their addiction. (6,13) Increasing poverty and homelessness, and an accompanying decline in access to health care as a result of cuts in public health services health services Managed care The benefits covered under a health contract , may have also played a part in the rise in STDs. (6,13) In addition, AIDS has drawn attention that might otherwise have been focused on other STDs. "Dirty" Diseases Long-standing perceptions of STDs have contributed to the persistence of these diseases while other infectious diseases have been brought under control. STDs, also known as venereal venereal /ve·ne·re·al/ (ve-ner´e-al) due to or propagated by sexual intercourse. ve·ne·re·al adj. 1. Transmitted by sexual intercourse. 2. diseases, have long been viewed as "dirty" diseases linked to promiscuity Promiscuity See also Profligacy. Anatol constantly flits from one girl to another. [Aust. Drama: Schnitzler Anatol in Benét, 33] Aphrodite promiscuous goddess of sensual love. [Gk. Myth. and illicit sex, and considered by many people to be a just punishment for those who have deliberately engaged in immoral behavior. At times, this perception has resulted in conflict among public health officials over whether to view STDs primarily as a moral issue or as a medical problem, with some arguing that making treatment widely available would encourage more promiscuous behavior and lead to higher infection levels. (1) STDs have also been perceived as afflictions restricted primarily to prostitutes, immigrants, the urban poor (1) and, with the advent of AIDS, drug addicts and homosexuals-- groups who do not normally elicit public support for a strong effort to eradicate disease or to provide treatment. As an early leader of the national STD control effort observed, "First and foremost among American handicaps to progress against syphilis is the widespread belief that nice people don't talk about syphilis, nice people don't have syphilis, and nice people shouldn't do anything about those who have syphilis."(1) Widespread Risk These notions of who gets sexually transmitted infections are wrong. People of all backgrounds, economic levels and ages acquire STDs. (24) Certain diseases, especially syphilis and gonorrhea, are particularly widespread among low-income, racial and ethnic minority populations; (13) but other common infections, including chlamydia, HPV and herpes, are diffused throughout the population: Studies have found up to 5% of middle-class pregnant women (6) and 8% of female college students to be infected with chlamydia. (32, 33) HPV has been found in 17-46% of female college students; many of these young women are infected with a strain of the virus associated with cervical cancer and other genital cancers. (34, 35) Many STDs, including syphilis and chlamydia, are increasing rapidiy among teenagers of all incomes, races and ethnic groups. (23) Yet, most individuals probably do not view themselves as being at risk for a sexually transmitted infection. According to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. a survey of AIDS knowledge and attitudes, 96% of persons 18 and older thought their risk of acquiring HIV was low or nonexistent non·ex·is·tence n. 1. The condition of not existing. 2. Something that does not exist. non . (36) Many probably underestimated their risk, since another study estimates that each year, (12-17) million women aged 15-44 may be at increased risk of acquiring an STD because of exposure to multiple sexual partners. The number of men exposed to multiple partners is as high, or higher. (29) In this report, we examine the dimensions of the problem of STDs in the United States and the federal program charged with combating their spread. After providing information about the most serious STDs, we examine the principal factors that increase an individual's risk of becoming infected, the groups that are most affected by STDs and the financial implications of STDs for society. We then discuss the federal program to control and prevent the spread of STDs. The role of states and private physicians in this effort is also described, although in less detail because of the lack of information about their activities. In conclusion, we discuss issues related to strengthening the federal STD program and targeting limited resources more effectively. References (1.) A.M. Brandt, No Magic Bullet (jargon) magic bullet - (Or "silver bullet" from vampire legends) A term widely used in software engineering for a supposed quick, simple cure for some problem. E.g. "There's no silver bullet for this problem". : A Social History of Venereal Disease venereal disease (vənēr`ēəl): see sexually transmitted disease. in the United States Since 1880, Oxford University Press, New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , 1987. (2.) Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation ), "Summary of Notifiable Diseases, United States, 1990," Morbidity and Mortality Weekly Report Morbidity and Mortality Weekly Report (MMWR) is a weekly epidemiological digest for the United States published by the Centers for Disease Control and Prevention. The 5 June 1981 issue of the MMWR published the cases of five men in what turned out to be the first report of AIDS. , 39:55-60,1991. (3.) Division of STD/HIV Prevention, Division of STD/HIV Prevention, 1992 Annual Report, CDC, Atlanta, 1993 (forthcoming). (4.) Calculated by the Alan Guttmacher Alan Frank Guttmacher (1898-1974) was an American physician. He served as president of Planned Parenthood and vice-president of the American Eugenics Society, founded the Association for the Study of Abortion in 1964, was a member of the Association for Voluntary Institute (AGI (Artificial General Intelligence) A machine intelligence that resembles that of a human being. Considered impossible by many, most artificial intelligence (AI) research, projects and products deal with specific applications such as industrial robots, playing chess, ) on the basis of CDC incidence data and estimates. (5.) Division of STD/HIV Prevention, "Preventive Health Services-Sexually Transmitted Disease Accelerated Prevention Campaigns Cooperative Agreements," Announcement No.301, FY 1993, CDC, Atlanta, 1992 (draft). (6.) S.O. Aral and K.K. Holmes, "Sexually Transmitted Diseases in the AIDS Era," Scientific American Scientific American U.S. monthly magazine interpreting scientific developments to lay readers. It was founded in 1845 as a newspaper describing new inventions. By 1853 its circulation had reached 30,000 and it was reporting on various sciences, such as astronomy and , 264:62-69,1991. (7.) Division of STD/HIV Prevention, Sexually Transmitted Disease sexually transmitted disease (STD) or venereal disease, term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, Surveillance 1991, CDC, Atlanta, 1992. (8.) Division of STD/HIV Prevention, HIV/AIDS Surveillance, year-end edition, CDC, Atlanta, Feb. 1993. (9.) Senate Committee on Appropriations, "Departments of Labor, Health and Human Services Noun 1. Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Department of Health and Human Services, HHS , and Education and Related Agencies Appropriation Bill, 1993," report accompanying H.R. 5677, Report No. 102-397, Washington DC, Sept. 10,1992. (10.) F.A. Althaus, "An Ounce of Protection...STD and Women's Health Women's Health Definition Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. ," Family Planning family planning Use of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources. Perspectives, 23:173-177,1991. (11.) Division of STD/HIV Prevention, "An Update on Sexually Transmitted Diseases (STDs)," Factsheet, CDC, Atlanta, 1992. (12.) National Institute of Allergy and Infectious Disease Infectious disease A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. (NIAID NIAID National Institute of Allergy and Infectious Diseases. ), "Hepatitis," Factsheet, NIH "Not invented here." See digispeak. NIH - The United States National Institutes of Health. , Bethesda, MD, 1992. (13.) Division of STD/HIV Prevention, Division of STD/HIV Prevention 1991 Annual Report, CDC, Atlanta, 1992. (14.) NIAID, "Human Papillomavirus and Genital Warts," Factsheet, National Institutes of Health (NIH), Bethesda, MD, 1992. (15.) NIAID, "Genital Herpes," Factsheet, NIH, Bethesda, MD, 1992. (16.) J.N. Wasserheit, "Epidemiological Synergy: Interrelationships Between Human Immunodeficiency Virus Infection and Other Sexually Transmitted Diseases," Sexually Transmitted Diseases, 19:61-77,1992. (17.) A.E. Washington and P Katz, "Cost of and Payment Source for Pelvic Inflammatory Disease: Trends and Projections, 1983 Through 2000," Journal of the American Medical Association JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world. , 266:2565-2569,1991. (18.) Calculated by the AGI on the basis of A.E. Washington, R.E. Johnson and L.L. Sanders, "Chlamydia Trachomatis Chlamydia tra·cho·ma·tis n. A species of Chlamydia that causes trachoma, inclusion conjunctivitis, lymphogranuloma venereum, nonspecific urethritis, and proctitis in humans. Infections in the United States: What Are They Costing Us?" Journal of the American Medical Association, 257:2070-2072,1987. (19.) Calculated by the AGI on the basis of Institute of Medicine, New Vaccine Development: Establishing Priorities, Vol. 1, Diseases of importance in the United States, National Academy Press, Washington, DC, 1985. (20.) S.O. Aral and M.E. Guinan, "Women and Sexually Transmitted Diseases," in K.K. Holmes et al., eds., Sexually Transmitted Diseases, McGraw-Hill, New York, 1984, pp. 85-89. (21.) NIAID, "Pelvic Inflammatory Disease," Factsheet, NIH, Bethesda, MD, 1992. (22.) H.H. Neumann and S. Simmons ,Dr. Neumann's Guide to New Sexually Transmitted Diseases, Acropolis acropolis (əkrŏp`əlĭs) [Gr.,=high point of the city], elevated, fortified section of various ancient Greek cities. The Acropolis of Athens, a hill c.260 ft (80 m) high, with a flat oval top c. Books, Washington, DC, 1987. (23.) S.B. Toal, ed., "Sexually Transmitted Disease Strategies: Review of an Ad Hoc For this purpose. Meaning "to this" in Latin, it refers to dealing with special situations as they occur rather than functions that are repeated on a regular basis. See ad hoc query and ad hoc mode. Panel," CDC, Atlanta, 1991 (report on a panel convened by the National Center for Prevention Services, March 18-19, 1991). (24.) NIAID, "An Introduction to Sexually Transmitted Diseases," Factsheet, NIH, Bethesda, MD, 1992. (25.) E.F. Jones et al., Teenage Pregnancy teenage pregnancy Adolescent pregnancy, teen pregnancy Social medicine Pregnancy by a ♀, age 13 to 19; TP is usually understood to occur in a ♀ who has not completed her core education–secondary school, has few or no marketable skills, is in Industrialized Countries, Yale University Yale University, at New Haven, Conn.; coeducational. Chartered as a collegiate school for men in 1701 largely as a result of the efforts of James Pierpont, it opened at Killingworth (now Clinton) in 1702, moved (1707) to Saybrook (now Old Saybrook), and in 1716 was Press, New Haven New Haven, city (1990 pop. 130,474), New Haven co., S Conn., a port of entry where the Quinnipiac and other small rivers enter Long Island Sound; inc. 1784. Firearms and ammunition, clocks and watches, tools, rubber and paper products, and textiles are among the many , 1986. (26.) J.D. Forrest and S. Singh, "The Sexual and Reproductive Behavior Reproductive behavior Behavior related to the production of offspring; it includes such patterns as the establishment of mating systems, courtship, sexual behavior, parturition, and the care of young. of American Women, 1982-1988," Family Planning Perspectives, 22:206-214, 1990. (27.) National Center for Health Statistics, "Advance Report of Final Marriage Statistics, 1988," Monthly Vital Statistics Report, Aug. 26,1991 (supplement). (28.) National Center for Health Statistics, "Advance Report of Final Divorce Statistics, 1988," Monthly Vital Statistics Report, May 21, 1991 (supplement 2). (29.) K. Kost and J.D. Forrest, "American Women's Sexual Behavior sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. and Exposure to Risk of Sexually Transmitted Diseases," Family Planning Perspectives, 24:244-254,1992. (30.) J.A. Catania et al., "Prevalence of AIDS-Related Risk Factors and Condom Use in the United States," Science, 258:1101-1106,1992. (31.) W. Cates, Jr., and K.M. Stone, "Family Planning, Sexually Transmitted Diseases and Contraceptive Choice: A Literature Update--Part I," Family Planning Perspectives, 24:75-84,1992. (32.) M.L. Swinker et al., "Prevalence of Chlamydia Trachomatis Cervical Infection in a College Gynecology Clinic: Relationship to Other Infections and Clinical Features," Sexually Transmitted Diseases, 15:133-136,1988. (33.) H.R. Harrison et al., "Cervical Chlamydia Tra,chomatis Infection in University Women: Relationship to History, Contraception, Ectopy, and Cervicitis cervicitis Inflammation of the cervix of the uterus, caused by infection or irritation. It is most common during the years of menstruation. Cervicitis can be acute or chronic and may worsen during pregnancy. It does not cause pain but may lead to polyps. ," American Journal of Obstetrics and Gynecology, 153:244-251,1985. (34.) N.B. Kiviat et al., "Prevalence of Genital Papillomavirus Infection Among Women Attending a College Student Health Clinic or a Sexually Transmitted Disease Clinic," Journal of infectious Diseases, 159:293-302,1989. (35.) H.M. 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"FDA Panel Recommends Female Condom Approval; Efficacy Concerns Remain," Washington Memo, Dec. 21, 1992 (WM-20), pp. 1-2. (43.) M.J. Rosenberg and E.L. Gollub, "Commentary: Methods Women Can Use That May Prevent Sexually Transmitted Disease, Including HIV," American Journal of Public Health, 82:1473-1478,1992. (44.) W. Cates, Jr., F.H. Stewart and J. Trussell, "Commentary: The Quest for Verb 1. quest for - go in search of or hunt for; "pursue a hobby" quest after, go after, pursue look for, search, seek - try to locate or discover, or try to establish the existence of; "The police are searching for clues"; "They are searching for the Women's Prophylactic prophylactic /pro·phy·lac·tic/ (pro?-fi-lak´tik) 1. tending to ward off disease; pertaining to prophylaxis. 2. an agent that tends to ward off disease. pro·phy·lac·tic n. Methods--Hopes vs. Science," American Journal of Public Health, 82:1479-1481,1992. (45.) P. 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Blanco Blanco (meaning the color white in Spanish) is an adjective often used in Spanish surnames. Below is a list of famous people and places associated with the word. , "Chlamydial chlamydial pertaining to members of the family Chlamydiaceae. chlamydial abortion abortion in cows, ewes, sows and goat does caused by Chlamydophila abortus and C. pecorum. See enzootic abortion of ewes. Infections," Primary Care, 17:85-93, 1990. (52.) J. Schachter, "Why We Need a Program for the Control of Chlamydia Trachomatis," editorial, New England Journal of Medicine The New England Journal of Medicine (New Engl J Med or NEJM) is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It is one of the most popular and widely-read peer-reviewed general medical journals in the world. , 320:802-804, 1989. (53.) L.T. Gutman and G.M. Wilfert, "Gonococcal Gonococcal The bacteria Neisseria gonorrheae that causes gonorrhea, a sexually transmitted infection of the genitals and urinary tract. The gonococcal organism may occasionally affect the eye, causing blindness if not treated. Mentioned in: Conjunctivitis Diseases in Infants and Children," in K.K. Holmes et al., eds., Sexually Transmitted Diseases, 2nd edition, McGraw-Hill, New York, 1990. (54.) S. Blanche et al., "A Prospective Study of Infants Born to Women Seropositive seropositive /se·ro·pos·i·tive/ (-poz´i-tiv) showing positive results on serological examination; showing a high level of antibody. se·ro·pos·i·tive adj. for Human Immunodeficiency Virus Type 1," New England Journal of Medicine, 320:1643-1648, 1989. (55.) NIAID, "Syphilis," Factsheet, NIH, Bethesda, MD, 1992. (56.) NIAID, "Other Important STDs," Factsheet, NIH, Bethesda, MD, 1992. (57.) Bureau of the Census Noun 1. Bureau of the Census - the bureau of the Commerce Department responsible for taking the census; provides demographic information and analyses about the population of the United States Census Bureau , "United States Population Estimates, by Age, Sex, Race, and Hispanic Origin, 1980-1988," Current Population Reports, P25-1045, 1990. (58.) Calculated by the AGI on the basis of references 26,37 and 57 and on F.L. Sonenstein, J.H. Pleck and L.C. Ku, "Sexual Activity, Condom Use and AIDS Awareness Among Adolescent Males," Family Planning Perspectives, 21:152-158, 1989. (59.) A.G. Randolph and A.E. Washington, "Screening for Chlamydia Trachomatis in Adolescent Males: A Cost-Based Decision Analysis," American Journal of Public Health, 80:545-550, 1990. (60.) J.D. Forrest, AGI, personal communication, Nov.11, 1992. (61.) A. Moscicki et al., "Human Papillomavirus Infection in Sexually Active Adolescent Females: Prevalence and Risk Factors," Pediatric Research Pediatric Research is one of the most respected peer-reviewed medical journals within the field of pediatrics in the world. It is the official publication of the American Pediatric Society, the European Society for Paediatric Research, and the Society for Pediatric , 28:507- 513, 1990. (62.) A.E. Washington, R.E. Johnson and L.L. Sanders, "Chlamydia Trachomatis Infections in the United States: What Are They Costing Us?" Journal of the American Medical Association, 257:2070-2072, 1987. (63.) A.A. Scitovsky and D.P. Rice, "Estimates of the Direct and Indirect Costa of Acquired Immunodeficiency Syndrome acquired immunodeficiency syndrome, see AIDS. in the United States, 1985, 1986 and 1991,' Public Health Reports, 102:5-12, 1987. (64.) Institute of Medicine, The Future of Public Health, National Academy Press, Washington, DC, 1988. (65.) J. Kosterlitz, "AIDS Wars," National Journal, July 25, 1992, pp. 1727-1732. (66.) Ryan White Ryan Wayne White (December 6, 1971 – April 8, 1990[1]) was a young man with AIDS from Kokomo, Indiana who became a national spokesman for AIDS, after being expelled from school because of his infection. Comprehensive AIDS Resources Emergency Act of 1990 (Title XXVI, Public Health Service Act). (67.) W. Cates, Jr., and K.M. Stone, "Family Planning, Sexually Transmitted Diseases and Contraceptive Choice: A Literature Update--Part II," Family Planning Perspectives, 24:122-128, 1992. (68.) 42 U.S.C. 247c (Section 318, Public Health Service Act). (69.) K. Toomey, GDC, personal communication, Dec. 9, 1992. (70.) W Gates, Jr., GDC, personal communication, Dec. 8, 1992. (71.) CDC, HIV/AIDS Prevention Fact Book 1992, Atlanta, 1992. (72.) K. Toomey, CDC, personal communication, Sept. 25, 1992. (73.) R. Merriweather, North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures Area, 52,586 sq mi (136,198 sq km). Pop. Health Department, personal communication, Dec. 1,1992. (74.) Calculated by the AGI on the basis of GDC funding data. (75.) Division of STD/HIV Prevention, "Program Announcement and Notice of Availability of Funds for Fiscal Year 1990, Project Grants for Preventive Health Services, Sexually Transmitted Diseases Prevention," Announcement 004, GDC, Atlanta. (76.) Public Health Foundation, Washington, DC, unpublished data, Oct. 1992. (77.) Public Health Foundation, Public Health Agencies 1991: An Inventory of Programs and Block Grant Expenditures, Washington, DC, 1991. (78.) P. Donovan, "Family Planning Clinics: Facing Higher Costs and Sicker Patients," Family Planning Perspectives, 23:198-203, 1991. (79.) R.B. Gold and D. Daley, "Public Funding Public funding is money given from tax revenue or other governmental sources to an individual, organization, or entity. See also
Any surgical procedure intended to end fertility permanently (see contraception). Such operations remove or interrupt the anatomical pathways through which the cells involved in fertilization travel (see reproductive system). and Abortion Services, Fiscal Year 1990," Family Planning Perspectives, 23:204-211, 1991. (80.) CDC, Directory of STD Clinics, Atlanta, 1987. (81.) K. Toomey, GDC, personal communication, Jan. 15, 1992. (82.) S. DeLisle, James Bowman For the Speaker of the Canadian House of Commons see James Langstaff Bowman James Thomas Bowman (b. November 6, 1941) is a famous countertenor born in Oxford, England. His career spans Opera, Oratorio, Contemporary music and solo recitals. Associates, Seattle, personal communication, Dec. 7,1992. (83.) K. Toomey, CDC, personal communication, Dec. 4, 1992. (84.) Calculated by the AGI on the basis of data from the 1988 National Survey of Family Growth. (85.) B. Johnson and D. Moser, CDC, personal communication, Mar. 3, 1992. (86.) "Program Spotlight: Widespread Screening Seeks to Lower Chlamydia Prevalence," Family Planning Perspectives, 24:135-136, 1992. (87.) Region X Chlamydia Project, "A Cost Effective Screening Program for Women in Family Planning Clinics," Factsheet, undated un·dat·ed adj. 1. Not marked with or showing a date: an undated letter; an undated portrait. 2. . (88.) TL. Chorbaetal., "Mandatory Reporting mandatory reporting The obligatory reporting of a particular condition to local or state health authorities, as required for communicable disease and substance abuse Infectious disease State boards of health maintain records and collect data resulting from MR of of Infectious Diseases by Clinicians," Journal of the American Medical Association, 262:3018-3026, 1989. (89.) N. Gibbs, GDC, personal communication, Oct. 7, 1992. (90.) K. Toomey, GDC, personal communication, Oct. 1, 1992. (91.) K. Toomey, CDC, personal communication, Nov. 22, 1991. (92.) W. Cates, Jr., GDC, personal communication, Nov. 24, 1992. (93.) J. Wasserheit, CDC, remarks made at meeting of STD Coalition, Feb. 11, 1993, Washington, DC. (94.) H. Hunter Handsfield, "Control of Sexually Transmitted Chlamydial Infections," editorial, Journal of the American Medical Association, 257:2073-2074, 1987. (95.) A. Caughran, American Social Health Association, personal communication, Nov. 9, 1992. (96.) "Special Report... U.S. Government Criticized for Censorship, Prudishness prud·ish adj. Marked by or exhibiting the characteristics of a prude; priggish. prud  ish·ly adv. on Sexuality-Related Issues," Washington
Memo, May 5, 1992 (WM-8), pp. 4-5.
(97.) "Preventive Health Amendments of 1992," Conference report accompanying H.R. 3635, Report No. 102-1019, Washington DC, Oct. 5, 1992. (98.) PHS, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, U.S. Government Printing Office, Washington, DC, 1990. (99.) A.I. Trachtenberg, A.E. Washington and S. Halldorson, "A Cost-Based Decision Analysis for Chlamydia Screening in California Family Planning Clinics," Obstetrics and Gynecology, 71:101-108, 1988. (100.) B.G. Gellin and D.E. Rogers, "The Stalled Response to AIDS," Issues in Science and Technology, Fall 1992, pp. 24-28. (101.) J. Rovner, "Vote to End Fetal Tissue Ban Hinged on Personal Stakes," Congressional Quarterly Congressional Quarterly, Inc., or CQ, is a privately owned publishing company that produces a number of publications reporting primarily on the United States Congress. , Apr. 4, 1992, pp. 879-880. (102.) AGI, Risk and Responsibility: Teaching Sex Education in America's Schools Today, New York, 1989. (50.) S.O. Aral, W.D. Masher and W Gates, Jr., "Self-Reported Pelvic Inflammatory Disease in the United States, 1988," Journal of the American Medical Association, 266:2570-2573, 1991. (51.) J.M. Graham and J.D. Blanco, "Chlamydial Infections," Primary Care, 17:85-93, 1990. (52.) J. Schachter, "Why We Need a Program for the Control of Chlamydia Trachomatis," editorial, New England Journal of Medicine, 320:802-804, 1989. (53.) L.T. Gutman and G.M. Wilfert, "Gonococcal Diseases in Infants and Children," in K.K. Holmes et al., eds., Sexually Transmitted Diseases, 2nd edition, McGraw-Hill, New York, 1990. (54.) S. Blanche et al., "A Prospective Study of Infants Born to Women Seropositive for Human Immunodeficiency Virus Type 1," New England Journal of Medicine, 320:1643-1648, 1989. (55.) NIAID, "Syphilis," Factsheet, NIH, Bethesda, MD, 1992. (56.) NIAID, "Other Important STDs," Factsheet, NIH, Bethesda, MD, 1992. (57.) Bureau of the Census, "United States Population Estimates, by Age, Sex, Race, and Hispanic Origin, 1980-1988," Current Population Reports, P25-1045, 1990. (58.) Calculated by the AGI on the basis of references 26,37 and 57 and on F.L. Sonenstein, J.H. Pleck and L.C. Ku, "Sexual Activity, Condom Use and AIDS Awareness Among Adolescent Males," Family Planning Perspectives, 21:152-158, 1989. (59.) A.G. Randolph and A.E. Washington, "Screening for Chlamydia Trachomatis in Adolescent Males: A Cost-Based Decision Analysis," American Journal of Public Health, 80:545-550, 1990. (60.) J.D. Forrest, AGI, personal communication, Nov.11, 1992. (61.) A. Moscicki et al., "Human Papillomavirus Infection in Sexually Active Adolescent Females: Prevalence and Risk Factors," Pediatric Research, 28:507- 513, 1990. (62.) A.E. Washington, R.E. Johnson and L.L. Sanders, "Chlamydia Trachomatis Infections in the United States: What Are They Costing Us?" Journal of the American Medical Association, 257:2070-2072, 1987. (63.) A.A. Scitovsky and D.P. Rice, "Estimates of the Direct and Indirect Costa of Acquired Immunodeficiency Syndrome in the United States, 1985, 1986 and 1991,' Public Health Reports, 102:5-12, 1987. (64.) Institute of Medicine, The Future of Public Health, National Academy Press, Washington, DC, 1988. (65.) J. Kosterlitz, "AIDS Wars," National Journal, July 25, 1992, pp. 1727-1732. (66.) Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Title XXVI, Public Health Service Act). (67.) W. Cates, Jr., and K.M. Stone, "Family Planning, Sexually Transmitted Diseases and Contraceptive Choice: A Literature Update--Part II," Family Planning Perspectives, 24:122-128, 1992. (68.) 42 U.S.C. 247c (Section 318, Public Health Service Act). (69.) K. Toomey, GDC, personal communication, Dec. 9, 1992. (70.) W Gates, Jr., GDC, personal communication, Dec. 8, 1992. (71.) GDC, HIV/AIDS Prevention Fact Book 1992, Atlanta, 1992. (72.) K. Toomey, CDC, personal communication, Sept. 25, 1992. (73.) R. Merriweather, North Carolina Health Department, personal communication, Dec. 1,1992. (74.) Calculated by the AGI on the basis of GDC funding data. (75.) Division of STD/HIV Prevention, "Program Announcement and Notice of Availability of Funds for Fiscal Year 1990, Project Grants for Preventive Health Services, Sexually Transmitted Diseases Prevention," Announcement 004, GDC, Atlanta. (76.) Public Health Foundation, Washington, DC, unpublished data, Oct. 1992. (77.) Public Health Foundation, Public Health Agencies 1991: An Inventory of Programs and Block Grant Expenditures, Washington, DC, 1991. (78.) P. Donovan, "Family Planning Clinics: Facing Higher Costs and Sicker Patients," Family Planning Perspectives, 23:198-203, 1991. (79.) R.B. Gold and D. Daley, "Public Funding of Contraceptive, Sterilization and Abortion Services, Fiscal Year 1990," Family Planning Perspectives, 23:204-211, 1991. (80.) CDC, Directory of STD Clinics, Atlanta, 1987. (81.) K. Toomey, GDC, personal communication, Jan. 15, 1992. (82.) S. DeLisle, James Bowman Associates, Seattle, personal communication, Dec. 7,1992. (83.) K. Toomey, CDC, personal communication, Dec. 4, 1992. (84.) Calculated by the AGI on the basis of data from the 1988 National Survey of Family Growth. (85.) B. Johnson and D. Moser, CDC, personal communication, Mar. 3, 1992. (86.) "Program Spotlight: Widespread Screening Seeks to Lower Chlamydia Prevalence," Family Planning Perspectives, 24:135-136, 1992. (87.) Region X Chlamydia Project, "A Cost Effective Screening Program for Women in Family Planning Clinics," Factsheet, undated. (88.) TL. Chorbaetal., "Mandatory Reporting of Infectious Diseases by Clinicians," Journal of the American Medical Association, 262:3018-3026, 1989. (89.) N. Gibbs, GDC, personal communication, Oct. 7, 1992. (90.) K. Toomey, GDC, personal communication, Oct. 1, 1992. (91.) K. Toomey, CDC, personal communication, Nov. 22, 1991. (92.) W Gates, Jr., GDC, personal communication, Nov. 24, 1992. (93.) J. Wasserheit, CDC, remarks made at meeting of STD Coalition, Feb. 11, 1993, Washington, DC. (94.) H. Hunter Handsfield, "Control of Sexually Transmitted Chlamydial Infections," editorial, Journal of the American Medical Association, 257:2073-2074, 1987. (95.) A Caughran, American Social Health Association, personal communication, Nov. 9, 1992. (96.) "Special Report... U.S. Government Criticized for Censorship, Prudishness on Sexuality-Related Issues," Washington Memo, May 5, 1992 (WM-8), pp. 4-5. (97.) "Preventive Health Amendments of 1992," Conference report accompanying H.R. 3635, Report No. 102-1019, Washington DC, Oct. 5, 1992. (98.) PHS, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, U.S. Government Printing Office, Washington, DC, 1990. (99.) AL Trachtenberg, A.E. Washington and S. Halldorson, "A Cost-Based Decision Analysis for Chlamydia Screening in California Family Planning Clinics," Obstetrics and Gynecology, 71:101-108, 1988. (100.) B.G. Gellin and D.E. Rogers, "The Stalled Response to AIDS," Issues in Science and Technology, Fall 1992, pp. 24-28. (101.) J. Rovner, "Vote to End Fetal Tissue Ban Hinged on Personal Stakes," Congressional Quarterly, Apr. 4, 1992, pp. 879-880. (102.) AGI, Risk and Responsibility: Teaching Sex Education in America's Schools Today, New York, 1989. (50.) S.O. Aral, W.D. Masher and W Gates, Jr., "Self-Reported Pelvic Inflammatory Disease in the United States, 1988," Journal of the American Medical Association, 266:2570-2573, 1991. (51.) J.M. Graham and J.D. Blanco, "Chlamydial Infections," Primary Care, 17:85-93, 1990. (52.) J. Schachter, "Why We Need a Program for the Control of Chlamydia Trachomatis," editorial, New England Journal of Medicine, 320:802-804, 1989. (53.) L.T. Gutman and G.M. Wilfert, "Gonococcal Diseases in Infants and Children," in K.K. Holmes et al., eds., Sexually Transmitted Diseases, 2nd edition, McGraw-Hill, New York, 1990. (54.) S. Blanche et al., "A Prospective Study of Infants Born to Women Seropositive for Human Immunodeficiency Virus Type 1," New England Journal of Medicine, 320:1643-1648, 1989. (55.) NIAID, "Syphilis," Factsheet, NIH, Bethesda, MD, 1992. (56.) NIAID, "Other Important STDs," Factsheet, NIH, Bethesda, MD, 1992. (57.) Bureau of the Census, "United States Population Estimates, by Age, Sex, Race, and Hispanic Origin, 1980-1988," Current Population Reports, P25-1045, 1990. (58.) Calculated by the AGI on the basis of references 26,37 and 57 and on F.L. Sonenstein, J.H. Pleck and L.C. Ku, "Sexual Activity, Condom Use and AIDS Awareness Among Adolescent Males," Family Planning Perspectives, 21:152-158, 1989. (59.) A.G. Randolph and A.E. Washington, "Screening for Chlamydia Trachomatis in Adolescent Males: A Cost-Based Decision Analysis," American Journal of Public Health, 80:545-550, 1990. (60.) J.D. Forrest, AGI, personal communication, Nov.11, 1992. (61.) A. Moscicki et al., "Human Papillomavirus Infection in Sexually Active Adolescent Females: Prevalence and Risk Factors," Pediatric Research, 28:507- 513, 1990. (62.) A.E. Washington, R.E. Johnson and L.L. Sanders, "Chlamydia Trachomatis Infections in the United States: What Are They Costing Us?" Journal of the American Medical Association, 257:2070-2072, 1987. (63.) A.A. Scitovsky and D.P. Rice, "Estimates of the Direct and Indirect Costa of Acquired Immunodeficiency Syndrome in the United States, 1985, 1986 and 1991,' Public Health Reports, 102:5-12, 1987. (64.) Institute of Medicine, The Future of Public Health, National Academy Press, Washington, DC, 1988. (65.) J. Kosterlitz, "AIDS Wars," National Journal, July 25, 1992, pp. 1727-1732. (66.) Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (Title XXVI, Public Health Service Act). (67.) W. Cates, Jr., and K.M. Stone, "Family Planning, Sexually Transmitted Diseases and Contraceptive Choice: A Literature Update--Part II," Family Planning Perspectives, 24:122-128, 1992. (68.) 42 U.S.C. 247c (Section 318, Public Health Service Act). (69.) K. Toomey, GDC, personal communication, Dec. 9, 1992. (70.) W Gates, Jr., GDC, personal communication, Dec. 8, 1992. (71.) GDC, HIV/AIDS Prevention Fact Book 1992, Atlanta, 1992. (72.) K. Toomey, CDC, personal communication, Sept. 25, 1992. (73.) R. Merriweather, North Carolina Health Department, personal communication, Dec. 1,1992. (74.) Calculated by the AGI on the basis of GDC funding data. (75.) Division of STD/HIV Prevention, "Program Announcement and Notice of Availability of Funds for Fiscal Year 1990, Project Grants for Preventive Health Services, Sexually Transmitted Diseases Prevention," Announcement 004, GDC, Atlanta. (76.) Public Health Foundation, Washington, DC, unpublished data, Oct. 1992. (77.) Public Health Foundation, Public Health Agencies 1991: An Inventory of Programs and Block Grant Expenditures, Washington, DC, 1991. (78.) P. Donovan, "Family Planning Clinics: Facing Higher Costs and Sicker Patients," Family Planning Perspectives, 23:198-203, 1991. (79.) R.B. Gold and D. Daley, "Public Funding of Contraceptive, Sterilization and Abortion Services, Fiscal Year 1990," Family Planning Perspectives, 23:204-211, 1991. (80.) CDC, Directory of STD Clinics, Atlanta, 1987. (81.) K. Toomey, GDC, personal communication, Jan. 15, 1992. (82.) S. DeLisle, James Bowman Associates, Seattle, personal communication, Dec. 7,1992. (83.) K. Toomey, CDC, personal communication, Dec. 4, 1992. (84.) Calculated by the AGI on the basis of data from the 1988 National Survey of Family Growth. (85.) B. Johnson and D. Moser, CDC, personal communication, Mar. 3, 1992. (86.) "Program Spotlight: Widespread Screening Seeks to Lower Chlamydia Prevalence," Family Planning Perspectives, 24:135-136, 1992. (87.) Region X Chlamydia Project, "A Cost Effective Screening Program for Women in Family Planning Clinics," Factsheet, undated. (88.) TL. Chorbaetal., "Mandatory Reporting of Infectious Diseases by Clinicians," Journal of the American Medical Association, 262:3018-3026, 1989. (89.) N. Gibbs, GDC, personal communication, Oct. 7, 1992. (90.) K. Toomey, GDC, personal communication, Oct. 1, 1992. (91.) K. Toomey, CDC, personal communication, Nov. 22, 1991. (92.) W Gates, Jr., GDC, personal communication, Nov. 24, 1992. (93.) J. Wasserheit, CDC, remarks made at meeting of STD Coalition, Feb. 11, 1993, Washington, DC. (94.) H. Hunter Handsfield, "Control of Sexually Transmitted Chlamydial Infections," editorial, Journal of the American Medical Association, 257:2073-2074, 1987. (95.) A Caughran, American Social Health Association, personal communication, Nov. 9, 1992. (96.) "Special Report... U.S. Government Criticized for Censorship, Prudishness on Sexuality-Related Issues," Washington Memo, May 5, 1992 (WM-8), pp. 4-5. (97.) "Preventive Health Amendments of 1992," Conference report accompanying H.R. 3635, Report No. 102-1019, Washington DC, Oct. 5, 1992. (98.) PHS, Healthy People 2000: National Health Promotion and Disease Prevention Objectives, U.S. Government Printing Office, Washington, DC, 1990. (99.) AL Trachtenberg, A.E. Washington and S. Halldorson, "A Cost-Based Decision Analysis for Chlamydia Screening in California Family Planning Clinics," Obstetrics and Gynecology, 71:101-108, 1988. (100.) B.G. Gellin and D.E. Rogers, "The Stalled Response to AIDS," Issues in Science and Technology, Fall 1992, pp. 24-28. (101.) J. Rovner, "Vote to End Fetal Tissue Ban Hinged on Personal Stakes," Congressional Quarterly, Apr. 4, 1992, pp. 879-880. (102.) AGI, Risk and Responsibility: Teaching Sex Education in America's Schools Today, New York, 1989. [Graph omitted] Figure 2 Incidence: In 1992, the estimated numbers of new cases of STDs varied from 40,000 for HIV to four million for chlamydia and totaled 12 million. (*) HIV 40,000 Syphyilis 120,000 Hepatitis B 200,000 Genital Herpes 500,000 HPV 1 mil. Gonorrhea 1.1 mil Trichomoniasis 3 mil. Chlamydia 4 mil. (*)The chart does not include 2.2 million cases of urethritis and cervicitis caused by sexually transmitted organisms other than gonorrhea and chlamydia or 4,000 cases of chancroid. Sources: Division of STD/HIV Prevention, Division of STD/HIV Prevention 1992 Annual Report, CDC, Atlanta, 1993 (forthcoming); Senate Committee on Appropriations, "Departments of Labor, Health and Human Services, and Education and Related Agencies Appropriation Bill, 1993," report accompanying H.R. 5677, Report No. 102-397, Washington DC, Sept. 10. 1992. Figure 3 Curable cur·a·ble adj. Capable of being cured or healed. , Nonviral STDs: The five most serious in the United States, in order of estimated annual incidence in 1992, are chlamydia, trichomoniasis trichomoniasis (trĭk'əmənī`əsĭs), sexually transmitted disease caused by the parasitic protozoan Trichomonas vaginalis. , gonorrhea, syphilis and chancroid.
ANNUAL
STD INCIDENCE
Chlamydia 4 million (1)
Trichomoniasis 3 million (1)
Gonorrhea 1.1 million (1)
Syphilis 120,000, (1)
including
40,000-50,000
cases of
infectious
syphilis. (17)
Chancroid 3,500 (17)
STD DESCRIPTION
Chlamydia A bacterial infection acquired
chiefly through vaginal or anal
intercourse, although it can
also be trasmitted through oral
sex. (2) Up to 75% of cases in
women and 25% of cases in men
are asymptomatic. (3) When symptoms
are present, they usually appear
within 1-3 weeks of exposure and
may be very mild. Symptoms include
abnormal genital discharge and
burning during urination; (2) women
may experience lower abdominal pain
or pain during intercourse, and men
may suffer swelling or pain in the
testicles. (4)
Trichomoniasis A parasitic infection that most
often occurs in the vagina in women
and urethra in men. Symptoms are
often not present, especially in
men. When they do occur, symptoms
usually appear within 4-20 days
after exposure; they include vagi-
nal discharge, discomfort during
intercourse, vaginal odor and
painful urination. (10)
Gonorrhea A bacterial infection of the
cervix, urethra, rectum or throat
acquired through vaginal, anal or
oral sex. Symptoms, which are often
mild or absent, usually appear
within 2-10 days after exposure;
they include discharge from the
penis, vagina or rectum and burn-
ing or itching during urination.
(13)
Syphilis An infection caused by bacteria that
can spread throughout the body. The
most common way to acquire syphilis is
through vaginal, anal or oral sex with
someone who has an active infection. It
can also be spread by nonsexual contact
between sores produced by the disease,
which contain active bacteria, and
broken skin of another individual. In
the initial (primary) stage, it produces
painless sores, or chancres; these are
usually on the genitals, but can appear
anywhere on the body 10 days to three
months after exposure. Sores disappear
within a few weeks even without
treatment, but if not treated, the
disease may progress to other stages of
infection. Secondary syphilis is marked
by a rash that typically appears 3-6
weeks after the chancres emerge, (18)
although it can appear months
later. (11) It may cover the entire body
or occur only in a few areas. Other
symptoms may include mild fever,
fatigue, sore throat, hair loss and
swollen glands throughout the body.
These symptoms will also disappear
without treatment, but may come and go
for 1-2 years. If untreated at this
stage, the disease lapses into the
latent stage, during which it is not
contagious and produces no symptoms;
many infected persons who are not
treated will suffer no further
consequences, but about one-third will
develop the complication of late, or
tertiary, syphilis. (18)
Chancroid A bacterial infection acquired through
vaginal or anal intercourse that causes
painful open genital lesions, sometimes
accompanied by swollen, tender lymph
nodes in the groin. In women, symptoms
may be limited to painful urination or
defecation, painful intercourse, rectal
bleeding or vaginal discharge. Symptoms
appear within one week after
exposure. (19) The disease is more
common in men than in women. (20)
STD DETECTION
Chlamydia The most accurate way to diagnose
a chlamydial infection is to cul-
ture a sample of genital secreti-
onss, but this method is expensive
and results are not available for
several days. New non-culture tests
are slightly less accurate, but pe-
rmit rapid detection and can be pe-
rformed during routine checkups.
(2)
Trichomoniasis The parasitic can usually be iden-
tified in women through microsco-
pic examination of a specimen of
vaginal discharge. In men; a cul-
ture of fluid from the penis is a
more accurate means of diagnosis.
(10)
Gonorrhea Infection in men can be detected
through microscopic examination of
a specimen of genital discharge;
in women the preferred methods is
to culture cervical secretions.
(13)
Syphilis A diagnosis is usually made through
a physician's assessment of symptoms,
together with a blood test and a micro-
scopic examination of a specimen
from a chancre. (18)
Chancroid Lesions are difficult to distinguis
from ulcers caused by syphilis of
genital herpes. (19) The disease can be
detected through microscopic examination
of a specimen from a lesion, to
eliminate the possibility of syphilis,
followed by a complicated straining
procedure to identify the bacteria.
The identification process is difficult
and is not available in most public
clinics. (3)
STD TREATMENT
Chlamydia Infection can
be cured with
antibiotics. (2)
Trichomoniasis Infection can usually
be cured with oral
antibiotics. (10) New
formulations,
including a vaginal
cream and a gel, are
also effective.
(11,12)
Gonorrhea Infection can be cured
with antibiotics. (13)
However, the
proportion of cases
that are resistant to
penicillin has
increased
substantially, from
less than 1% in 1980
to more than 8% in
1990; penicillin-
resistant strains are
as much as 10 times
more expensive to
treat. (14)
Syphilis The disease can be cured
with penicillin, even in
the later stages; however,
damage done to body organs
cannot be reversed. (18)
Chancroid Infection can be cured will
antibiotics.
CONSEQUENCES FOR THE
STD INFECTED PERSON
Chlamydia If untreated in women,
up to 30% (5) of
infections may ascend
from the lower genital
tract into the uterus,
fallopian tubes,
ovaries or peritoneum,
causing PID, which in
turn often leads to
ectopic pregnancy,
infertility and
chronic pelvic pain.
(6) In men, chlamyda
can cause epidid-
ymitis, an inflam-
mation of a part
of the reproductive
system located near
the testicles where
sperm are stored and
mature; untreated, this
condition can result
in infertility. (2)
Infected individuals
are at increased risk
of acquiring HIV if
exposed to that
virus. (7)
Trichomoniasis Infected individuals
are at increased risk
of acquiring HIV if
exposed to that
virus. (7)
Gonorrhea Untreated gonorrhea
is a major cause of
PID and its sequelae-
ectopic pregnancy,
tubal infertility and
chronic pelvic
pain (13)-and can
cause sterility in
men. (15) Untreated
gonorrhea can spread
to the bloodstream
and infect the joints,
heart valves or brain.
(13) Infected
individuals are at
increased risk of
acquiring HIV if
exposed to that
virus. (7)
Syphilis If untreated, syphilis may
eventually cause serious damage
to the heart brain, eyes, nervous
system, bones and joints; it can
result in mental illness,
blindness, heart disease and death.
(18) Active stogukus increases the
risk that exposure to HIV will lead
to infection, probably because the
chancres provide an entry point for
the virus. (7)
Chancroid The disease increases the ask that
exposure to HIV will lead to
Infection, probably because the
sores provide a point of entry for
the virus. (7)
CONSEQUENCES FOR THE
STD FETUS AND NEWBORN
Chlamydia Infection in a pregnant
woman may result in
premature rupture of the
membranes and premature
delivery. (8) The
disease may be
transmitted to the baby
during delivery and is a
major cause of infant
pneumonia, which can be
life-threatening and
cause long-term
respiratory
complications. It is
also a major cause of
neonatal eye
infections. (9)
Trichomoniasis The disease may
contribute to
complications of
pregnancy, especially
premature delivery and
low birth weight. (10)
Gonorrhea The disease can cuase
blindness (13) and
systemic diseases such
as meningitis and
septic arthritis (16)
in infants infected
during delivery.
Syphilis A pregnant woman with active
syphilis who is not treated will
usually transmit the infection to
the fetus. About 25% of such women
have a stillbirth or bear an
infant who will die in the
neonatal period; some 40-70%
deliver an infant with active
syphills. If the infection is
undetected, the child may suffer
damage to the heart, brain and
eyes. (18)
Chancroid Unknown.
Sources (1.) Division of STD/HIV Prevention, Division of STD/HIV Prevention 1992 Annual Report, CDC, Atlanta, 1993 (forthcoming). (2.) National Institute for Allergy and Infectious Diseases (NIAID), "Chlamydial Infection," Factsheet, NIH, Bethesda, MD, June 1992. (3.) Division of STD/HIV Prevention, Division of STD/HIV Prevention 1991 Annual Report, CDC, Atlanta, 1992. (4.) American Social Health Association, "Some Questions and Answers About Chlamydia," Factsheet, Research Triangle Park Research Triangle Park, research, business, medical, and educational complex situated in central North Carolina. It has an area of 6,900 acres (2,795 hectares) and is 8 × 2 mi (13 × 3 km) in size. Named for the triangle formed by Duke Univ. , NC, 1990. (5.) Division of STD/HIV Prevention and Division of Reproductive Health Within the framework of WHO's definition of health[1] as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene , "Prevention of Infertility in the United States: Current Federal Program Activity and Future Program Needs," CDC, Atlanta, Sept. 1990. (6.) S. Harlap, K. Kost and J.D. Forrest, Preventing Pregnancy. Protecting Health: A New Look at Birth Control Choices in the United States, Alan Guttmacher Institute (AGI), New York, 1991. (7.) J.N. Wasserheit, "Epidemiological Synergy: Interrelationships Between Human Immunodeficiency Virus Infection and Other Sexually Transmitted Diseases," Sexually Transmitted Diseases, 19:61-77, 1992. (8.) F.A. Althaus, "An Ounce of Protection...STDs and Women's Health," Family Planning Perspectives, 23:173-177, 1991. (9.) J. Schachter, "Why We Need a Program for the Control of Chlamydia Trachomatis," Editorial, New England Journal of Medicine, 320:802-804, 1989. (10.) NIAID, "Vaginal Infections," Factsheet NIH, Bethesda, MD, June 1992. (11.) K. Toomey, CDC, personal communication, Dec. 4, 1992. (12.) M. Policar, Planned Parenthood Planned Parenthood A service mark used for an organization that provides family planning services. Federation of America, personal communication, Jan. 6, 1993. (13.) NIAID, "Gonorrhea," Factsheet, NIH, Bethesda, MD, June 1992. (14.) Division of STD/HIV Prevention, Sexually Transmitted Disease Surviellance 1990. CDC, Atlanta, July 1991. (15.) K. Forrest, "Gonorrhea," Factsheet, ETR ETR Estimated Time of Return/Repair ETR Early to Rise (health e-zine) ETR Effective Tax Rate Etr Etruscan (linguistics) ETR Eastern Test Range ETR Express Toll Route Associates, Santa Cruz, CA, 1989. (16.) L.T. Gutman and C.M. Wilfert, "Gonococcal Disease in Infants and Children," in K.K. Holmes et. al., eds., Sexually Transmitted Diseases, 2nd edition, McGraw-Hill, New York, 1990. (17.) Division of STD/HIV Prevention, Sexually Transmitted Disease Surveillance 1991, CDC, Atlanta, July 1992. (18.) NIAID, "Syphilis," Factsheet, NIH, Bethesda, MD, June 1992. (19.) NIAID, "Other Important STDs," Factsheet, NIH, Bethesda, MD, June 1992. (20.) H.H. Neumann and S. Simmons, Dr. Neumann's Guide to New Sexually Transmitted Diseases, Acropolis Books, Washington, DC, 1987. Figure 4 Incurable, Viral STDs: The four most serious in the United States, in order of estimated annual incidence in 1992, are HPV, genital herpes, hepatitis B Hepatitis B Definition Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic and HIV.
ANNUAL
STD INCIDENCE
HPV 500,000-
1 million (1)
Some 24-20
million people
are believed to
be infected
with HPV. (1,2)
Genital Herpes 200,000-
500,000 (1)
Approximately
31 million
Americans are
believed to have
genital herpes. (1)
Hepatitis B 100,000-
200,000 (1)
Approximately
1.5 million.
Americans carry
the infection. (10)
HIV 40,000 (13)
An estimated 1 million Am
already infected.
STD DESCRIPTION
HPV An infection that
sometimes produces
painless, flesy,
cauliflowerlike warts on
and inside the genitals,
anus and throat, which
is acquired through
vaginal anal or oral sex.
About one-third of the
more than 60 known
strains of HPV can be
transmitted sexually,
even when warts are not
visible. (3,4)
Genital Herpes An infection that is
spread by direct skin-to
-skin contact with the
infected site, (7) even
when the infected
individual has no
symptoms; usually caused
by herpes simplex virus
type 2 (HSV-2). (Another
strain of the virus,
HSV-1, which is most
commonly spread by
nonsexual contact and
usually causes sores on
the lips, can also be
transmitted through oral
sex and can cause
genital infections, as
well.) Symptoms of the
infection, which are
often very mild, may
include an itching or
burning sensation, pain
in the legs, buttocks,
or genital area, or
vaginal discharge.
Symptoms develop 2-10
days after exposure and
last about 2-3 weeks.
Within a few days,
blisters or painful open
sores may appear,
usually in the genital
area, buttocks, anus and
thighs, although they
can erupt virtually
anywhere. Sores heal
after several weeks, but
many people suffer
painful recurrences. (8)
Hepatitis B An infection that attacks
the liver. The virus is found
in semen, saliva, blood
and urine. (11) It is spread
through sexual contact, especially
anal intercourse; by sharing drug
needles; and by piercing
the skin with contaminated
instruments such as those used
in dental and medical
procedures. (10,11) About
one-third of people with HBV
have a completely "silent" disease.
When symptoms are present, they may
be mild or severe; they include
fever, headaches, muscle
aches, fatigue, loss of
appetite, vomiting and diarrhea.
Later stages may be marked
by dark urine, abdominal pain
and yellowing of the skin and the
whites of they eyes. (10)
HIV An infection that progressively
destroys the body's ability to
fight infections and certain
cancers by destroying or damaging
cells of the immune system. The
virus is present in semen, blood
and vaginal secretions. It is most
commonly transmitted through sex
with an infected partner; it
can enter the body through the
lining of the vagina, vulva,
penls, rectum or mouth it can
also be spread through contact
with infected blood, primarily by
sharing drug needles contaminated
with blood of an infected person.
Some individuals experience no
symptoms when first infected;
others have flulike symptoms--
fever, loss of apptite and weight,
fatigue, enlarged lymph nodes--
1-2 months after exposure.
These symptoms usually disappear
within a week to a month;
the virus may then be dormant for
years, but it continues to weaken
the immune system, leaving the
individual increasingly unable
to fight opportunistic infections.
Individuals may experience a
variety of smptoms long before the
onset of AIDS, including prolonged
enlargement of lymph node
(i.e., for more than three
months), weight loss, frequent
fevers or sweats; and persistent
yeast infections, rashes and other
infections. (14)
STD DETECTION
HPV Some strains of the virus
cause warts, which are
usually visible to the
infected person unless
they are in the vagina or
on the cervix. Women with
genital warts should be
examined for precancerous
conditions of the cervix.
An abnormal Pap smear can
indicate a cervical HPV
infection. (3)
Genital Herpes Active sores are usually
visible, but lab tests are
needed to distinguish
genital herpes sores
from other infections.
The most accurate method
of diagnosis is a viral
culture of a specimen
from a lesion, (8)
although microscopic
examination is also
possible. (5) Bloot tests
can detect antibodies to
the virus indicating an
individual has at some
time been infected.
However anitbodies do not
prevent reactivation of
the latent virus. (8)
Hepatitis B The virus, as well as antibodies
to the virus, can be dete
by a blood test. (10)
HIV HIV infection can be detected
by testing blood for the presence
of antibodies. (14)
STD TREATMENT
HPV Warts can be suppressed by
chemicals, freezing, laser therapy
and surgery, but evidence of
infection often reappers. Women
with HPV infection should have a
Pap test at least annually to
monitor for changes in cervical tissue
that could indicate progression
toward cancer. (3)
Genital Herpes An antiviral drug is usually
effective in reducing the
frequency and duration of
outbreaks. (8)
Hepatitis B Most infections
clear up by
themselves within
4-8 weeks. (10) Some
individuals, however,
become chronically
infected. A Vaccine
is available, but it
is under-utilized in
public clinics, in
part because it is
too costly to offer
without charge
to all at-risk
individuals. (2)
HIV New antiviral drugs
have proven effective
in slowing the
spread of HIV and
delaying the onset
of opportunistic
infections. (14)
CONSEQUENCES FOR THE
STD INFECTED PERSON
HPV Several strains of the
virus are strongly
associated wth cervical
cancer, as well as
cancers of the vulva,
vagina, penis and anus.
These stains generally
do not cause visible
warts (3,5)
Genital Herpes When sores are present,
herpes infection
increases the risk that
exposure to HIV will
lead to infection,
probably because the
sores provide an
entry point for the
virus. (9)
Hepatitis B In individuals who are
chronically infected, the
disease can lead to cirrhosis,
liver cancer and immune
system disorders. (10) The
disease kills about 6,000
Americans annually. (12)
HIV Virtually everyone who
becomes infected with HIV
will eventually develop AIDS
and die of AIDS-related
complications. HIV appears
promote the spread of other
STDs by compromising the
immune system and making
treatment less effective. (9)
CONSEQUENCES FOR THE
STD FETUS AND NEWBORN
HPV Infants exposed to the
virus in the birth canal can
develop warts in the
throat, a rare but
potentially life-
threatening condition
that obstructs their
air passages. (3,6)
Genital Herpes Women who develop a
first episode of genital
herpes during pregnancy
may be at higher risk
for premature delivery
Outbreaks present
during labor usually
indicate the need for
a cesarean delivery
because infection can
be passed to the
newborn during
children; half of
infants who become
infacted die or suffer
serious brain
damage. (8)
Hepatitis B Infected pregnant women can
transmit the infection to
their offspring. Some 90% of
infants infected at birth
become chronic carriers, (10)
and thus are at risk of liver
disease and liver cancer, and
can transmit the virus. If a
pregnant woman is screened
and identified as a carrier
of HBV, her infant can be
given immunoglobulin and
vacinated at birth,
potentially eliminating the
risk of chronic infection. (6)
HIV A third of infants born to
infected mothers are
themselves infected and
develop evidence of infection
within one year after birth;
20% of these babies die by
the time they are 18 months
old. (15)
Sources (1.) Division of STD/HIV Prevention, Division of STD/HIV Prevention 1992 Annual Report, CDC, Atlanta, 1993 (forthcoming). (2.) Division of STD/HIV Prevention, "An Update on Sexually Transmitted Diseases (STDs)," Factsheet, CDC, Atlanta, 1992. (3.) NIAID, "Human Papillomavirus and Genital Warts," Factsheet, NIH, Bethesda, MD, June 1992. (4.) American Social Health Association (ASHA), HPV News, Vol. 1, Winter 1991. (5.) Division of STD/HIV Prevention, Division of STD/HIV 1991 Annual Report, CDC, Atlanta, 1992. (6.) K. Toomey, CDC, personal communication, Dec. 4, 1992. (7.) ASHA, "Herpes," Factsheet, Research Triangle Park, NC, 1991. (8.) NIAID, "Genital Herpes," Factsheet, NIH, Bethesda, MD, June 1992. (9.) J.N. Wasserheit, "Epidemiological Synergy: Interrelationships Between Human Immunodeficiency Virus Infection and Other Sexually Transmitted Diseases, Sexually Transmitted Diseases, 19:61--77, 1992. (10.) NIAID, "Viral Hepatitis viral hepatitis n. Any of various forms of hepatitis caused by a virus. viral hepatitis, n an inflammatory condition of the liver, caused by the hepatitis viruses: A, B, C, delta, E, F, G, or H. ," Factsheet, NIH, Bethesda, MD, June 1992. (11.) Abbott Laboratories, "Hepatitis: Everything from A to E," Factsheet, Abbott Park, IL, undated. (12.) R. Harpaz, CDC, personal communication, Jan. 18, 1993. (13.) Senate Committee on Appropriations, "Departments of Labor, Health and Human Services, and Education and Related Agencies Appropriation Bill, 1993," report accompanying H.R. 5677, Report No. 102-397, Washington DC, Sept. 10,1992. (14.) NIAID, "HIV Infection and AIDS," Factsheet, NIH, Bethesda, MD, June 1992. (15.) S. Blanche et al., "A Prospective Study of Infants Born to Women Seropositive for Human Immunodeficiency Virus Type 1," New England Journal of Medicine, 320:1643-1648, 1989. |
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