- Email: [email protected]
Rising STD Rates
J Pediatr Adolesc Gynecol (2008) 21:371e372
Perspectives of the Allied Health Profession Rising STD Rates Angela Nicoletti, MS, RNC, WHNP Brigham and Women’s Hospital, Boston, Massachusetts
Disturbing trends are revealed in the CDC Sexually Transmitted Disease Surveillance 2006. Rates of gonorrhea (GC), chlamydia (CT), and syphilis increased in 2006.1 Since the 15e24 age group bears the highest disease burden for GC and CT, this trend is worrisome and deserves some examination of possible causes. Gonorrhea rates increased in 2006 for the second consecutive year.2 As in previous years, the South had the highest GC rates of the four regions of the USA. For many years the GC rates in the South had been declining, but in 2006, the GC rates rose by 12.3%. In contrast, the GC rate in the Northeast declined by 21.2%. The trend is similar for African Americans. After ten years of declining rates of GC, in 2006, the GC rate for African Americans increased by 6.3%. While the rate of GC among African Americans has always been greater than that of Caucasians, recent trends demonstrate that the disparity has gotten smaller. For the second consecutive year gonorrhea rates among women are slightly higher than among men, which has not been the case historically. In 2006, the GC rates continued to be highest among adolescents and young adults. The highest rates were among 15e19 year old females. This age group of females also has the distinction of having the highest rates of CT. African American women are disproportionately affected, having rates of CT more than seven times that of Caucasian females. GC and CT are major causes of PID in young women. Since the rates of CT are so high in young women, CDC now recommends annual CT screening for all sexually active women under age 26. Repeat testing in 3 months is recommended because the re-infection rate is high. For this reason, it makes sense to treat partners for CT, which can be done even in services that routinely treat only females. If getting the male partner in for treatment is unsuccessful, a prescription for azithromycin 2 gm in the partner’s name can be given to the female patient. That represents a more serious effort to reduce CT rates.
Concurrent with the rise in STD rates, CDC preliminary data indicates a rise in teen births after a consistent 14-year decline in those rates.3 It bears noting that the rising STD and teen pregnancy rates roughly coincide with the rise of abstinence-only-until-marriage educational programs. The government invests over $175 million dollars annually in these programs.4 Abstinence-only curricula are not allowed to provide information about contraception and condom use, except for failure rates. The money comes through Title V, Section, of the Social Security Act in 1996. The funded community-based or faith-based organizations must have as their exclusive purpose the promotion of abstinence outside of marriage and may not in any way advocate contraceptive use or discuss contraceptive methods or condoms except to emphasize their failure rates. No such designated federal funding exists for comprehensive sexuality education.4 The rise of abstinence-only programs has resulted in a decrease in the number of adolescents receiving comprehensive sexuality education. If the rates of STDs and teen pregnancies continued to decline, the funding for abstinence-only programs might be considered money well spent. However, not only is this not the case, but studies have begun to reveal that abstinence-only programs do not reduce teen sexual activity, but are harmful because they contain scientifically inaccurate information, distort data on topics such as condom efficacy, and withhold potentially life-saving information.4 In contrast, comprehensive sexuality education has been shown to delay initiation of sexual intercourse and promote protective behaviors such as condom use. According to the Annenberg National Health Communication Survey, there is broad public support for sex education programs that teach both abstinence and other methods to prevent pregnancy and STDs.5 In view of the fact that abstinence-only programs have not been shown to be beneficial and may be harmful, it would seem wiser to divert funding to programs which include both abstinence and other protective behaviors.
Ó 2008 North American Society for Pediatric and Adolescent Gynecology Published by Elsevier Inc.
1083-3188/08/$34.00 doi:10.1016/j.jpag.2008.01.069
372
Nicoletti: Perspectives on Pediatric and Adolescent Gynecology from the Allied Health Care Professional
References 1. STD Surveillance 2006. Trends in Reportable Sexually Transmitted Diseases in the United States, 2006. Available: http://www.cdc.gov/std/stats/trends2006.htm#chlamidiatrends. Accessed Dec. 13, 2007 2. STD Surveillance 2006. National Profile—Gonorrhea. Available: http://www.cdc.gov/std/stats/gonorrhea.htm. Accessed Dec. 13, 2007
3. CDC National Center for Health Statistics. Teen birth rate rises for first time in 14 years. Available: http://www.cdc.gov. nchs/pressroom/07newsreleases/teenbirth.htm 4. Ott MA, Santelli JS: Abstinence and abstinence-only education (review). Curr Opin Obstet Gynecol 2007; 19:446 5. Bleakley A, Hennessy M, Fishbein M: Public opinion on sex education in US schools. Arch Pediatr Adolesc Med 2006; 160:1151
Perspectives of the Allied Health Profession Rising STD Rates Angela Nicoletti, MS, RNC, WHNP Brigham and Women’s Hospital, Boston, Massachusetts
Disturbing trends are revealed in the CDC Sexually Transmitted Disease Surveillance 2006. Rates of gonorrhea (GC), chlamydia (CT), and syphilis increased in 2006.1 Since the 15e24 age group bears the highest disease burden for GC and CT, this trend is worrisome and deserves some examination of possible causes. Gonorrhea rates increased in 2006 for the second consecutive year.2 As in previous years, the South had the highest GC rates of the four regions of the USA. For many years the GC rates in the South had been declining, but in 2006, the GC rates rose by 12.3%. In contrast, the GC rate in the Northeast declined by 21.2%. The trend is similar for African Americans. After ten years of declining rates of GC, in 2006, the GC rate for African Americans increased by 6.3%. While the rate of GC among African Americans has always been greater than that of Caucasians, recent trends demonstrate that the disparity has gotten smaller. For the second consecutive year gonorrhea rates among women are slightly higher than among men, which has not been the case historically. In 2006, the GC rates continued to be highest among adolescents and young adults. The highest rates were among 15e19 year old females. This age group of females also has the distinction of having the highest rates of CT. African American women are disproportionately affected, having rates of CT more than seven times that of Caucasian females. GC and CT are major causes of PID in young women. Since the rates of CT are so high in young women, CDC now recommends annual CT screening for all sexually active women under age 26. Repeat testing in 3 months is recommended because the re-infection rate is high. For this reason, it makes sense to treat partners for CT, which can be done even in services that routinely treat only females. If getting the male partner in for treatment is unsuccessful, a prescription for azithromycin 2 gm in the partner’s name can be given to the female patient. That represents a more serious effort to reduce CT rates.
Concurrent with the rise in STD rates, CDC preliminary data indicates a rise in teen births after a consistent 14-year decline in those rates.3 It bears noting that the rising STD and teen pregnancy rates roughly coincide with the rise of abstinence-only-until-marriage educational programs. The government invests over $175 million dollars annually in these programs.4 Abstinence-only curricula are not allowed to provide information about contraception and condom use, except for failure rates. The money comes through Title V, Section, of the Social Security Act in 1996. The funded community-based or faith-based organizations must have as their exclusive purpose the promotion of abstinence outside of marriage and may not in any way advocate contraceptive use or discuss contraceptive methods or condoms except to emphasize their failure rates. No such designated federal funding exists for comprehensive sexuality education.4 The rise of abstinence-only programs has resulted in a decrease in the number of adolescents receiving comprehensive sexuality education. If the rates of STDs and teen pregnancies continued to decline, the funding for abstinence-only programs might be considered money well spent. However, not only is this not the case, but studies have begun to reveal that abstinence-only programs do not reduce teen sexual activity, but are harmful because they contain scientifically inaccurate information, distort data on topics such as condom efficacy, and withhold potentially life-saving information.4 In contrast, comprehensive sexuality education has been shown to delay initiation of sexual intercourse and promote protective behaviors such as condom use. According to the Annenberg National Health Communication Survey, there is broad public support for sex education programs that teach both abstinence and other methods to prevent pregnancy and STDs.5 In view of the fact that abstinence-only programs have not been shown to be beneficial and may be harmful, it would seem wiser to divert funding to programs which include both abstinence and other protective behaviors.
Ó 2008 North American Society for Pediatric and Adolescent Gynecology Published by Elsevier Inc.
1083-3188/08/$34.00 doi:10.1016/j.jpag.2008.01.069
372
Nicoletti: Perspectives on Pediatric and Adolescent Gynecology from the Allied Health Care Professional
References 1. STD Surveillance 2006. Trends in Reportable Sexually Transmitted Diseases in the United States, 2006. Available: http://www.cdc.gov/std/stats/trends2006.htm#chlamidiatrends. Accessed Dec. 13, 2007 2. STD Surveillance 2006. National Profile—Gonorrhea. Available: http://www.cdc.gov/std/stats/gonorrhea.htm. Accessed Dec. 13, 2007
3. CDC National Center for Health Statistics. Teen birth rate rises for first time in 14 years. Available: http://www.cdc.gov. nchs/pressroom/07newsreleases/teenbirth.htm 4. Ott MA, Santelli JS: Abstinence and abstinence-only education (review). Curr Opin Obstet Gynecol 2007; 19:446 5. Bleakley A, Hennessy M, Fishbein M: Public opinion on sex education in US schools. Arch Pediatr Adolesc Med 2006; 160:1151