Sexually Transmitted Diseases | Introduction
Sexually transmitted diseases (STDs), also called venereal diseases, are caused by germs that travel from person to person through sexual contact. Common STDs include syphilis, chlamydia, genital herpes, gonorrhea, and AIDS. Because the germs that cause STDs die quickly outside the human body, these sicknesses are not spread through coughing, sneezing, or contact with infected objects such as toilet seats or eating utensils. Most STDs, however, can be transmitted from an infected pregnant woman to her baby, often causing serious and life-threatening complications for the infant. Some viral diseases, including AIDS and hepatitis B, are spread through direct exposure to infected blood and can be transmitted through sexual contact or through nonsexual means such as the sharing of needles for drug use.
Sexually transmitted diseases have become a serious health problem in the United States. The Institute of Medicine, an arm of the National Academy of Sciences, asserts that STDs are prevalent and constitute a “hidden epidemic” because of the reluctance of Americans to “address sexual health issues in an open way.” With twelve million new cases a year, America has one of the highest rates of STD infection in the industrialized world. STDs (including AIDS) cost the United States an estimated $17 billion in health care costs each year.
Chlamydia, a bacterial infection, is the most common sexually transmitted disease in the United States, affecting at least four million Americans annually. It is one of several STDs that can cause pelvic inflammatory disease—the inflammation of a woman’s reproductive tract, which if left untreated can lead to infertility and death. The effects of other STDs vary. Genital herpes can create blistering and discomfort. The human papillomavirus (HPV) may cause cervical cancer. AIDS can fatally impair the body’s immune system.
Young people are especially at risk for many sexually transmitted diseases. Teenagers account for three million cases of STDs annually. One out of every four sexually active teenagers acquires a new STD each year. One quarter of new infections of HIV (the virus that causes AIDS) are found in people under 22. Young women are at greater risk than older women for reproductive and health complications caused by STDs.
The medical options for the treatment and prevention of sexually transmitted diseases are somewhat limited. Some bacterial STDs, including chlamydia, syphilis, and gonorrhea, can be treated with antibiotics if detected early enough (although the evolution of new germs resistant to antibiotics is a growing problem). Antibiotics are useless against viral STDs, however. Public health measures have therefore focused primarily on preventing the spread of STDs. Because vaccinations for STDs are still in the research stage, efforts to prevent STDs have centered on reducing risky sexual activities. Yet while most people agree that healthy and re- sponsible sexual behaviors should be promoted in the media, in clinics, and in sex education classes, profound disagreements exist as to what constitutes responsible behaviors.
For some people, responsible and disease-preventing behavior is synonymous with sexual restraint. They believe that everyone should be taught that abstaining from sex altogether or confining sex within a mutually monogamous relationship are the only 100 percent effective methods of keeping oneself free of all sexually transmitted diseases. Engaging in sex with multiple partners and relying on condoms to prevent STDs, in this view, is risky because condoms sometimes break, are not used properly, or are simply ineffective. Many advocates of abstinence criticize sex education programs in schools for including information on condoms and “safe sex,” arguing that such a curriculum gives teenagers a false sense of security about sex and fails to discourage sexual activity. “To present ‘protected’ sex as an alternative to abstinence is inadequate,” argues Joe S. McIlhaney, a gynecologist and founder of the Medical Institute for Sexual Health. “The best that ‘safer sex’ approaches can offer is some risk reduction. Abstinence, on the other hand, offers risk elimination. When the risks of pregnancy and disease are so great, even with contraception, how can we advocate anything less?”
Most people agree that abstinence is the most effective way of preventing sexually transmitted diseases and that people should be made aware that certain activities—including sex at an early age and sex with multiple partners or prostitutes—greatly increase the risks of contracting STDs. But many sex education authorities, such as Debra W. Haffner of the Sexuality Information and Education Council of the U.S., contend that abstinence should not be the sole emphasis of STD prevention and sex education programs. Americans should acknowledge that many teenagers are engaging in sexual activity, Haffner and others maintain. Studies have found that the average age of first intercourse in the United States is sixteen and that two-thirds of America’s high school seniors are sexually experienced prior to graduation. Haffner argues that, given the reality that many teenagers reject the option of abstinence, young people should be given comprehensive sexuality information “about their bodies, gender roles, sexual abuse, pregnancy, and STD prevention,” including the proper use of condoms to prevent diseases. She asserts that “fearbased, abstinence-only programs” that “discuss contraception only in negative terms” threaten to reverse “the significant strides American youth have made during the last two decades to delay sexual activity or else protect themselves.”
Many of the viewpoints in At Issue: Sexually Transmitted Diseases reflect the differences between those who highlight sexual restraint and traditional values as imperative to preventing STDs and those who emphasize condom use and other methods of risk reduction. The relative merits of abstinence and condoms are among the several controversial issues discussed by the educators, health activists and organizations, and other contributors to this volume, all of whom present differing views on how best to stem the ongoing “hidden” epidemic of sexually transmitted diseases.
