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Sexually Transmitted Diseases: Incidence and Precautions
by Stanley Ducharme, Ph.D.

In 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 safety.


The 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.

The 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%.

Today 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 world’s 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.

Gay health issues

Men 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.

Among 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.

Symptoms of STDs

STDs 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.

People 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.

There 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.

In 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.

For 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.

In 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.

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