A description of the sexually transmitted disease risks to American college students. Consumer Health Education Council. 1990.
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AIDS is not the only sexual di$ease risk to students
While AIDS gets the lion' s share of
publicity and research dollars, other Sexu- ally Transmitted Diseases (STDs) may represent a much graver threat to most sexually active college students. About three of every thousand stu- dents-mostly males- across the country have tested positive for the HIV virus which causes AIDS. Some of these sbl- dents are undoubtedly aware that they are infected and have modified their sexual behavior or intravenous drug usage to avoid infecting others. But many are probably unaware of their condition, and they are at substantial risk of infecting another per- son with each sexual encounter. At the end of 1990, surveyors reported that only one of every 5000 female college students across the U.S. is infected with AIDS, demonstrating that these young women are at much higher risk of being infected by STDs other than AIDS. These other diseases represent a much greater to the health of students be- cause of their easy transmission and their already high incidence among adolescents and young adults. Some of these STDs have consequences which are every bit as horrific and deadly as AIDS. Cervical cancer Six thousand woman will die in 1989 from cancer of the cervix, and hundreds of thousands more will contract infections strongly associated with development of the disease, or have abnormal Pap tests indicating cervical changes possibly ing to cancer. To illustrate, 17 percent of the female students at the University of Akron show such abnormal smears. Women who begin sex at a young age or who have multiple sexual partners are at increased risk for cervical cancer. In large part, certain infections obtained in these sexual encounters may be respon- sible for increased cancer risk. Several of these infections are common on campuses. Warts (HPV) A strong association has been estab- lished between cervical cancer and some of the more than 40 herpes viruses which cause genital warts (HPV). Physician and clinic visits for treatment of HPV in the U.S. increased by 500 percent between 19(>6 and 1981, to more than one million per year. Eighty-five percent of those ex- posed to sexual partners with HPV will be infected with these incurable viruses. HPV is the major cause of abnormal Pap smears in women of college age. At the University of Washington, 11.4 per- cent of the female students examined had cervical infection by HPV even though they had no visible warts. Nearly half of these students had pre-cancerous cell changes. Researchers emphasize, "all cer- vical HPV must be treated as having ma- lignant potential." HPV can also invade the bladder, eyes and other areas with mucous membranes. Another herpes vi- rus, known as Epstein-Barr Virus (EBV), is also a potential cause of cervical cancer. Ominously, one swdy detected HPV Consumer Health Education Council 2660 Lehman Rd. No. 602-E Cincinnati, OH 45204 606-275-3378 @ 1990, Heallh EducaJion Council. Permission to reprint in whole or parts granted if credit is given. infection in 72 percent of male partners of infected females even though the men had no symptoms. Chlamydia trachomatis The most common STD, Chlamydia has also been found to be associated with cervical cancer. Four million new cases of the Chlamydia infection are estimated to occur annually in the U.S. One-half to two-thirds of all involuntary blbal infertility is due to this infection. Up to 62 percent of women with Pelvic Inflammatory Disease (PID) have been infected with Chlamydia. At the University of South Florida, 6.9 percent of female students with no symptoms were infected with Chlamydia. Forty-eight percent of the females with vaginal symptoms (itching, discharge, etc.) tested positive, and 50 percent of the males with non-specific urethritis had Chlamydia. In 1988, 20 percent of the sexually ac- tive males at Bowling Green State Uni- versity tested positive for Chlamydia, and 7 percent of the males with no symptoms were infected. Up to one-third of all sexu- ally active male adolescents are estimated to have the disease. Since few of them are treated, many bring Chlamydia with them to college to share with their female partners. More bad news: Perhaps 30 per- cent of infected (and infectious) people have no symptoms. In 1990, a urine test for Chlamydia was approved, allowing for easier testing and the first practical test for males. Gonorrhea Gonorrhea is the most reported STD among college sbldents, probably because it usually produces distinct symptoms. High school and College-aged Americans have the highest rate of gonorrhea infec- tion. Sixty percent of cases are reported in people under 20 years of age. While gonorrhea is fairly readily treated, it is not a wholly innocuous disease. A substantial percentage of women with (PID) previ- ously had gonorrhea. Herpes As with other STDs, genital herpes (HSV-2) is epidemic among college sw- dents, and easily transmitted to an unin- fected partner. Less widely known, a study of students at Pennsylvania State showed that common oral herpes (HSV-1) "is readily transmitted to the genitalia" during oral sex. It is also transmitted by kissing. While the drug acyclovir is of tremen- dous importance in treating herpes, it does not reduce the infected person's ability to infect a sexual partner. Viral shedding (and spreading) can occur even when no sore is visible. HSV may increase the risk of cervical cancer and have unpleasant effects on the nervous system. Hepatitis B According to the Centers for Disease Control (CDC), college swdents who have 3 sexual partners within 4 months are 10 times more likely to contract hepatitis B, a major cause of liver cancer and cirrho- sis. Students with 2 or more episodes of STD were 25 times as likely to be infected than students with fewer episodes. Over the next 20 years, the cost of treating people with hepatitis B, which is totally prevent- able by vaccination, is estimated to exceed the cost of treating AIDS. Molluscum contagiosum Molluscum contagiosum is another in- curable viral infection whose highest in- cidence is among college-aged Americans. In the general population, patient visits for the disease increased by 1,100 percent be- tween 1966and 1983. The long-term health risks of molluscum infection are unknown, but based on the harmful effects of other STD viruses there is reason for concern. PID As previously mentioned, Pelvic In- flammatory Disease (PID) is precipitated by gonorrhea and Chlamydia infection. It is a major cause of infertility and ectopic pregnancy. Twenty percent of women with PID become infertile. One of every 8 ado- lescent women will get PID, and 7 of every 1,000 women aged 20-24 will be hospi- talized with the disease. Interestingly, oral contraceptives seem to reduce the risk of developing PID. Attitudes Why do young people--and college students in particular-have such a high incidence of Sexually Transmitted Dis- ease? Very simply because they have a lot of sex and multiple partnl78. They also engage in risky sexual behaviors. Brandeis University researchl78 report ~ ~ ~ = = = = , , Type-1 (oral) herpes, is easily transmitted to the genitals of a partner receiving oral sex C5"'!11oo..,. ______________ -t''Z5vl that the percentage of males aged 17-19 who have had sex went up from 66 percent in 1979 to 75 percent in 1988. At Wake Forest, the percentage of fe- male students having multiple sexual part- nl78 went from 19.4 percent in 1970 to 48.8 percent in 1981, nearly the same per- centage as males. If the national trend has held true, the percentage is probably con- siderably higher today. The average age of first intercourse dropped to 17 years for males and 17.6 for females. (By com- parison, in a lower-middle-class com- munity in Illinois, the age for boys was 12.5 and for girls 14.5.) At Indiana University, 27 percent of male and 24 percent of female swdents report having anal intercourse, a higher risk sexual behavior for contracting AIDS when performed without condoms. (Regular receptive anal intercourse with- out condoms is also known to interfere with a healthy immune system.) 'These are Indiana students, cheer- leaders, basketball players, the heart of America They are having multiple part- nl78 at a very high rate, they have an av- erage of four years of sexual experience and are averaging six or seven partners over that time. They are not using condoms-they have a sort of a natllral idea that if you use one a year it sort of protects you," says the researcher who conducted the survey. . Other surveyors note that, although "AIDS-specific knowledge [is] high among adolescents/young adults," those who were sexually active scored high on a scale of sex risk behaviors. Two-thirds reported sex without proper condom use. Those with more AIDS knowledge were no more likely to take precautions. Educational programs are, say these researchers, "unlikely to re- duce risk behaviors in sexually active ado- lescents." In a Santa Cruz, California study of sexually active women aged 14-20, more than 50 'percent had more than one sexual partner in the prior year, but only 12 per- cent used condoms consistently. Frustrat- ingly, 20 percent of the women had used condoms with their primary partner, but only 12 percent used condoms with other partners. Thirty-two percent had a prior history of STD, 16 percent had been pregnant Researchers at the University of Cali- fornia at San Francisco who examined the women reported that "although perceptions [among young people] that condoms pre- vent sexually transmitted diseases and the value and importance placed on avoiding STDs remained high, they were neither reflected in increased intentions to use condoms nor in increased use." Former Surgeon General Koop agrees that AIDS education is not influencing young people. "We do know that teen- agers are not listening" to warnings against unsafe sex." (And neither are college stu- dents.) Dr. Koop speculates on why young people have not modified their behavior to combat the spread of AIDS and STDs: "Teenagers are risk takers. They feel they are immortal. They don't like any admo- nition that begins with the word 'don't'." Ninety percent of college health pro- fessional rank sexual health problems as the primary threat to the physical and emotional well-being of young adults. Solutions? As Dr. Koop has observed, short of an unlikely outbreak of abstinence, condoms are the first line of defense against AIDS and STDs. If your sexual partner is infected with AIDS, the risk of becoming infected is about 150 times less if you use a condom. Condoms have been shown to be effective against herpes simplex, hepatitis B, Ch- lamydia, gonorrhea, and cytomegalovirus (CMV) (another herpes virus which is sexually transmitted). Condom use reduces the incidence of PID, ureaplasma infec- tion, and cervical cancer. They are prob- ably somewhat less protective but still valuable against warts and molluscum. If you or your partner has had prior sexual experience it is thoroughly irre- sponsible for you not to use a condom with each sexual encounter, from start to finish. This means not only during vaginal and anal intercourse, but also oral sex, which is now known to be a method for transmitting and receiving SID in- fections, including AIDS. If you are a male, consider that several STDs place a young woman at increased risk of cancer, sterility, and even death. Is that a risk you would like. her to take? If you are a female, remember that he might be infected and show no symptoms. And, while they may not significantly in- crease his risk of cancer, the effects of STDs on males can be unpleasant, expen- sive, and perhaps more dangerous than is presently known. Remember, each person you infect may infect several others. In the future you could be reinfected with the same or another STD. And there may be many other STDs.-possibly CMV or Epstein-Barr Virus.-with effects not fully understood. Condoms are not perfect About one of every 100-165 breaks. They should not be used with any lubricating product- like baby oil-containing mineral oil, which quickly destroys them. Their value is increased in conjunction with a sepa- rately applied spermicide (in addition to the kind that comes already on the condom). Spermicides are also indepen- dently associated with reduced risk of certain STDs. Use only latex condoms. If you have had sex with someone who previously had multiple partners you should be examined for the spectrum of SIDs while embarking on a safer approach to sex. Females should have regular Pap tests and report any prior history of STD. Early detection of cervical cell changes is a powerful weapon in preventing them from developing into cancer. Three important barriers to the spread of AIDS and STDs are reason, prudence and communication. Adopting the fol- lowing approaches will dramatically re- duce exposure to and spread of all SIDs. . t/ Choose low risk sexual partners and behaviors. t/ Always use a condom, or require that 'JOur partner use one. Avoid exchange of body fluids. Always use a spermicide. t/ Find out your partner's sexual his- tory. Require that he/she be examined for STDs and treated if necessary. t/ Women should obtain regular Pap tests and report STD history. t/ Unless your partner is a virgin, never presume that he/she is STD-free. t/ If you have any doubts, simply refuse to have sex. Sexual choices are part of the moral and intellectual fabric of life. To engage in behavior known to be risky or harmful is demeaning and self-destructive. A young person who takes on the responsibility to become educated, wear seat belts, and to look both ways before crossing the road, can exercise similar judgement in choos- ing safer sex. To do otherwise makes you a danger to yourself and a menace to others. Choosing a condom Which provide superior protection?* *Best Condoms tested wtih 1.5% failure rate: Embrace Ultra-Thin Excita Extra Excita Fiesta Gold Circle Coin Kimono Koromex with Nonoxynol-9 Lady Protex Ultra-Thin Lady Protex with Spermicidal Lubricant Lady Trojan LifeStyles Conture LifeStyles Extra Strength Lubricated LifeStyles Stimula Vibra-Ribbed Protex Arouse Protex Contracept Plus with Spermicidal Lubricant Protex Secure Protex Touch Ramses Extra with Spermicidal Lubricant Ramses Non-Lubricated Reservoir End Saxon Wet Lubricated Sheik Elite Sheik Fetherlite Snug-Fit Sheik Non-Lubricated Reservoir End Today with Spermicidal Lubricant Trojan Naturalube Ribbed Trojan Plus 2 Trojan Ribbed Trojan-Enz Trojan-Enz Lubricated Trojans Trojans Plus Wrinkle Zero-0 2000. Yamabuki No. 2 Lubricated *Medium Condoms tested with 4% failure rate: Lifestyles Nuda Mentor Ramses NuFORM Ramses Sensitol Lubricated Saxon Ribbed Lubricated Sheik Non-Lubricated Plain End *Worst Condoms tested with 10% failure rate: LifeStyles Extra Strength with Nonoxynol-9 LifeStyles Nuda Plus *According to testing reportsd by Consumers Union