5 Things You Don't Know About Sexually Transmitted Diseases

I like to think I am relatively knowledgeable. Academically, I have been steeped in political philosophy and can discuss Plato’s Myth of the Cave or the uniqueness of American federalism and how it shapes public health. Important topics, for sure, but not always the most useful in the day-to-day. I also thought my many years of doing sexual and reproductive health work made me an expert of sorts.

Then I entered the world of sexually transmitted infections and diseases...and doubt settled in.

I am now three months into my new role as the executive director of the National Coalition of STD Directors (NCSD) and I have begun to reflect on a few things I did not know previously that have been, well, shocking to me, and have tested what I thought was a well-honed repertoire of knowledge. We’ve been working here at NCSD to highlight some key issues related to STDs given that April is National STD Awareness Month and I thought I would take the liberty of providing a few reflections of my own.

Here are a few things I did not know that I think every sexual and reproductive health advocate should:

We are on the verge of a highly untreatable gonorrhea epidemic.

Gonorrhea is a bacterial infection and bacteria have a funny way of developing resistance to treatments – their own built-in evolutionary survival mode. This is what has happened with gonorrhea, the second most commonly reported notifiable disease in the United States with more than 336,000 cases reported in 2008.

It is also among one of the most racially- and age-disparate diseases. For example, according to the CDC, though blacks make up only 12 percent of the U.S. population, more than 70 percent of reported cases of gonorrhea in 2008 were among blacks. It also affects young people disproportionately, with the majority of new cases being consistently reported among 15 to 24 year olds. In early 2007, after much reporting of resistance to the class of antibiotics known as quinolones, the CDC stopped recommending them for use in treating gonorrhea. We now have just a single class of antibiotics left to treat gonorrhea but resistance is also developing with this class and the pipeline of new drugs is nearly empty. Future treatment might require multiple drug combinations or multiple doses over a longer period of time and even then, we are not sure what the future holds.

Gonorrhea leads to all sorts of adverse sexual health outcomes including infertility and likely exacerbates susceptibility to HIV. Something called Disseminated Gonococcal Infection that can cause crippling arthritis could become commonplace, and toxic blood and outright organ failure are likely prospects for infected persons if we do not get ahead of this situation with new treatments. I hate to sound alarmist, but the prospects of this situation are frightening.

The public health workforce is full of incredible, unsung heroes.

There are these amazing front line workers in the public health workforce known as Disease Intervention Specialists (DIS) that are just below the radar screen, but are the most fascinating folks whose jobs would make for the most watchable reality television show. DIS are funded by CDC to do STD work, but their expertise goes beyond STDs. For example, many were tapped to deal with the H1N1 situation because their skills were relevant. And what a skill set! DIS-ers do lots of things but their primary job is to find people who’ve had sexual contact with someone who has been diagnosed with a reportable STD – chlamydia, gonorrhea, or syphilis – and get them tested and if necessary, treated. Now that is some work, often requiring Columbo-like detective skills and more chutzpah to get the job done than most professions. But it is also comingled with compassion when they are speaking to patients about a positive diagnosis for HIV or another STD, or doing the much needed behavioral counseling that requires the additional skills of a therapist and social worker. They’re my new heroes in public health.