Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. CDC estimates that there are approximately 19 million new STD infections each year — almost half of them among young people 15 to 24 years of age. The cost of STDs to the U.S. health care system is estimated to be as much as $15.9 billion annually.

Condoms or Abstinence?

While it is probably best to abstain from sexual intercourse until you have a lifelong sexual relationship, this is not the norm with today's teens. Most teenagers are not saving themselves for marriage. The trend has shifted.

What can happen from unprotected intercourse? Why is it important, if you are going to be sexually active, to use a condom EVERY TIME and use it CORRECTLY? Read the following descriptions to fully understand the risks of having unprotected sex, including oral sex as well as intercourse.

Genital Herpes

This is a recurrent lifelong viral infection for which there is NO cure. 16.2% of Americans are infected with Herpes Simplex Virus-2 (HSV-2), and many do NOT know it! HSV-1 and HSV-2 are transmitted through direct contact: kissing, sexual contact and direct skin-to-skin contact.

It can be transmitted with or without the presence of sores or other symptoms. Up to 30% of first-episode genital herpes is now HSV-1, with oral sex being the most likely source of infection (shedding from the mouth).

Infection rates are highest among those people who initiated intercourse at an age younger than 17 and with a greater number of lifetime sexual partners.

For more information, see http://www.cdc.gov/std/Herpes/STDFact-Herpes.htm.

Genital Warts

Approximately 20 million Americans are currently infected with HPV, the virus that causes genital warts. Another 6 million people become newly infected each year. HPV is so common that at least 50% of sexually active men and women get it at some point in their lives. The adolescent cervix is MORE susceptible to infection with this virus due to the nature of the adolescent cervix and its mucosa. 95% of cervical cancer is associated with HPV. This is the second most costly STD after HIV disease.

Most people who become infected with HPV do not even know they have it.

Vaccines are now available that can protect males and females against some of the most common types of HPV. The vaccines are most effective when given before a person's first sexual contact, when he or she could be exposed to HPV.

Condoms may lower the risk of HPV infection, and the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom, so condoms may not fully protect against HPV.

This disease has great psychosocial impact:

• Fear of transmission and recurrence of symptoms
• lifestyle changes: abstinence or fewer partners, sex only with condom use, depression, low self-esteem, and feelings of contamination
• Strained relationships due to the disease
• Anxiety related to disclosure to your partner

Genital HPV CAN be prevented! Abstinence is the most effective strategy to prevent HPV infection. The vaccine available does reduce the risk substantially, but there are 40 types of HPV virus that can infect you!

For more information, see http://www.cdc.gov/std/HPV/STDFact-HPV.htm#common.

Other reasons to be concerned for the sexual health of teenagers

• Chlamydia .  Chlamydia is the most commonly reported STD in the United States. In 2008, 1,210,523 chlamydial infections were reported to the CDC, an increase of 9.2% compared with the rate in 2007.  Over the 20 years from 1989 through 2008, the rate of reported chlamydial infection increased from 102.5 to 401.3 cases per 100,000 population. Easy to cure, chlamydia can impact a woman’s ability to have children if left untreated.
• Hepatitis A, B, and C.  Hepatitis C virus (HCV) infection affects nearly 4 million persons and causes an estimated 12,000 deaths each year in the United States. Approximately 20% MAY be sexually transmitted.  Hepatitis C is a liver disease caused by the hepatitis C virus (HCV) that sometimes results in an acute illness, but most often becomes a silent, chronic infection that can lead to cirrhosis (scarring), liver failure, liver cancer, and death. There is no vaccine for hepatitis C.
• Pregnancy

The potential outcomes of STDs

In summary, the following outcomes can result from the most prevalent STDs:

• HPV can lead to cervical cancer and death
• HIV/AIDS, with aggressive treatment, can become a lifelong chronic condition, but with untimely death still occurring in many cases.
• Hepatitis can cause chronic active liver disease and may eventually require a liver transplant.
• Chlamydia, left untreated, can lead to female infertility

Condoms –why do they fail?

Condoms can fail for many reasons:

• Manufacturing defects (a rarity)
• Breakage during withdrawal or during intercourse
• Slippage during intercourse
• User failure
  • Incorrect use
  • Genital contact prior to using the condom
  • Flipping the condom over after the initial application
  • Fingernail holes poked in the condom
  • Use of oil-based lubricants
  • Not holding onto the condom during withdrawal
  • Improper positioning of the condom
  • Not withdrawing while the penis is erect

In 2002, the CDC issued a report (STD Treatment guidelines 2002) that said:

Consistent/correct use of latex condoms are effective in preventing sexual transmission of HIV infection and can reduce the risk of other STDs. Likely to be more effective in prevention of infections transmitted by fluids from mucosal surfaces (gonorrhea and HIV) than those transmitted by skin-to-skin contact (HSV, HPV, syphilis).

In July 2001, The Condom Report stated that there was strong evidence for the effectiveness of condoms reducing sexually transmitted gonorrhea for men and that consistent condom use decreased the risk of HIV/AIDS transmission by approximately 85%

Is abstinence realistic?

The most reliable way to avoid transmission of STDs is to abstain from intercourse, OR to be in a long-term, mutually monogamous relationship with an uninfected partner. Remember, abstinence is a lifestyle choice. It is NEVER too late to abstain from all forms of intercourse UNTIL you have selected your lifelong partner. Abstinence will prevent skin-to-skin disease transmission and maintain health. I will be happy to discuss this subject with you at an appointment where I can answer any questions you might have.

Download these brochures for more information.

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