The incidence of sexually transmitted diseases has increased dramatically in recent years, particularly among women and teenagers, but federal public-health funding to detect and treat the diseases goes to clinics that predominantly serve men, says Dorothy Mann, the executive director of the Family Planning Council of Southeastern Pennsylvania.
“It is rare that a patient comes into a family-planning clinic these days who does not have a sexually transmitted disease,” said Mann, who is responsible for distributing money to 60 clinics that serve about 100,000 low-income women and teens in the Philadelphia area.
“We have seen a dramatic increase in all STDs in the last five to eight years, and the most significant increase is occurring in young women, primarily teenagers,” she said.
Women and teens tend to seek health care at family planning clinics, which are not part of the Center for Disease Control and Prevention’s STD system. The system is set up to distribute money to state and local public health departments that in turn fund STD clinics.
“The way the money flows, it doesn’t get to the places where young teens and women are being seen,” Mann said. “The thing that is difficult for us is we are screening and treating a tremendous amount of STD, but we are not considered part of the STD system. So we have to use our family planning funds to support this component of our service.”
Mann’s observations are borne out in a new report that estimates that 12 million sexually transmitted infections occur every year in the United States, meaning that one in four Americans will be at risk at some point.
The report, “Testing Positive: Sexually Transmitted Disease and the Public Health Response,” prepared by the Alan Guttmacher Institute, an independent, nonprofit research organization, notes that women are hit hardest by STDs because they are more susceptible to infection and are less likely to experience symptoms than men. They also are more likely to suffer serious health consequences.
An estimated 1 million women contract pelvic infections each year as a result of undetected STDs, and many of these women become infertile as a result, the report said. About 15 to 30 percent of the 2.3 million American couples who are infertile may be unable to conceive as a result of STDs.
Women who have had pelvic infections also are 6 to 10 times as likely to have ectopic pregnancies, potentially life-threatening conditions in which a fertilized egg cannot pass into the uterus because of scarring in a fallopian tube and instead implants in a tube or in an ovary. Ectopic pregnancies are a major cause of maternal death in the United States, particularly among black women.
More than 4,500 women die annually from cervical cancer, which is associated with several strains of human papillomavirus, a common sexually transmitted disease.
In addition, pregnant women infected with STDs can transmit the infections to their children during pregnancy or childbirth. This can result in miscarriage, stillbirth, infant death, premature delivery, low birth weight, chronic respiratory problems, blindness and mental retardation.
“Until the early 1980s there were five well-known STDs, including syphilis and gonorrhea,” said Patricia Donovan, Alan Guttmacher Institute’s senior associate for law and public policy and author of the report.
“The CDC now says there are over 50 well-known diseases that are sexually transmitted, and some of them are increasing very rapidly.
“Anybody who is sexually active is at risk of contracting a STD unless they are involved in a longstanding, mutual and monogamous relationship,” Donovan said.
Some of the diseases, such as syphilis, gonorrhea and chlamydia, are bacterial; if detected early, they can be treated and cured. Others, such as genital herpes, hepatitis B or HPV, are viral and incurable.
The HIV virus, which causes AIDS, can be transmitted sexually as well.
Because of the high profile of the deadly AIDS disease, the CDC spent $478 million on HIV prevention in fiscal 1992, compared to the $75 million on testing and treating of all other STDs.
Donovan’s report recommends that higher priority be given to primary prevention activities aimed at persuading individuals to change their behavior (such as reducing the number of sexual partners to reduce exposure to STDs) and to use condoms consistently and correctly.
Currently, the federal STD program focuses primarily on controlling the spread of disease through activities such as screening and partner notification rather than on interventions designed to assist individuals in avoiding infection altogether.
The emphasis on secondary prevention reflects the program’s historic focus on bacterial diseases that can be cured with antibiotics rather than on incurable viral diseases.
The report also recommends that Congress increase funds for primary prevention and for the detection and treatment of STDs in early stages, and to allocate more money for services targeted to women and teenagers who are disproportionately affected by STDs.
Other findings in the report include:
– At least 56 million Americans-more than 1 in 5-are estimated to be infected with incurable venereal diseases such as genital herpes, HPV or hepatitis B.
– One of the fastest-growing sexually transmitted diseases is chlamydia, a bacterial infection that affects about 4 million people a year. Up to 75 percent of chlamydia infections in women and up to 25 percent of cases in men show no symptoms.
– While syphilis and gonorrhea have virtually disappeared in most industrial countries, in the United States, infectious syphilis is at its highest level in 40 years and gonorrhea is the country’s most commonly reported communicable disease. Yet those two diseases represent only 10 percent of the total annual number of cases of STDs in America.
