Sexually transmitted diseases—they’re successful, we’re not

Sexually transmitted diseases (STDs) are frighteningly common, as highlighted by a study released by the CDC earlier this month. The U.S. is in a unique position: few countries have the resources we do to prevent and treat STDs, and few countries squander such resources so effectively.

Let me give you a brief front-line perspective.


One of the hats I wear is that of a teaching physician at a large U.S. hospital, supervising resident physicians as they take care of their own patients. After hours, we see walk-ins, and that’s where the STD fun really begins. For whatever reason, I see STDs daily at the walk-in clinic, but almost never in my private practice. Most commonly, we see only one partner, and, at least in my state, treatment of the absent partner is prohibited. Basically, we only get one shot at folks, and we don’t have access to rapid tests. So what do we do? We order a lot of “party packs”—ceftriaxone and azithromycin, to treat gonorrhea and chlamydia. My residents will often ask, “why don’t we wait for the test results?”, and my answer is, “you will probably never see them again, and when you try their phone, it will be disconnected. Treat ’em while you got ’em.” We can give this treatment on site, and it cures most cases of gonorrhea and chlamydia. We also offer testing for HIV, syphilis, and other STDs, and try to get the patients to come back for general health care, but many of these patients are young, and disappear until their next bout of discharge. We often see patients who return re-infected because their partner wasn’t treated.

Public policy is affected by such idiocy as “abstinence programs“, a politically popular but scientifically discredited idea. The government seems to be in a fight with itself. The CDC has made wise recommendations about HIV screening (basically, test everyone), but prevention is thwarted at every turn. Condoms aren’t encouraged, sex-ed is a joke, and when we do find something wonderfully effective, such as Gardasil, the cranks come out of the woodwork to prevent the introduction of effective public health measures.

Until we develop a sane, national STD-prevention policy, that includes education, vaccination, and testing, my job security is assured. People will always have sex. Always. And as long as they do, there will be STDs. But to live in a rich, technologically advanced nation, and have STD rates as high as we do is not only embarrassing, it’s a travesty.

14 thoughts on “Sexually transmitted diseases—they’re successful, we’re not”

  1. If you treat the STD without being able to treat the sexual partner thus resulting in almost certain reinfection, are you risking creating a drug resistant strain? Especially if the person given the medicine prematurely stops taking the medicine the moment (s)he feels better and possibly before all of the pathogens are terminated.

    How would you treat the absent partner in a state that allows it anyways?

  2. Sorry, let me be more clear. The treatments for gonorrhea and chlamydia are one time deals…you can give the medicine right in the clinic, and it’s essentially cured. No need to rely on patient behavior.

    As to the partner…often, a patient will ask if they can take a prescription to their partner, on the assumption that they are also infected. There are many pros and cons to this.

  3. I once went to my private physician because I thought I had a STD; I didn’t. But he treated me so poorly and I was so embarrassed because I had to tell the receptionist over the phone about it that I never went back to see him.

  4. You know, I can’t figure out why people, even cdesign proponentsists, are so obtuse as to believe that abstinence-only education works. Whether or not you believe in evolution, the fact is that for at least 6000 years (and of course more like millions), these diseases have infected humans, and for about 6000 years, “God” has been saying to keep it in your pants. If that abstinence crap had ever worked, then those diseases would be extinct. Not only do you have modern studies of abstinence-only programs being much less effective in preventing STDs and pregnancy, you have the fact that STDs exist showing that it has *never* worked! WTF is wrong with people? Are they really that dumb?

  5. How would you treat the absent partner in a state that allows it anyways?

    When I was younger I dealt with chronic bronchitis. I was hitchhiking my way around the country and pretty much partied all the time. The “easiest” way to get antibiotics for the bronchitis, was to go to local health departments and claim that I had had unprotected sex with someone I found out had the clap. They would give me a spectrum test, condoms and antibiotics. When I first did this in Missouri, the doctor asked if the women I had slept with was taking anything, to which I replied not that I know of. He gave me an extra script for her, just in case. I didn’t knock it, because included in the spectrum test, is a urethral swab. I also got tested quarterly anyways, because I was very sexually active – though I was also a condom/safe sex nut.

    It may not be a perfect system, but I can believe that it does make it more likely to avoid reinfection due to one partner not getting treated. I know of a homeless young man here in Portland, who let chlamydia go for too long and nearly died. His partner apparently went in for treatment for it three times, unfortunately to different places each time. His excuse for not going, fear of the urethral swab and a general fear of doctors. He ended up in the hospital for almost two weeks.

    I have a doctor friend, whom I met through an HIV/AIDS support group that I volunteer with when I have the time. He got involved with a public health project after retiring from general practice and has run across some doosies. His “favorite” story to relate, was of a young man who apparently believed quite firmly that if he had been treated for the venereal disease and then had unprotected sex with his infected partner, it would take care of their infection as well. Said doctor was clear that misconceptions of this type are all too common and not limited to preteens and teens. If never corrected, kids carry these bullshit notions into their twenties and even occasionally into adulthood. Some even pass them on to their children, especially common with children who have children.

    It’s problems like this that have me carrying condoms with me everywhere I go, in spite of it being years since I needed them personally (though as we await my fated snipping, after the birth of our second child, we have used them when we want to be spontaneous in recent weeks). I feel like an old fuddy duddy sometimes (certainly have been accused of being a drag), but that’s a very small price to pay if it actually helps someone.

  6. You know, I can’t figure out why people, even cdesign proponentsists, are so obtuse as to believe that abstinence-only education works.

    I think most of them know it doesn’t work. But, they’re so determined to force the concept of “no sex before marriage” on everyone, that they don’t care. They don’t want to do anything at all to encourage extra-marital sex, and they take the denialist approach: don’t talk about it and the kids won’t know about it!

    Which is a load of crap, but it gives them a comforting belief. This is why we get such vehement opposition to things like condoms or Gardisil, with wild claims it will encourage young people to have sex. When the fact is that they’re having sex anyway, and having protection isn’t an encouragement.

  7. A major reason that there is so much resistance to sex ed & STD prevention is that far too many people feel that premarital sex or nonmonogamous sex should be punished. What better way to get punished than getting some disease.

  8. i’m curious about the quote-
    “But to live in a rich, technologically advanced nation, and have STD rates as high as we do is not only embarrassing, it’s a travesty.”
    what are the comparative statistics for UK, france, spain, italy, etc? are they higher or lower in the russian republic?
    jim

  9. The fact that other technologically advanced nations fare better or worse than we do is pretty much irrelevant. The critical point is that we have the wealth, knowledge, and technology to deal with this, yet we act like a friggin’ theocratic ostrich.

  10. Doesn’t EPT open you up to huge amounts of liability if the partner has a reaction to the antibiotics?

  11. “You know, I can’t figure out why people, even cdesign proponentsists, are so obtuse as to believe that abstinence-only education works.”

    I can help there. You are approaching it from the wrong angle.

    First, you need to understand its a different definition of ‘works.’ To you, the success of any sex-ed program is measured by two main metrics – the rates of teen pregnency and STI transmission. To the abstinance proponent, the most important metric is the amount of premarital sex being had. The STI and pregnency rates are of almost no significence beside the various measures of sex.

    This is because they see sex-ed not as a matter of public health, but public morality. Its purpose to them isn’t to protect the people, but to keep them from engaging in immoral practices. And to them, all sex except for that between married heterosexuals is immoral by definition.

    In public, they will often attempt to argue that abstinance-only education is the most effective way to reduce pregnency rates and STIs. Many of them even believe this – but if they didn’t, it wouldn’t change anything. They still believe it to be unacceptable for government to ‘endorse’ premarital sex by telling people how to use contraception, even if doing so saves lives.

    After all, what would be the point of saving people’s health if in doing so you only allow them to sacrifice their souls? I have no doubt that if someone were to introduce a bill into congress tomorrow to make premarital sex a criminal offence it would enjoy considerable political support.

  12. Suricou Raven said:

    To the abstinence proponent, the most important metric is the amount of premarital sex being had. The STI and pregnency rates are of almost no significence beside the various measures of sex.

    Not to nitpick your point, but given that the STI and pregnancy rates of kids unfortunate enough to be inflicted with an abstinence-only education is so high I’d query how effective it is in even getting the amount of premarital sex down.

    It seems to me that the point seems to be about getting the numbers of people who admit to having premarital sex down – and to ensure that those who do have sex outside marriage feel suitably guilty about it rather than feeling free to *gasp* enjoy their bodies safely and as they see fit.

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