STD's (Sexually Transmitted Diseases)

Circular Morals

I am not a doctor (actually, I am; I do hold a Ph.D., but not in a medical field). The information presented below is believed to be accurate, but no guarantees of any kind are made.

These are my personal views. They are not to be mistaken for advice.

An electronic version of an article in USA Today (06/29/98) caught my attention. It was claimed that U.S. rates for sexually transmitted diseases (STD's) are 50 to 100 times greater than those of any other industrialized nation (note: that is not true for AIDS, AIDS rates are almost comparable in some European countries).

Federal health officials reported an all-time low syphilis rate, but an estimated 12 million Americans will this year contract at least one of the more than 20 STDs, such as chlamydia and herpes. (The number of HIV positives is just over a million, I believe).

This may be consistent with the rumor that in the US, one man in five and one woman in four has been exposed to genital herpes.

This sounds Scary. It is. There is clearly a bunch of work to.

We expect to be able to go to a restaurant, eat what we like and not catch hepatitis or E-colli. So why is it that one US citizen cannot have sex with another US citizen, without the fear of catching a disease, or even risk his or her life?

If we make it a priority to ensure a safe food supply (FDA), shouldn't it also be a priority to make sure people do not carry communicable diseases?

Actually, there is a government mechanism to address the issue: the Center for Disease Control, or CDC. They are willing and capable of doing the job right. But when it comes to sexually transmitted diseases, they just need more funding. A few lousy billion dollars would probably go a long way in eradicating most STD's, with the possible exception of AIDS, which may take more money as well as more time.

So why is it not happening? According to some articles I have since read (some of them in popular women's magazines), the biggest problem is Washington. Or more accurately: the influence of the Religious Right in Washington. Any suggestion of a federal effort to combat STD's, generates an immediate outcry. Lawmakers dare not even bring up the subject, for fear of being chastised or Ostracized by their conservative electorate.

When women's groups or public service organizations try to talk to senators about the problem, they are usually dismissed with a stern "If you don't sleep around, you won't have to worry."

There is a perception that STD's do not concern the general public. But they do.

In principle, one could catch one from sitting down in a public restroom (especially women). One can catch one from an unfaithful lover, or from a lover who did not know that he or she had a problem.

Some women find out they have one when delivering a child, although they may not have had another partner but their husband since high-school. There have been cases of newborns being infected by herpes and dying.

When I first started checking into this problem, I figured I would buy some scientific literature on the subject. I checked Barnes and Noble. I checked Borders'. I checked the section on human sexuality. I checked the medical section. Except for some social studies on AIDS, there was nothing to be found!

The "official" line on the prevention of STD's is: " don't have sex, or if you do, make sure it is monogamous". I can't argue that; that should work, provided your partner is really monogamous and free of STD's to start with.

But it is also a little limiting. Sex is one of the great human experiences, and a lot of us choose to enjoy it with more than one person in a lifetime.

Common sense, as well as reality, indicate that most people do indeed have more than one partner. Young people especially. A University of Florida study (in the recent Newsweek Article on Sex) describes how 20% of 12th graders have had 6 partners or more.

Condoms work. They apparently do a very good job preventing the transmission of the HIV virus (AIDS). But they do not necessarily prevent all other diseases all the time. They may not completely prevent herpes and genital warts.

Chlamydia, gonorrhea and even the much more dangerous syphilis, can be completely cured with antibiotics (at least in most cases). That would seem to imply that these diseases should have been eradicated already. All we would need to do, is periodically test everybody in a certain population, and treat those who are positive. One could even consider giving the whole population preventive antibiotics, and no test at all.

It would be easier than eradicating tuberculosis. It would not be terribly expensive. But we can't wait. New strains of the bacteria are appearing, which have become resistant to antibiotics. It is now or never...

Genital warts can be removed or treated, to the point that they are less contagious.

A cure and a vaccine are not inconceivable, but will take some more expensive research. It seems like it would be worth spending some real money on this cause, though. Over 1 million Americans are HIV positive. That still means 1 million premature deaths.

At a time where everybody talks about protecting smokers from themselves, AIDS has apparently been somewhat forgotten.

AIDS and HIV have been called the number one health threat to African-Americans.

AIDS is still fatal, but life expectancies are rising due to new treatments.

The HIV virus is much harder to transmit than most people think. The probability of transmission through sexual intercourse alone, may be less than 1% each time. When a condom is correctly used, the probability is virtually zero.

There are also reliable HIV tests. There may be a period that one could carry the virus and still test negative, but that period seems to be no more than a few months (during which the chances of infecting someone else may be much lower anyway). HIV testing is a very good option.

HIV is also transmitted through needles. A recent federal scientific study found that a government needle exchange program for intravenous drug users could save 22, 000 lives. President Clinton had to think really hard, but decided not to approve the program. The rationale was that it is better to send a "strong" message that drugs are bad. Instead, Mr. Clinton decided to concentrate on reducing the 18, 000 drunk driving deaths by a few percent, by trying to "convince" states to lower legal blood alcohol limits.

There are two variants of the herpes virus: type 1 and type 2.

Type 1 is normally associated with cold sores and canker sores around the mouth and affects up to 90% of the population at some time or another. Type 1 can be transmitted through kissing, or by sharing drinking utensils.

Type 2 is normally associated with genital herpes. It is normally transmitted by sexual contact. It affects 20 to 25% of the population.

However, both type 1 and part 2 can actually affect any part of the body, and can be transmitted from one part to another. The viruses do not typically penetrate unbroken skin, but can invade the body through the eyes, mouth or genitals.

Herpes type 2 does not normally result in death or severe illness in adults, but can lead to periodic outbreaks, which are accompanied by blisters (which are contagious), as well as other annoying and possibly painful symptoms. In rare case, herpes type 2 can affect, or even kill children at birth.

Besides that, herpes type 2 is a scarlet letter. Nobody likes to sleep with someone who has herpes. Symptoms or no symptoms. Contagious or not.

The herpes virus can actually be killed by warm water and soap.

Sadly, there is no 100% safe sex. But with good information and some elementary precautions, sex can be made quite safe. When combined with professional medical testing, precautions can be very effective.

While 100% safe does not exist, 99.9% safe can probably be achieved.

The authors of the book "Sex in America", published in 1994, made a very insightful statement about STD's. It was along the lines of " STD's are not created; they are communicated. If a number of people are free of STD's, it really does not matter how often they have sex with each other, or what kind of sex they have. They will not get STD's as long as they only have sex with each other. "

That brings me to another thought. Why don't we all get tested? A relative majority of us (at least for now) are still free of STD's, and if we can make sure that we only have sex with other people who are free of STD's, we will be fine.

A good frequency would be every six months or so. It may be expensive (I am guessing a few $100, not reimbursed by health insurance). But for peace of mind, that would still be a bargain.

I visualize this method as a sort of "club" people join. In exchange for membership dues, they periodically get a complete battery of STD tests. When they pass, they get a special picture ID card they can carry to a bar or disco, and proudly display. All they have to do is look for a potential mate who carries a similar card...

Lack of action on STD's makes absolutely no sense.

• It is immoral, against most religions, and against the medical oath of Hypocrates, to knowingly let people become ill.
• It is expensive. Treating diseases that could have been easily prevented, eventually costs society a ton of money. Private money, public money and money from insurance companies.

Conclusion

It is my personal belief that STD's exist, because we want them to exist. Or at least, because we don't do anything serious about them.

Apparently, there is a segment of the population who finds comfort in this situation. In a perverse way, the threat of STD's is used as a convenient justification for conservative lifestyles.

Public awareness and good, reliable, scientific information would a long way in avoiding the problem. But for similar reasons, information on the topic is often not available to those who could use it most.

It's a shame. Life would be a lot more fun without STD's.

One of the few organizations, who cares about reproductive rights, and provides full and accurate information on STD's (it is a bit of a shame that they do not even receive any government funding):