STD Prevention, Part 1: Get to Know Your Partner

Sexually transmitted diseases (STDs) affect men and women of all backgrounds and economic levels. However, STDs disproportionately affect women, infants of infected mothers, people of color, and adolescents and young adults. Although 15-to-24-year-olds represent only one-quarter of the sexually active population, they account for nearly half of all new STDs each year.

Some contributing factors in the rise of STDs, particularly among young people, are that teenagers are increasingly likely to have more sex partners at earlier ages, and that sexually active teenagers often are reluctant to obtain STD services or they face serious obstacles when trying to obtain them.

Tyshunda Manning, MD, Assistant Professor of Obstetrics and Gynecology at the Medical College of Wisconsin, practices at the Lincoln Avenue Clinic and the Lisbon Avenue Health Center. Dr. Manning says that today's shorter courtships encourage the transmission of STDs, because partners don't know each other very well. "It used to be that a man courted a woman, got to know her family, and took her out several times" before the relationship became physical, she notes. "Now we have 'hook-ups' where sexual partners hardly know each other."

Women between the ages of 20 and 30 with multiple partners are most at risk for contracting a sexually transmitted disease, says Dr. Manning. Most of the young women who come to see Dr. Manning are diagnosed with one of three common STDs: genital herpes, genital warts (HPV), or chlamydia.

Herpes
Herpes is a contagious viral infection caused by the herpes simplex virus (HSV). An estimated one out of five (or 45 million) Americans has already been infected with herpes. The virus remains in certain nerve cells of the body for life, causing periodic symptoms in some people. The virus can be transmitted even when there are no obvious symptoms. These asymptomatic episodes occur when the virus is released from the skin in a process called viral shedding.

There are two types of HSV. HSV Type 1 most commonly causes sores on the lips (known as fever blisters or cold sores), and can be passed by activities such as kissing, or by sharing items such as towels, toothbrushes, cups, forks, knives, or spoons.

HSV Type 2 is spread by sexual contact, and most often causes genital sores in and around the vaginal area, on the penis, around the anal opening, and on the buttocks or thighs. Occasionally, sores also appear on other parts of the body where broken skin has come into contact with HSV.

Doctors estimate that as many as 500,000 new cases of genital herpes occur each year. Infection is more common in women than in men.

In addition, herpes Type 1 or Type 2 can be passed to a partner during oral-genital sexual contact. In other words, oral herpes can be spread to the genitals or genital herpes can be spread to the mouth.

There is no cure for herpes, but antiviral medications can shorten and prevent outbreaks.

HPV
Dr. Manning says HPV (Human Papillomavirus) is the condition she most often sees in her practice. Although not a true STD because it does not require bodily fluids for transmission, but can be transmitted through skin contact alone, HPV is commonly thought of as an STD. It is extremely common in the US, with estimates of as many as 24 million people infected at some point in their lives.

HPV is actually a group of more than 100 different types of viruses. More than 30 of these are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum. Some types of HPV cause genital warts, the most recognizable sign of genital HPV infection. Other types of HPV can cause cervical cancer and other genital cancers.

At least 50% of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80% of women will have acquired genital HPV infection.

There is no cure for HPV infection, although in most women the symptoms of infection go away on its own.

A recently approved vaccine protects against four HPV types, which together cause 70% of cervical cancers and 90% of genital warts. "It's a great vaccine," says Dr. Manning, "but it's very expensive. It will not be fully effective until it reaches all women who need it." Fortunately, many insurance plans cover the vaccine, she says, including Medicaid.

Chlamydia
Chlamydia is the most frequently reported bacterial STD in the US. It can be transmitted during vaginal, oral, or anal sexual contact with an infected partner. An estimated 2.8 million Americans are infected with chlamydia each year. The highest rates of chlamydial infection are in 15- to 19-year-old adolescents, regardless of demographics or location.

Dr. Manning often sees women who have tested positive for chlamydia when screened. "They're asymptomatic, and don't know they have the disease until they're screened," she says. Screening for chlamydia is very important, because its symptoms are usually mild or absent, but it can damage a woman's reproductive organs and cause serious complications if left untreated. Chlamydia also can cause discharge from the penis of an infected man, although complications among men are rare.

Pelvic inflammatory disease (PID), a serious complication of chlamydial infection, has emerged as a major cause of infertility among women of childbearing age.

Chlamydia can be easily treated and cured with antibiotics.

Effects are Lasting
Having an STD, even one that's treatable, often affects more than just a patient's physical health. Many of Dr. Manning's patients have been misled by a partner. "They trust that people are who they say they are, and when they find out that their partner has been lying about an STD, or about how many partners they've had, it can be devastating."

Having an STD can also lead to low self-esteem. "People who have heart disease or diabetes can talk about their conditions, but someone with an STD often feels very uncomfortable talking about it." This contributes to the spread of STDs, because people don't want to talk about it to a new partner. This is especially true in the case of genital herpes. "It's a lifelong condition," says Dr. Manning. "And even though about 20% of people in the US have it, it's still stigmatized."

"Some patients become more cautious about prevention after contracting an STD," says Dr. Manning. But unfortunately, about 5% of her patients have come to her with an STD before. Typically in these cases, a young woman who has been treated for an STD will come back several months later for treatment of a different STD.

"Many of these patients - young women especially - don't realize that they have the power to say 'no' to a partner with an STD." Assertiveness doesn't come until the mid-20s for most people, she says, and a teenage girl usually doesn't know how to say 'no'."

Of course, prevention of STDs is preferred over treatment. "Do your homework on your sexual partners; get to know their background, their experience, their character," says Dr. Manning. Although condoms are not 100% effective in preventing STDs, she says, "Even when you know your partner well enough to feel you can trust him or her...use condoms for each and every sexual act."

P. J. Early
HealthLink Contributing Writer

This article includes information from the US Centers for Disease Control and Prevention (CDC) and the National Institutes of Health/MedlinePlus.

For more information on this topic, see the second part of this article, For Some STDs, the Numbers Are Still Increasing.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.