Dr. David H. Martin, professor and chief of the Section of Infectious Diseases at LSU Health Sciences Center New Orleans School of Medicine, updated reporters and the National Foundation for Infectious Diseases on sexually transmitted diseases in the United States on July 22, 2009 at the National Press Club in Washington, D.C. Martin, whose presentation was titled “Sexually Transmitted Diseases: Neither Gone nor Forgotten,” revealed significant information about STDs including Chlamydia trachomatis, gonorrhea, syphilis, and a relatively new STD, Mycoplasma genitalium.
Highlights include :
-- the number of cases of the asymptomatic Chlamydia trachomatis, the most common reportable infectious disease in the US, is growing
-- gonorrhea, the second most common reportable infectious disease in the US, is growing more resistant to treatment
-- syphilis is making a comeback which could wipe out the gains made in syphilis control following the epidemic of the late 1980s
-- M. Genitalium has the potential to become a public health target as recent work has now linked it to pelvic inflammatory disease in women along with being a known cause of nongonococcal urethritis in men.
The most common bacterial STD
Chlamydia trachomatis is the most common reportable infectious disease in the United States and the number of cases is growing every year thanks in part to increasing screening efforts. It is particularly of concern in adolescents and young adults, and also in African-American populations, among who reported case rates are 8-fold higher than in whites. The major adverse events associated with chlamydial infections are borne by women and include pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy and infertility. The organism also can infect infants at birth and causing conjunctivitis and, more importantly, pneumonia. In men C. trachomatis causes urethritis and occasionally a testicular inflammatory condition known as epididymitis. However, most chlamydial infections are asymptomatic. These silent infections form a large reservoir of infection in the population resulting in potential for continuous transmission of the organism among those who are sexually active outside of long term monogamous relationships. Excellent C. trachomatis diagnostic tests are now available and can be performed on urine specimens. Treatment is inexpensive and safe. Therefore, theoretically, this common STD could be dramatically curtailed in the U.S. population if broad based screening efforts were undertaken. In 1989 the U.S. Preventive Services Task Force recommended C. trachomatis screening of all sexually active young women. However there are significant barriers to achieving this goal. These include lack of access to health care, health care provider reticence to address sexual health issues with their patients, limited budgets to support screening programs, insufficient treatment of exposed sex partners, and lack of knowledge on the part of young sexually active individuals about the true risk of unprotected sexual intercourse with multiple partners. An example of the limited effect of the screening recommendation can be found in the data reported by the Healthcare Effectiveness Data and Information Set (HEDIS) during 2000 2007 and collected by the CDC. Nationally, the annual screening rate increased from 25.3 percent in 2000 to 43.6 percent in 2006, and then decreased slightly to 41.6 percent in 2007. We should be doing better. Approaches that are being employed by some public health agencies around the country include screening high risk populations in high schools, juvenile retention facilities, adolescent clinics, and drug treatment centers. Self collection of specimens (vaginal swabs in women and urine specimens in both sexes) which can be mailed to testing facilities is now possible and some public health agencies across the country are experimenting with novel ways of encouraging the at risk population to do so. Increased Chlamydia testing and treatment should be a goal of evolving plans for healthcare reform in the U.S.
