Everywhere you look in the news this week, there seems to be something about sex. Whether it’s the Spitzer scandal, HPV and oral cancer connection, or the frighteningly high rate of sexually-transmitted disease (STD) among America's teenage girls, sex is on the minds of many. One thing that should be eminently clear is that sex (in all forms) can lead to STD infections, some forms of cancer, and loss of job as governor.
A recent national study released by the CDC, based on data from a 2003-4 national survey, found that at least one in four teenage girls nationwide has one of four sexually transmitted diseases, which translates to over three million teens. The teens were only tested for four infections: human papillomavirus (HPV), with an 18% infection rate; chlamydia with 4%; trichomoniasis with 2.5%; and herpes simplex virus with 2%.To make matters worse, among the infected women and girls, 15% had more than one. Worse still, among the girls who admitted to ever having sex, 40% were infected with an STD. So how do girls who claim to be virgins contract an STD? There are ways to come in contact with infectious microbes short of intercourse, including oral sex, but obviously some of the girls were not completely truthful about their sexual behaviors.
Surprisingly the girls were not tested for gonorrhea or syphilis, which are also common (in fact, a new report outlines the significant increase in syphilis over the past two years). Gonorrhea can cause serious and permanent health problems in both men and women, and syphilis can cause genital sores that may increase the risk of HIV infection, among other complications.
Health problems caused by STDs tend to be more severe for women than for men, and many of these STDs initially cause no symptoms, especially in women. These two factors make the results of the CDC study all the more disconcerting.
Accumulating data also indicate that infection with some strains of HPV also are a risk factor for oral cancer in both men and women. A study conducted by Dr. Maura Gillison of Johns Hopkins University, published last month, found that the proportion of oral cancers that were possibly HPV-related increased in the US over the period from 1973 to 2004, with a particularly significant rise among young white men. Gillison was quoted saying that "If current trends continue, within the next 10 years there may be more oral cancers in the United States caused by HPV than by tobacco or alcohol.”
What tools can we give teens so they can better navigate this sexual minefield? For starters, getting vaccinated against HPV –which accounts for a significant percentage of the STDs– with Merck's Gardasil (or another vaccine will soon be available--GlaxoSmithKline's Cervarix). Both vaccines will protect against HPV 16 and 18, which have been found in 70% of cervical cancer cases. It is hoped that the protection from these vaccines will have long lasting effects, but studies have not yet concluded just how long the protection lasts. Women who have already been infected with one or more types of HPV might still benefit from vaccination, getting protection from HPV types to which they have not yet been exposed. And boys and men will benefit directly, getting protection from HPV-induced ano-genital warts and possibly oral-pharyngeal cancer--plus, they will no longer be "vectors" of HPV, becoming immune to the virus and thus unable to pass it along to their sexual partners. Getting both sexes vaccinated may help to stem the STD epidemic.
In terms of public health, the CDC study should serve as a wake up call: our current federally-subsidized sex education policy is not getting the message home. "Abstinence only" programs, a head-in-the-sand approach to teen sexuality, is a disservice to youth. It is painfully obvious that abstinence is not being practiced, when half of the girls in the study admitted to being sexually active. It does no one any good to pretend that sex among teens doesn’t occur. It’s time to teach in-depth safe sex practices. Any discussion on sex needs to include oral sex, which is not emphasized enough as a risk factor for STDs, especially now that oral cancer has been linked to HPV.
Although there isn’t an STD for every letter of the alphabet, AIDS, chlamydia, gonorrhea, herpes, HPV, syphilis and trichomoniasis are just a few of the 20-plus sexually transmitted diseases out there. One would hope with all the available knowledge on STDs, that appropriate precautions would be taken. The ABC strategy – Abstinence, Be Faithful, and Condoms– could be promoted to prevent STD infection, as long as you add a PS at the end, for Prevention (vaccines) and for Screening (yearly screening once sexually active).