The Hidden Epidemic
Confronting Sexually Transmitted Diseases
Sexually transmitted diseases (STDs) are hidden epidemics of tremendous health and economic consequence in the United States. They are hidden from public view because many Americans are reluctant to address sexual health issues in an open way and because of the biological and social factors associated with these diseases. In addition, the scope, impact, and consequences of STDs are underrecognized by the public and health care professionals.
Of the top ten most frequently reported diseases in 1995 in the United States, five are STDs. Rates of curable STDs in the United States are the highest in the developed world and are higher than in some developing regions. Approximately 12 million new cases of STDs, 3 million of them among teenagers, occur annually. The committee estimates that the annual direct and indirect costs of selected major STDs are approximately $10 billion or, if sexually transmitted HIV infections are included, $17 billion. Along with the human suffering associated with STDs, this cost is shared by all Americans through higher health care costs and taxes. STDs represent a growing threat to the nation's health and national action is urgently needed.
The term "STD" denotes the more than 25 infectious organisms that are transmitted through sexual activity, along with the dozens of clinical syndromes that they cause. The spectrum of health consequences ranges from mild acute illness to serious long-term complications such as cervical, liver, and other cancers and reproductive health problems. Women and infants bear a disproportionate burden of STD-associated complications. A variety of women's health problems, including infertility, ectopic pregnancy, and chronic pelvic pain, result from unrecognized or untreated STDs. From 1973 through 1992, more than 150,000 U.S. women died of causes associated with STDs (including HIV infection) and their complications. Women are particularly vulnerable to STDs be cause they are more biologically susceptible to certain sexually transmitted infections than men and are more likely to have asymptomatic infections that commonly result in delayed diagnosis and treatment. Active infection with STDs during pregnancy may result in a range of serious health problems among infected infants, including severe central nervous system damage and death. Adolescents are at greatest risk of STDs because they frequently have unprotected sexual intercourse, are biologically more susceptible to infection, and are likely to have social problems that significantly increase their risk.
STDs are difficult public health problems because of the "hidden" nature of these diseases. The sociocultural taboos related to sexuality are a barrier to STD prevention efforts on a number of levels. Effective STD prevention efforts also are hampered by biological characteristics of STDs, societal problems, unbalanced mass media messages, lack of awareness, fragmentation of STD-related services, inadequate training of health care professionals, inadequate health insurance coverage and access to services, and insufficient investment in STD prevention.
Although the barriers to STD prevention are formidable, STDs can be prevented by intervening at multiple points with behavioral, biomedical, and structural interventions on both individual and community levels. These and other effective interventions, however, are not being fully implemented or utilized. Because STDs are complex diseases that are associated with a variety of social issues and involve a wide spectrum of stakeholders in the community, a collaborative, multifaceted approach to STD prevention is essential.
