Sexually transmitted diseases—they’re successful, we’re not

Sexually transmitted diseases (STDs) are frighteningly common, as highlighted by a study released by the CDC earlier this month. The U.S. is in a unique position: few countries have the resources we do to prevent and treat STDs, and few countries squander such resources so effectively.

Let me give you a brief front-line perspective.

One of the hats I wear is that of a teaching physician at a large U.S. hospital, supervising resident physicians as they take care of their own patients. After hours, we see walk-ins, and that’s where the STD fun really begins. For whatever reason, I see STDs daily at the walk-in clinic, but almost never in my private practice. Most commonly, we see only one partner, and, at least in my state, treatment of the absent partner is prohibited. Basically, we only get one shot at folks, and we don’t have access to rapid tests. So what do we do? We order a lot of “party packs”—ceftriaxone and azithromycin, to treat gonorrhea and chlamydia. My residents will often ask, “why don’t we wait for the test results?”, and my answer is, “you will probably never see them again, and when you try their phone, it will be disconnected. Treat ’em while you got ’em.” We can give this treatment on site, and it cures most cases of gonorrhea and chlamydia. We also offer testing for HIV, syphilis, and other STDs, and try to get the patients to come back for general health care, but many of these patients are young, and disappear until their next bout of discharge. We often see patients who return re-infected because their partner wasn’t treated.

Public policy is affected by such idiocy as “abstinence programs“, a politically popular but scientifically discredited idea. The government seems to be in a fight with itself. The CDC has made wise recommendations about HIV screening (basically, test everyone), but prevention is thwarted at every turn. Condoms aren’t encouraged, sex-ed is a joke, and when we do find something wonderfully effective, such as Gardasil, the cranks come out of the woodwork to prevent the introduction of effective public health measures.

Until we develop a sane, national STD-prevention policy, that includes education, vaccination, and testing, my job security is assured. People will always have sex. Always. And as long as they do, there will be STDs. But to live in a rich, technologically advanced nation, and have STD rates as high as we do is not only embarrassing, it’s a travesty.