RI Skin Doc | Sex, Teens, and Dermatologists - I can treat you now

Sex, Teens, and Dermatologists

I can treat you NOW or treat you LATER!

PLEASE NOTE: this site is educational and while it might offend some, this is meant to educate our youth. Ideally, through education, we can prevent sexually transmitted diseases (STD) and their sequelae. Your comments and criticisms are welcomed. This subject was the "brainchild of Kim K. Dernovsek, M.D.". After attending a lecture by this woman in Washington, D.C. in February 2004, I was so impressed by her talk and statistics presented, that I felt my patients would benefit from this subject.

It is a known fact that 65 MILLION Americans live with a sexually transmitted disease. Most of these infections are viral. There are 15 million new cases every year reported in the United States, with 3.75 million (1/4) new cases occurring in teenagers! The Center for Disease Control (CDC) estimates that $17 Billion is spent annually on treatment for these diseases. For these reasons, it is important to educate our teens as to the dangers of STDs.

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 to some adolescents saving themselves, but they are still in the minority. 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?………………………….

Genital Herpes

This is a recurrent lifelong viral infection [CDC MMWR 2002:51 (rr-6)] to which there is NO cure. 45 Million Americans are infected with Herpes Simplex Virus-2 (HSV-2) and do NOT know it! [New England Journal of Medicine 1997;337:1106-1111). 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 (JAMA 2000;283: 791-794). Up to 30% of first episode genital herpes is now HSV-1 in type [(CDC, STD Treatment guidelines 2002 MMWR 2002;51 (RR-1)], with oral sex being the most likely source of infection (shedding from the mouth).

21.9% of the US population, aged 12 and older (=45 million people) are positive for HSV-2. 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.

Genital Warts

Genital warts, due to the human papilloma virus (HPV) are found in 1.5-13% of all sexually active adults. The adolescent cervix is MORE susceptible to infection with this virus due to the nature of the adolescent cervix and its mucosa. In the US, it is estimated that there will be 12,200 cases of cervical cancer reported with 4,100 deaths in 2003. 95% of cervical cancer is associated with HPV. For women, HPV-related mortality is at least 2X that of HIV. This is the second most costly STD after HIV disease.

This disease has great psychosocial impact:

fear of transmission and recurrence
lifestyle changes: abstinence, fewer partners, and/or condom use depression, low self-esteem, and feelings of contamination
strained relationships due to the disease
anxiety related to disclosure to the partner

Genital HPV CAN be prevented! Abstinence is the most effective strategy to prevent HPV infection.

Other reasons to be concerned for the sexual health of our teenagers:

Chlamydia

Hepatitis A, B, and C (there are 4 million cases of Hepatitis C in the US, or 1.8% of the population. Approximately 20% MAY be sexually transmitted.

Pregnancy

The potential sequelae of STD:

HPV à cervical cancer à death
HIV/AIDS à death
Hepatitis à chronic active hepatitis à liver transplant
Chlamydia à infertility

Condoms………why do they fail?

This relates to the condom itself Method failure is breakage during withdrawal or during intercourse
Slippage during intercourse Manufacturing defects (RARE)

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 on to 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 CDC) 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 Kaiser family foundation reported, over a period of time the following statistics:

75% of 7-12th graders have NEVER had sexual intercourse (9/26/00)
70% of teens ages 15-17 have NEVER had sexual intercourse (5/2001)
66% of 6th graders have NEVER had sexual intercourse (9/27/02)
64% of teens aged 15-17 have NEVER had sexual intercourse (10/02)
10.5% more 11th grade boys in 2001 have NEVER had sexual intercourse than in 1991
67% of teens ages 15-17 have NEVER had sexual intercourse (10/03)
It appears that the prevalence of sexual experience ("ever having had sexual intercourse") has decreased 16% from 1991-2001. Positive behavior changes have been seen with alcohol related deaths, bike helmets, seat belt use, and increased sunscreen use. Behavior modification and disease prevention is very important, especially when thinking about preservation of life and freedom from disease.

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.