While AIDS is the deadliest sexually-transmitted disease, we easily forget how much more widespread other STDs are. Today, there are an estimated 800,000 to 900,000 people living with HIV/AIDS in the United States, roughly one out of every 345 people. It has rightly gained mass media attention and come to dominate sex education materials. Let's take a look at the numbers on some other scourges, though:
65 million, or 1 out of every 4 people: The number of people living with a sexually transmitted disease (STD) in the United States.
50 million, or 1 out of every 5 people: The number of individuals infected with incurable genital herpes, with 1 million new cases each year in the United States and at least 80% of those infected unaware that they even carry the virus.
20 million, or 1 out of every 13 people: The approximate number of people who have the human papillomavirus (HPV), with over 5 million becoming infected annually. More shocking, 50 to 75% of sexually active men and women in the United States will acquire HPV at some point in their lives.
15 million, or 1 out of every 18 people: In any given year, the estimated number of people who become infected with a sexually transmitted disease (STD) in the United States.
702,093: The number of reported chlamydia infections that occur annually; however, the CDC and NIH estimate that there are in actuality 4 to 8 million new cases each year, most going unreported.
360,000: The number of reported cases of gonorrhea, with drug-resistant strains making an appearance in the United States in the past few years.
While a great deal of attention and funding (some $10 billion at the federal level) has been focused on HIV/AIDS, the American public tends to know very little about the other, less dire sexually transmitted diseases out there. We are living in ignorance of the diseases that we are at the greatest risk of contracting, diseases that can have a significant impact on our lives.
Viral STDs
HPV
There are over 100 types of HPV, with thirty types of the disease passed through sexual contact. There is no known cure, but fortunately most cases of HPV clear up within six months. However, it is often symptomless and there lies the problem. Individuals are unaware that they carry the disease and thus pass it along.
Surprisingly, most Americans are not aware that HPV is one of the most common STDs. Only 2% of individuals identified it when they were asked to name an STD they're familiar with. A 2001 study in the Journal of the American Board of Family Practice found that only 45% of college students could answer basic HPV questions correctly. Finally, a 2000 study in the Journal of Community Health found that college students surveyed had greater knowledge about genital warts than HPV even though HPV causes genital warts and were uncertain about modes of transmission of both diseases.
The best defense against HPV is a monogamous relationship with an uninfected partner or abstinence. A 2000 workshop sponsored by the National Institute of Allergy and Infectious Diseases and the National Institutes of Health concluded that there is "no evidence that condom use reduced the risk of HPV infection." They are not nearly as effective against HPV as they are against HIV.
A possible negative health consequence of contracting HPV is cervical cancer. Cervical cancer is the first cancer affecting only females that has been found to be directly caused by a virus. A 1999 Journal of Pathology study concluded: "The worldwide HPV prevalence in cervical carcinomas is 99.7 per cent. The presence of HPV in virtually all cervical cancers implies the highest worldwide attributable fraction so far reported for a specific cause of any major human cancer." For the majority of women, HPV will not develop into cervical cancer, although persistent, chronic HPV infections in women past the age of thirty increase the risk. Such women experience cervical lesions caused by high-risk strains of the virus, which over time (ten to twenty years) turn into cancer if left untreated. Usually, these lesions are removed by surgical means. However, there is a drug in trial phase that has shown positive results in eliminating the lesions without surgery. The drug, ZYC101a, was found to eradicate the precancerous condition in 43% of women on the drug, compared to 27% in the control group. It was found to be even more effective in younger women, eliminating 70% of the lesions, compared to 23% in the placebo group.
Another result of HPV infection is genital warts. These hard, painless bumps in the genital area make an appearance within a few weeks of sexual contact with an infected person. If they are ignored, they can grow and develop into larger, fleshy, cauliflower-like growths. They can also take months or years to show up and are treated with freezing, a topical drug, or, if large, by surgery. Sometimes they return months after treatment and in rare cases return years after they are believed to be eradicated. However, most people who have warts that were successfully treated will never experience a flare up again.
Hepatitis B
Hepatitis B (HBV) is a viral infection that is transmitted through bodily fluids, either sexually (accounting for two-thirds of the 1 to 1.25 million cases in the U.S.), through the use of contaminated needles, or neonatally, and it is a hundred times more infectious than HIV. With no known cure, HBV can lead to cirrhosis of the liver, chronic infection, liver failure, and liver cancer, accounting for 4,000 to 5,000 deaths each year in the United States. However, there is a vaccine that is protective against the disease. (The more common Hepatitis C, which infects 3.9 million Americans, can also be spread through sexual contact, though much less efficiently than HBV and other viral STDs.)
Genital Herpes
Finally, the prevalence of genital herpes has increased by 30% since the 1970s, and a recent study in the October issue of Sexually Transmitted Diseases predicts that if nothing is done to curtail the current rate of transmission, nearly half of all women between the ages of fifteen and thirty-nine in the U.S. will be infected with genital herpes by 2025.
This outbreak of painful blisters and sores in the genital region is caused by the herpes simplex virus (HSV) and lasts for about two to three weeks. Even when the blisters disappear, the virus remains present in the body for life and the infected individual can experience recurring flare-ups. Condoms offer the best protection against the disease, but they do not totally eliminate risk, since they may not successfully cover all the lesions. Those with oral herpes should be aware that cold sores can be passed to the genital area (and that genital herpes can be passed to the mouth).
Non-Viral STDs
In 1996, two-thirds of all STDs were attributable to HPV or to the treatable trichomoniasis. Trichomoniasis is a sexually transmitted disease caused by a protozoan parasite and is the most common bacterial STD. Each year, nearly 5 million men and women become infected. While most men are asymptomatic, many women exhibit the symptoms of an infection, such as vaginal discharge, itching, and irritation. Luckily, trichomoniasis is easily treated with the prescription drug metronidazole.
Chlamydia infection is curable and easily treated with an antibiotic, but most people (85% of women and 40% of men) are unaware that they are infected, since they are asymptomatic. Thus, they unknowingly pass it along. When chlamydia goes untreated, approximately 50% of women will experience pelvic inflammatory disease (PID), which is one of the most common causes of ectopic pregnancy (9% in those with PID), infertility (20% in those with PID), and chronic, debilitating pain (18% of those with PID).
In 2001, gonorrhea was the second most reported communicable infection in the United States, behind chlamydia. For the most part, it is asymptomatic in women, but when symptoms do occur, they include discharge and painful urination. While it too can be treated with prescription drugs such as penicillin, in the last few years strains have been emerging in the United States that aren't so easy to treat. Untreated gonorrhea, like chlamydia, can lead to PID, ectopic pregnancy, and infertility.
Risk and Stigma
We should not ignore the great risk that accompanies sexual freedom, which exposes a sexually-active public to the more than twenty sexually transmitted diseases that have now been identified. It has been estimated that only 44% of adults have ever been tested for an STD other than HIV/AIDS, and only 14% of men and 8% of women think they are personally at risk. STD treatments cost society $8.4 billion annually: $4.5 billion for HIV, $1.6 billion for HPV, and another $2 billion for curable STDs.
There are personal costs as well. HIV/AIDS is not the only disease that is incurable, can carry a stigma, and has a great impact on lives. With two-thirds of STD cases occurring in individuals younger than twenty-five, we must increase awareness of all sexually transmitted diseases not just HIV/AIDS especially in this segment of the population. We cannot completely eliminate the risks associated with sex except by abstinence, but we can reduce the risks with education and awareness.
Karen Schneider is a research intern at the American Council on Science and Health.
