Wednesday, October 26, 2016

STDs- The "Underestimated Opponent"

The CDC recently released the 2015 National Overview of Sexually Transmitted Diseases, and the rising numbers are disturbing. The CDC's forward begins by very accurately labeling STDs as a long-standing "underestimated opponent in the public health battle". We CANNOT continue to ignore sexually transmitted infections and assume it is "those people over there" and not OUR crowd who gets these infections! While ZIKA VIRUS has definitely opened up more non-judgmental discussions about STDs, we have a long way to go. Here are a few highlights from the report:
  • CHLAMYDIA, the most common bacterial STD, has increased it's rate by 5.9% from 2014, with over 1.5 MILLION cases reported (and an estimated 3 MILLION actual cases), including 645.5 cases per 100,000 females, and 305.2 cases per 100,000 males. Simplified testing (with urine samples rather than only pelvic exams, for example) have increased the number of people tested, so yes that explains some increase, but the overall number is still...huge. And why do we care? Because undiagnosed and untreated chlamydia infection can lead to chronic pelvic pain, more serious infection (PID-Pelvic Inflammatory Disease), and even infertility. The vast majority of chlamydia infections are SILENT, so if you don't think you are "at risk" so you don't get screened, you will not know you have it. Between 10-30% of untreated chlamydia infections progress to PID, and 10-20% of those cause infertility. Think of the emotional, physical and financial burden that could be eased...if people simply were tested routinely, so diagnosed and treated. 
  • GONORRHEA, another bacterial STD, was on track to be eliminated back in 2009, but we are going the wrong direction now with a rate increase of 12.8% AND increased drug resistance. We literally only have ONE recommended treatment now for gonorrhea (a combination of an injection of ceftriaxone and an oral dose of azithromycin) and resistance is growing. How many actual cases? Not the 1.5 MILLION reported number like chlamydia, but approaching a half million at 395, 216 cases. And once again, this is only the number reported. More disease + less cure = SCARY. Untreated gonorrhea, like untreated chlamydia, can cause chronic pelvic pain, PID, and infertility, not to mention spreading throughout the body to joints, the heart and the brain (meningitis).
  • SYPHILIS is far less common that Chlamydia or Gonorrhea, with a bit less than 24,000 cases in 2015, but unfortunately this disease is rising as well, and sadly there were still 487 babies born with congenital syphilis last year.

These three STDs can be detected and treated successfully IF sexually active people will get tested regularly, but we have to improve our education and social dialogue so everyone understands that sexually transmitted diseases are underestimated on a personal basis, because we still think you can tell what "sort" of person would have these infections.

Bottom Line: If you are sexually active with a new partner, then you are that "sort" of person that could have an STD- because we ALL are, regardless of income, social status, religious beliefs or gender preferences. GET TESTED!! (And expect your partner to do the same.)

Thursday, October 6, 2016

ZIKA's Unexpected Gifts

In no way do I want to minimize the serious complications of Zika. However, the media buzz surrounding Zika offers an unexpected gift- effective STI (sexually transmitted infection) education. What is Zika doing that AIDS did not?

·      Zika normalizes TALKING about STIs
Zika arrived as the newest “malaria”- a mosquito-borne illness, with the added threat of potentially devastating consequences in pregnant women. Like familiar flu season reports, headlines track Zika’s progress across geographical borders, firmly establishing Zika as a hot topic. Pictures of infants with birth defects tug at our hearts, while reporters jockey to broadcast the latest Zika developments. And then, BOOM- when health experts discovered that Zika could also be transmitted sexually...the conversation automatically extended to include condom usage and medically recommended abstinence. Zika fortunately lacks the “yuck” factor (and visual images) that shove other STIs out of well-mannered conversations, so the buzz continues.

·      Zika clearly shows ANYONE can get an STI
HIV/AIDS pointed a national spotlight on STIs, but that light was sharply focused on subpopulations at the highest risk- homosexual males, sex workers and IV drug users. The greatest myth is that STIs only occur “over there, in those people” (translation- not MY peers). After twenty years of private practice in an educated, affluent community, I can assure you that sexually transmitted infections also occur commonly in college students, soccer moms (and dads), and successful professionals who fit none of the traditional “high risk” subgroups. (Curious? Check out Seductive Delusions: how everyday people catch STIs for a sneak peak behind exam room doors.)

·      Zika, like most STDs, is often SILENT.
Zika may cause mild to severe symptoms including fever, rash, headache, painful joints and irritated eyes. In pregnant women, Zika can cause birth defects.  But Zika often causes no symptoms at all, which means infected people may have no idea they are carrying a disease that they can pass on to another person- which is the scariest truth about ALL sexually transmitted infections. For example, chlamydia, the most common bacterial STD, causes either very transient or no symptoms the vast majority of the time (90% in males, and at least 70% in females), yet if not diagnosed and treated, can lead to chronic pelvic pain and even infertility. Take home lesson?  “No symptoms” does NOT equal “no disease”. Get tested. Ask your partner to get tested.

·      PREVENTION is better than CURE
For Zika, prevention is all we have. Travel advisories, environmental pest control, and personal insect repellent target mosquito transmission. Consistent condom use for all types of sexual intimacy (oral, vaginal and anal sex) decreases the transmission every STI, including Zika. Effective vaccines extend our STI prevention for hepatitis B and HPV, and anti-viral medications help decrease transmission of herpes and HIV. While antibiotics can cure bacterial disease, they cannot undo damage already caused by long-standing untreated infections. Treatment is good, but prevention is better.

BOTTOM LINE:  Thank you, Zika, for expanding and normalizing discussions about sexually transmitted infections, and reminding us that the only way to know if you or a potential partner is carrying a silent infection is to GET TESTED- and START TALKING.

*This post was first published in the Johns Hopkins University Press Blog