The Centers for Disease Control's latest report on national rates of sexually transmitted diseases (STDs) ranks Louisiana No. 1 in the nation for the number of syphilis cases, second for gonorrhea and fifth for chlamydia. Dr. David Martin, Professor and Head of Infectious Diseases at LSU Health Sciences Center and one of the country's leading experts on STDs, discusses the illnesses and their prevalence here.
Q: What are the most common STDs in the New Orleans area?
A: In terms of numbers, chlamydia. We divide them up into bacterial and viral. It turns out that overall, genital herpes (a viral infection) are the most common in the population because it accumulates over time. (It can't be cured with antibiotics.) Human papillomavirus (HPV) is another. (The CDC ranks HPV as the most common STD in the United States.) Neither is reported to the health department. The big three — chlamydia, gonorrhea and syphilis — are all bacterial. These are the ones that are reported. Others are perceived to be less significant in our population. We have very good tests for chlamydia, gonorrhea and syphilis, and they are perceived to have a significant public health impact.
Q: Is there a concentration of STDs among certain age groups?
A: Yes, indeed. There are very distinct age group distributions. Both gonorrhea and chlamydia are mostly in the 15- to 20-year-olds, where the chlamydia is concentrated. For women, it's true for gonorrhea as well. For men, the peak group is 20- to 24-year-olds. Syphilis tends to have an older age group; it probably has something to do with host immunity and transmission. The current thinking is, with initiation of sexual activity, there is no host immunity and it's an easily transmitted infection, so you see lots of cases. Then, over time, they develop immunity and you see fewer cases. Syphilis is heavily involved with men who have sex with men, so there is an older group there. The peak for both men and women in syphilis is the 20- to 24-year-old demographic. The 25- to 29-year-old age group is almost as high, so the demographic for syphilis is skewed more toward older.
Q: Aren't treatments fairly inexpensive and easy?
A: We have good treatments, so it's not because of treatment failure. Chlamydia case rates are much higher than gonorrhea. The reason we have such high rates of these diseases has to do with behavior: the drive for sexual activity and the perception that the diseases are fairly insignificant.
Q: What are the possible health consequences of STDs?
A: With gonorrhea and chlamydia, it's primarily pelvic inflammatory disease in women. And especially for chlamydia, an infection that is relatively mild, the majority of cases are relatively asymptomatic. With gonorrhea, the acute symptoms are more severe, so patients are more likely to come in for treatment. With chlamydia, though, the patient doesn't perceive symptoms. They have a low-grade inflammation, which can lead to scarring of the fallopian tubes, and that can lead to infertility. The inflammation also can lead to implantation of the ovum (fertilized egg) in the fallopian tube so the ovum can only grow six to eight weeks before the fallopian tube ruptures, and that is potentially life-threatening.
Q: With the availability of condoms and our knowledge of STDs, why is it still such a problem?
A: Part of being relatively risky with sex behavior is that our population doesn't perceive it to be such a problem. Men suffer less than women and are generally in control in the sexual encounters, so women are relatively limited in how they can protect themselves. There was hope that the female condom would help, but it was too difficult to use. There is a federally funded research effort to develop microbicides — creams and douches — that a woman could use to protect herself. The big push was for (protection against) HIV infection, but the hope is to find a product that will be effective against HIV, chlamydia and gonorrhea. The rationale for the research funding has been primarily for the HIV infection because it is life-threatening. Louisiana is No. 1 in the country for rates of syphilis, but (the number of cases) is far lower than those for chlamydia and gonorrhea. Complications with syphilis are (a pregnant woman's) transmission of the disease to an infant and the high mortality rate subsequent to that, so all women are screened for syphilis when they get prenatal care.
Q: What is the most important message you would impart to people who are sexually active?
A: I think women need to recognize the risk they are facing from all of these infections and take it upon themselves to protect themselves, i.e. insist on condom use. From a societal standpoint, men also need to use condoms. Education is the key part of this. If we don't have adequate education coming from the education system as well as parents, that's when it doesn't work. I think the parents' interaction with their kids is essential; I don't think the education system is able to get the message across. I wonder if there shouldn't be concurrent education for the parents of what the kids are learning (in school about sex).