Transmitted Diseases: Incidence and Precautions
Stanley Ducharme, Ph.D.
my work as a health psychologist, I have frequently been
shocked by the indifference and lack of information regarding
AIDS and sexually transmitted disease (STD). During acute
hospitalization as well as in the outpatient setting, many
individuals express a lack of concern and apathy about the
dangers of contracting this deadly virus. Asking a partner
about past sexual history is rarely discussed and using
adequate protection is often haphazard. Unfortunately for
many people, becoming sexually active seems to be far more
important than taking appropriate actions to assure personal
transmission of disease from individual to individual has
caused major health concerns and plagues throughout history.
No where in recent times however has any group of diseases
raised such anxiety as the spread and incidence of sexually
transmitted diseases. Unlike other contagious diseases,
the spread of sexually transmitted disease requires an act
of sexual intimacy for transmission. Some STDs, such as
gonorrhea and Chlamydeous infect the genitalia while other
diseases, such as hepatitis reside or pass through mucosal
areas that include the rectum and mouth.
incidence of STDs continues to grow throughout the world.
The World Health Organization estimates the annual incidence
of curable STDs, such as syphilis and gonorrhea to be approximately
33.5 million cases worldwide. Since the late 1970s, the
number of initial physician office visits for human immunodeficiency
virus, (HIV) has increased by more than 30%.
the estimated worldwide number of HIV cases is estimated
to be approximately 36,000,000 with the highest percentage
of cases residing in underdeveloped countries and those
with lower socioeconomic conditions. Africa alone has over
70% of the worlds HIV cases with currently over 25,000,000
individuals infected and 11,000 new cases diagnosed each
day. Poverty clearly has direct correlation with the incident
rates of sexually transmitted disease throughout the world.
who have sexual activity with other men are at an increased
risk for STDs. Among this population, the infection rates
are disproportionately higher than they are among the heterosexual
population. Sexual trauma to the genitals and anus also
tend to be higher among this population. All gay men however
do not have the same risk for STDs and sexual trauma. It
is the sexual behavior and not the sexual orientation of
this population that accounts for the high incidences of
infection and trauma. The criteria that determine the risk
of exposure to STDs include such criteria as number of sexual
partners, anonymous partners and the particular sexual practices
of the individual.
the female homosexual population, the incidence of infection
tends to be significantly less than among the gay male population.
In general, homosexual women tend to have fewer sexual partners
than homosexual men and the female genitalia tends to be
a less efficient means of transmission than the male sexual
anatomy. Women also tend to have less difficulty discussing
their sexual preferences with physicians and subsequently
may receive earlier evaluation and treatment for STDs. For
both homosexual men and women, access to health care may
also be inadequate because of attitudes, lack of understanding
and prejudice by health care providers.
can present themselves in a variety of ways. Often, people
with an STD come to the doctor with a complaint such as,
I have an ulcer or I have been having drainage.
At other times, the first sign of an STD may be feelings
of fatigue, diarrhea, a painful lesion or having a rash.
Various STDs each have their own unique variety of symptoms
which may be focused on the genitals or in other areas such
as the inside of the mouth, lips, tongue or face. At times,
there may be a variety of symptoms present since some individuals
may be infected with more than one organism. In many cases
laboratory testing may be necessary although treatment with
various anti-biotics may actually begin before a final definitive
diagnosis has been obtained.
who become infected with HIV are often seen by their primary
care doctor because of symptoms similar to those described
above. It is also not unusual for HIV symptoms to go undiagnosed
for long periods of time since often HIV is not considered
when the patient first comes to a clinic or doctor. For
many people with HIV, the onset of symptoms is abrupt and
symptoms typically last for one or two weeks. Of people
who become infected, 50% to 93% become symptomatic early
after becoming infected. In this population, oral ulcerations
are common and approximately 40% to 60% of people develop
a sudden rash on the face or body.
are many facets to the prevention of STDs. However, until
effective treatments and cures are discovered that will
control the spread of STDs, the best means to controlling
their number is to prevent them from occurring. This is
particularly important for chronic or fatal diseases such
as HIV infection. Strategies available as a means of prevention
include (a) changing all sexual behaviors that place a person
at increased risk for STDs and (b) the use of barrier contraception
which physically prevents their transmission. Infection
also tends to be high among men who have not been circumcised
and when sexual activity occurs in the presence of genital
or oral ulcers.
order to reduce the occurrence of STDs, it is important
to reduce the number of high-risk sexual behaviors and potentially
dangerous practices. Sexual activity with many partners
and especially with anonymous partners all increase the
risk of disease transmission. Additionally, certain forms
of sexual behavior carry more risk of disease transmission
than others. When these forms of sexual activity occur in
an unprotected manner the chances of disease
transmission is even higher.
people with disabilities, there are unique issues that are
important to consider and address. Often individuals who
have disabilities, as well as able-bodied people, find it
difficult to ask about the sexual practices and the history
of a potential sexual partner. In addition, not all infected
individuals are open and able to communicate about their
infection status. People with disabilities may find themselves
fearing rejection. Often this is accompanied by the perception
that sexual opportunities are limited. Physical limitations
of the arms and hands may make protected sexual activity
difficult to achieve without assistance in using a condom.
It is important to remember that health care professionals
are there to provide information and support when needed.
summary, education and knowledge about STDs is important
as a primary means of changing sexual behavior and practices.
Rehabilitation programs should be including such information
on a routine basis as part of their sexuality education
classes. Since this is seldom accomplished, it is important
for each of us to work toward controlling the spread of
these diseases through prevention of their occurrence.