Wednesday, November 14, 2007
Story of the Day -Sex Diseases Still Rising
Sex Diseases Still Rising; Chlamydia Is Leader
The incidence of gonorrhea, which had declined sharply, has risen in the last two years in this country while the number of chlamydia and syphilis cases continue to rise, federal health officials said yesterday.
Chlamydia and gonorrhea are the two most common diseases among those doctors must report in the United States. And the 1,030,911 cases of chlamydia in 2006 are the highest ever recorded for any nationally reported disease in any year, the officials said in releasing their annual report on sexually transmitted diseases. They said that because of underreporting, a more accurate estimate is 2.8 million new chlamydia cases annually.
About 19 million new cases of all kinds of sexually transmitted diseases occur in this country each year, but only the three are nationally reported. Genital herpes, papillomavirus and trichomonas infections account for the vast majority of cases, but doctors are not required to report them nationally.
Different reasons account for the rise of each of the three reportable and curable diseases, and for each a different approach is needed to reduce its incidence, Dr. John M. Douglas Jr., head of the division of sexually transmitted diseases at the Centers for Disease Control and Prevention, told reporters by telephone.
The three reported sexually transmitted diseases affect African-Americans disproportionately. The black to white ratios are gonorrhea 18 to 1, syphilis 6 to 1 and chlamydia 8 to 1, Dr. Douglas said in an interview. The reasons for the disparities are not clear. Lack of access to health care may be one problem.
“Chlamydia is now the most common S.T.D. ever reported,” Dr. Douglas said, but not by much. The next most common is gonorrhea, with just over one million cases reported each year from 1976 to 1980. The peak for gonorrhea was 1,013,00. Gonorrhea cases then declined steadily.
The chlamydia microbe can cause pelvic inflammatory disease and resulting abdominal pain, ectopic pregnancy and infertility in women.
Chlamydia’s rise in incidence is due mainly to urging by the centers for annual testing of sexually active women under age 26. Current tests are more sensitive in detecting chlamydia than those used a few years ago. Most cases were among women who had no symptoms but could transmit the microbe.
Chlamydia screening has led to detection of the microbe among more men as their female partners advise them to get tested and treated to avoid re-infections. Infected individuals are advised to get re-tested about three months after treatment to make sure they are cured.
The centers are also encouraging doctors to give antibiotics and educational material to patients to give to their sexual partners who are reluctant to seek care. One aim of the practice, called expedited partners therapy, is to reduce re-infections. The practice is legal in 11 states and ambiguous or illegal in the 39 others.
From 1975 through 1997 the reported rate of gonorrhea dropped 74 percent, then plateaued, only to rise the last two years to 358,366 cases in 2006. The centers estimate that at least twice that number actually occurred.
Much of the rise seems the result of an increasing tendency to couple gonorrhea and chlamydia testing of urine samples.
African-Americans account for 69 percent of all gonorrhea in this country. “The biggest increase in gonorrhea regionally has been in the South, and we do not have a ready explanation for that,” Dr. Douglas said.
Even in the days before penicillin became available in World War II to cure syphilis, the number of reported syphilis cases peaked at 575,000, and that total included individuals who never could be treated and developed the late stages of the disease that cause brain and heart damage.
Syphilis cases dropped to their lowest ever total in 2000 soon after health officials had announced a national syphilis elimination program.
But cases have risen each year since then to 9,756 cases in 2006. Most cases have involved gay men, who account for about 65 percent of cases, and to a lesser extent women. Also, a small number of cases have occurred among newborns.
Recently, health departments have had to take on more projects with little, if any, increase in budgets, Dr. Douglas said. Outbreaks have occurred in some areas where they were well controlled. Also, health workers have had to decrease partner notification programs and screening in detention centers and jails.
U.S. Sets Record in Sexual Disease Cases
More Than 1 Million Chlamydia Cases Sets Record for U.S. Sexually Transmitted Dieases
More than 1 million cases of chlamydia were reported in the United States last year the most ever reported for a sexually transmitted disease, federal health officials said Tuesday.
Officials at the Centers for Disease Control and Prevention said they think better and more intensive screening accounts for much of the increase, but added that chlamydia was not the only sexually transmitted disease on the rise.
Gonorrhea rates are jumping again after hitting a record low, and an increasing number of cases are caused by a "superbug" version resistant to common antibiotics.
Syphilis is rising, too. The rate of congenital syphilis which can deform or kill babies rose for the first time in 15 years.
"Hopefully we will not see this turn into a trend," said Dr. Khalil Ghanem, an infectious diseases specialist at Johns Hopkins University's School of medicine.
The CDC releases a report each year on chlamydia, gonorrhea and syphilis, three diseases caused by sexually transmitted bacteria.
Chlamydia is the most common. Nearly 1,031,000 cases were reported last year, up from 976,000 the year before.
The count broke the single-year record for reported cases of a sexually transmitted disease, which was 1,013,436 cases of gonorrhea, set in 1978.
Putting those numbers into rates, there were about 348 cases of chlamydia per 100,000 people in 2006, up 5.6 percent from the 329 per 100,000 rate in 2005.
Since 1993, the CDC has recommended annual screening in sexually active women ages 15 to 25. Meanwhile, urine and swab tests for the bacteria are getting better and are used more often, for men as well as women, said Dr. John M. Douglas Jr., director of the CDC's Division of Sexually Transmitted Disease Prevention.
About three-quarters of women infected with chlamydia have no symptoms. Left untreated, the infection can spread and ultimately can lead to infertility. It's easily treated if caught early.
Health officials believe as many as 2.8 million new cases may actually be occurring each year, he added.
Chlamydia infection rates are more than seven times higher in black women then whites, and more than twice as high in black women than Hispanics. But it's a risk women of all races should consider, CDC officials said.
If (health care) providers think young women in their practice don't have chlamydia, they should think again," said Dr. Stuart Berman, a CDC epidemiologist.
The gonorrhea story is somewhat different.
In 2004, the nation's gonorrhea rate fell to 112.4 cases per 100,000 people in 2004, the lowest level since the government started tracking cases in 1941.
But since then, health officials have seen two consecutive years of increases. The 2006 rate about 121 per 100,000 represents a 5.5 percent increase from 2005.
Health officials don't know exactly how many superbug cases there were among the more than 358,000 gonorrhea cases reported in 2006. But a surveillance project of 28 cities found that 14 percent were resistant to ciprofloxacin and other medicines in the fluoroquinolones class of antibiotics.
Similar samples found that 9 percent were resistant to those antibiotics in 2005, and 7 percent were resistant in 2004. The appearance of the superbug has been previously reported, and the CDC is April advised doctors to stop using those drugs against gonorrhea.
Douglas said it doesn't look like the superbugs are the reason for gonorrhea's escalating numbers overall, but they're not sure what is driving the increase.
Other doctors are worried. The superbug gonorrhea has been on the rise not only in California and Hawaii, where the problem has been most noticeable, but also in the South and parts of the Midwest.
"Suddenly we're starting to see the spread," Ghanem said.
Syphilis, a potentially deadly disease that first shows up as genital sores, has become relatively rare in the United States. About 9,800 cases of the most contagious forms or syphilis were reported in 2006, up from about 8,700 in 2005.
The rate rose from 2.9 cases per 100,000 people to 3.3, a 14 percent increase.
For congenital syphilis, in which babies get syphilis from their mothers, the rate rose only slightly from the previous year to 8.5 cases per 100,000 live births.
Chlamydia's Heavy Burden on Young Women
Adolescents and College Students May be Disproportionately Affected
Chlamydia is one of the most common sexually transmitted diseases in the United States, and its impact is huge -- not only can it cause infertility in women, it also increases the risk of catching HIV from an infected partner.
A slew of new research studies on the infection being presented this week at a national STD conference shows that chlamydia can be surprisingly common among younger women -- especially college freshmen, one of the studies shows. In another study, "repeat" infections were common, too.
Even more important, experts note, is the fact that health practitioners still don't have solid national numbers on just how many women and men have the infection. This is because, in part, not enough doctors are screening for the infection and reporting infections when they uncover them, experts said at a news briefing today at the 2006 National STD Prevention Conference, sponsored by various state and national health agencies.
It is estimated that 2.8 million cases occur each year, with the majority of those being undiagnosed and untreated, health officials say.
"The [Centers for Disease Control and Prevention] recommends that all sexually active women under the age of 26 be screened annually, but studies have shown that many of these women are not being tested," said Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention.
As a result, just how many people are actually infected is hard to know, with scientists only able to estimate. However, some new research is shedding some light.
In one evaluation, 780 college students were screened voluntarily for chlamydia at 10 colleges in the Southeast. Close to 10 percent of them tested positive for chlamydia, and when the numbers were broken down just to look at rates among freshman students, the percent infected rose to 13.
"It underscores the importance of screening among all students, primarily female freshmen," said Dr. Adelbert James of the Emory University School of Medicine.
Men probably have similar rates of infection, but the consequences are not as dire. If left untreated in women, chlamydia can scar the fallopian tubes, which can cause infertility. In men, complications are rare but, like women, include infertility and scarring of the urethra.
In another study, one in every eight females ages 10 to 29 who tested positive for chlamydia had a repeat infection within one year. The study also found that the repeat infection rate for adolescent females -- ages 10 to 19 -- was more than double the rate seen in women ages 25 to 29.
Why are younger women disproportionately affected? It's probably for a number of reasons, health experts say.
First, the cellular structure of the genital tissue of younger women allows more infections to invade. Also, older women are more monogamous, see doctors more often, and may have stronger immune systems.
"How much access does a woman have to health care? Many [young] women just don't go to health services. They are at college. They are independent," said Dr. Marc Laufer, chief of gynecology at Children's Hospital Boston. "You cannot guarantee that women even go in to see a doctor."
Regardless, screening young women is important, because it's now easy to do through a urine test, he said.
"This is a good recommendation," he said.
Why are sex diseases rising?
The number of people being diagnosed with sexually transmitted infections (STIs) is now at record levels.
Doctors have warned ministers they risk having a major public health crisis on their hands unless they take urgent action to tackle the problem.
STIs have jumped sharply in recent years. Syphilis has risen by 486% since 1996. Chlamydia is up by 108% over the same period and rates of gonorrhoea are 87% higher than they were seven years ago.
More people are also being diagnosed with HIV. In 2001, a total of 4,419 people were told they had the virus, up 17% on the previous year. The number of new infections is predicted to double between 1997 and 2005.
An estimated 40,000 people living in Britain are now HIV-positive. As many as one in three of these do not realise they have the disease.
There is no clear explanation for the sharp rise of recent years. For instance, there is little evidence to suggest it can be attributed to more people engaging in casual sex.
"Changes in sexual behaviour are not sufficient to explain the increase in sexually transmitted infections," says Dr Roger Ingham of the Centre for Sexual Health Research at the University of Southampton.
"It may be the case that more people are engaging in casual sex. However, the rise in STIs is so high that it cannot be explained by this."
The most obvious explanation is that people are simply failing to practise safe sex.
However, even this isn't clear cut. Teenage pregnancy rates are falling suggesting that more couples are using contraception.
Recent studies have also found that more people are using condoms when they first have sex.
Problems appear to be linked to the choice of contraception. While more teenage girls may be taking the Pill or emergency contraception, the statistics suggest they are not using condoms. Condoms are the most effective way of preventing the spread of STIs.
In addition, there is evidence to suggest that couples put themselves at risk by deciding to stop using condoms when their relationship becomes more stable.
"Our research shows young and older people are finding it difficult to maintain condom use once they are in a trusting relationship," says Dr Ingham. "Obviously, if there is a STI it can then be transmitted."
The sharp increase in STIs suggests that couples are becoming more complacent and are not listening to calls to practice safe sex.
"In the late 1980s and early 1990s, we had campaigns warning people about HIV. They also helped to prevent STIs," says Derek Bodell, director of the National Aids Trust.
"While there have been some new campaigns, overall there hasn't been the same level of promotion. Increasingly, generations are coming forward who have not heard about HIV and who do not know much about using condoms. They are missing out on the key messages," he says.
This is compounded by the fact that many people have major misconceptions about STIs and HIV. A study published last year suggested one in three 18 to 24 year olds wrongly believed there is a cure for HIV.
Cultural issues also play a part. Many people are simply too embarrassed to talk about sex, let alone STIs, with their friends or family.
"We don't talk about sex," says Simon Blake, director of the Sex Education Forum.
"A lot of people have feelings of embarrassment, shame and guilt around sex. People also do not access sexual health services or get the support they need.
"We need to raise awareness and to tell people that STIs are still around and that HIV is still here."
The government published a 10-year-plan to improve sexual health in July 2001. The National Strategy for Sexual Health and HIV Services was backed with £47.5m.
However, that money represents a mere drop in the ocean. According to doctors, it won't even cover the cost of implementing a national screening programme for Chlamydia let alone improve services elsewhere.
"Sexual health is not an NHS or political priority," says Professor Michael Adler, chairman of the group which drew up the strategy. "It is no exaggeration we now face a public health crisis in relation to sexual health."
Experts believe that the situation will fail to improve unless sexual health becomes a government priority.
"A lack of prioritisation is making it very difficult for charities, local hospitals and primary care trusts to deliver the services which are so badly needed," says Colin Dixon of the Terrence Higgins Trust.
One of the major problems is that money for sexual health services is allocated at a local level. In many areas of the country, it comes a long way behind other health priorities such as fighting cancer and heart disease.
As a result, many sexual health clinics are struggling to cope with demand. While clinics have seen their workload increase by 155% over the past 10 years, their budgets and staff levels have largely remained the same.
Patients are often forced to wait days for an appointment and sometimes weeks for treatment even after they have been diagnosed with a STI.
"Clearly, if you have someone who has a STI then diagnosis and ease of access for patients is crucial in preventing it from spreading," says Derek Bodell.
"Some professional associations have suggested that as many as 150,000 people are waiting to be seen at sexual health clinics at any one time."
These delays increase the risks of people passing on infections, according to the Liberal Democrats.
"People are turned away from overloaded sexual health clinics, remaining at risk to themselves and to others," says Patsy Calton, its health spokeswoman.
The Department of Health insists that its 10-year strategy will deliver improvements.
"Teenage pregnancy rates have come down over the past three years," says Dr Roger Ingham.
"We would hope that given the same time, we will see similar improvements in STIs."
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