Are women hit harder by STDs than men?
How common are STDs among Americans, really?
Is hepatitis B the only type of hepatitis that can be sexually transmitted?
I don't have any STD symptoms and neither does my partner. Do we need to be concerned if we are having unprotected sex?
If I test positive for HIV or AIDS, will it be reported?

Sexually transmitted diseases cause suffering for all who are infected, but in many ways, women and girls are the hardest hit, for both biological and social reasons. Among Americans, 62% of all cases of adverse health problems from STDs occur in women. Worldwide, as many women as men now die from AIDS each year, and in the hardest-hit regions of Africa, nearly 60% of HIV-positive adults are women.

          Male-to-female transmission of many infections is more likely to occur than female-to-male transmission. This is particularly true of HIV: Studies show that it is three to eight times easier for an HIV-positive man to transmit the virus to a woman than it is for an HIV-positive woman to infect a man.

          Young women are even more vulnerable to STDs than older women because the less-mature cervix is more susceptible to injury and infection. As a woman ages, the type of cells at the opening of the cervix gradually changes so that the tissue becomes more resistant to infection. If an 18-year-old woman and a 30-year-old woman are exposed to the same pathogen, the younger woman is far more likely to develop a serious STD. Young women are also more vulnerable for social and emotional reasons: Lack of control in relationships, fear of discussing condom use, and having an older sex partner are all linked to increased STD risk.

          Once infected, women tend to suffer more consequences of STDs than men. For example, gonorrhea and chlamydia can cause pelvic inflammatory disease (PID) and permanent damage to the oviducts in women, while these infections tend to have less serious effects in men. HPV infection causes nearly all cases of cervical cancer. HPV infection is also associated with penile cancer in men, but penile cancer is much less common than cervical cancer. Women also have the added concern of the potential effects of STDs during pregnancy.

          Between 1985 and 20004, the proportion of new U.S. AIDS cases in women increased from 7% to 27%. Women with HIV infection often face tremendous challenges when they are ill because they may be caring for family members who are also infected and ill. Many women are dealing with substance-abuse problems in themselves or in family members. In addition, women may become sicker at lower viral loads compared to men. Women and men with HIV do about equally well if they have the similar access to treatment, but in many cases women are diagnosed later in the course of HIV infection, receive less treatment, and die sooner.

          Worldwide, social and economic factors play a large role in the transmission and consequences of AIDS and other STDs for women. Violence against women is spreading AIDS, as are such practices as very early marriage for women, often to much older men who have had many sexual partners. For many women, being vulnerable to HIV can simply mean being married. Cultural gender norms that promote premarital and extramarital relationships for men, combined with women's lack of power to negotiate safer sex, make HIV a risk even for women who are married and monogamous. In addition, lack of education and limited economic opportunities can force women into commercial sex work, placing them at high risk for all STDs.

          In some parts of the world, the stigma of AIDS hits women harder. Men with HIV are typically cared for by female family members, without being questioned about the source of their infection. Women, in contrast, may be accused of having had extramarital sex and receive less help and support. It is women who typically provide care to relatives with HIV as well as support the household financially when other earners are too ill to work. But if husbands die, women often do not inherit property and can be thrown further into poverty.

          Solutions to the STD crisis in women must include empowerment in the social sphere in addition to direct health care.

SOURCES: Ebrahim, S. H., M. T. McKenna, and J. S. Marks. 2005. Sexual behaviour: Related adverse health burden in the United States. Sexually Transmitted Infection 81(1): 38-40. Dunkle, K. M., et al. 2004. Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet 363(9419): 1415-1421. Joint United Nations Programme on HIV/AIDS. 2004. AIDS Epidemic Update, December 2004. Geneva: UNAIDS. World Health Organization. 2003. Gender and HIV/AIDS. Geneva: World Health Organization.

The United States has the highest STD rate of any industrialized country. Estimates released in 2004 showed that half of all Americans will have at least one STD by age 25, and nearly half of all STDs that occur each year are in people ages 15 to 24. The direct lifetime medical cost of STDs, including HIV, is estimated at $10-15 billion for the new STDs acquired each year. STDs are public health challenge for many reasons.

• STDs are stealth diseases. Many STDs, including chlamydia, genital herpes, trichomoniasis, and HPV infection have few, if any, recognizable symptoms. The large number of disease carriers who are unaware of their infection makes these diseases extremely difficult to control. Experts believe that in most cases, HIV is transmitted very early in the disease, before people are aware of the infection. The fact that most people are symptom free for the first several years of HIV infection highlights the need to test people at risk often.
• Viral STDs are persistent and incurable: Even if detected, most viral STDs—genital herpes, HPV infection, and HIV infection—are not curable with current therapies. This means that the number of people capable of infecting others continues to grow. The best hope for controlling viral STDs is the development and widespread use of effective vaccines. The hepatitis B vaccine provides a positive example: In the years since the introduction of the vaccine, the rate of new cases of hepatitis B has dropped by more than 75%, and further declines are expected.
• Screening tests may be underutilized: Nationwide, too many physicians and clinics fail to follow the CDC recommendations for screening, especially for chlamydia in young women. In addition, too many individuals are too unaware or too embarrassed to request STD screening. Testing more people for STDs could potentially bring STD rates down; it would at least provide an opportunity to counsel people about risky sexual behavior. In surveys, up to 75% of people support offering STD testing in schools. Also potentially helpful would be media messages about the benefits and availability of confidential STD screening services.
• Young people are particularly vulnerable to STDs: Young adults are more likely to be ignorant about STDs and safer sex, embarrassed to ask for information, and unaware about how to access appropriate STD testing and treatment services. Nearly all young adults are sexually active by age 25, but young people are more likely to be unmarried, have more than one partner over time, and/or have a partner who has an STD. Young people need medically accurate information about abstinence, condoms, and other contraceptive methods—and open communication and encouragement from family, friends, and the community to behave responsibly.

          Until STDs are controllable with vaccines or effective screening and treatment, the only way to reduce your risk is to limit the number of sexual partners and to use condoms consistency (see the guidelines presented earlier in your textbook). For those who choose abstinence or a mutually monogamous relationship with one uninfected partner, there is no risk of STDs.

SOURCES: Cates, J. R., et al. 2004. Our Voices, Our Lives, Our Futures: Youth and Sexually Transmitted Diseases. Chapel Hill, N.C.: School of Journalism and Mass Communication, University of North Carolina at Chapel Hill. Weinstock, H., S. Berman, and W. Cates. 2004. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health 36(1): 6-10. Chesson, H. W., et al. 2004. The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health 36(1): 11-19.

No. Viral hepatitis is caused by one of several different viruses. Hepatitis A, the mildest form of the disease, is usually transmitted via contaminated food or water but it can be transmitted sexually, especially in people who engage in anal sex; a vaccine is available and is recommended for all people at risk. Hepatitis C is most often transmitted through direct contact with infected blood (such as in injection drug use), but it can also be transmitted sexually. Experts believe that traumatic sexual activity that causes tissue damage is most likely to transmit the hepatitis C virus. Like hepatitis B, hepatitis C can cause serious chronic liver disease; however, there is no vaccine against hepatitis C.

Yes, if one or both of you have had other sexual partners at any point. Almost all STDs—including HIV infection—can be completely asymptomatic for long periods of time. If you are sexually active, be sure to get periodic STD and HIV checks, even if you have no symptoms. If you have a risky (unprotected) sexual encounter, see a physician as soon as possible for testing and early treatment. Treating STDs like chlamydia and gonorrhea within a few days of infection is very likely to prevent complications such as PID and infertility. Don't wait for symptoms to develop—you may never have any. Permanent damage from STDs can occur even if you have no symptoms.

          Both men and women should have periodic STD screening, and sexually active young women need pelvic exams and Pap tests at least once a year. If you are given medication to treat an STD, take all of it as directed. Incomplete treatment can result in an incomplete cure, thereby contributing to the development of drug-resistant organisms. Do not share your medication with a partner. He or she should see a physician for testing and treatment. Do not have sexual intercourse until your treatment—and your partner's treatment—is complete. If your partner still carries the infection, even if he or she has no symptoms, you are likely to be reinfected when you resume sexual activity.

          If you have an incurable STD such as herpes or HPV infection, always use a condom and make sure your partner is fully informed of the potential risks of being intimate with you, even if you are using condoms. Remember, STDs can be—and most often are—transmitted by people who have no symptoms.

All diagnosed cases of AIDS must be reported to public health authorities. Before effective treatments for HIV infection were available, officials could use AIDS statistics to track the epidemic because nearly everyone with HIV developed AIDS within a fairly predictable time frame. However, the advent of more effective treatments has lengthened the time between infection and the onset of full-blown AIDS for many patients, making it more difficult to track the U.S. epidemic based on AIDS statistics alone. For this reason, the Centers for Disease Control and Prevention (CDC) recommended in 1999 that states require reporting of both HIV infection and AIDS.

          Despite efforts to safeguard confidentiality and prohibit discrimination, mandatory reporting of HIV infection remains controversial. If people believe they are risking their jobs, friends, or social acceptability, they may be less likely to be tested. At the same time, it is essential that enough information be disclosed to monitor the epidemic. The CDC recommends that states continue to provide opportunities for people to be tested anonymously; home HIV tests also allow anonymous testing.