Sexually-Transmitted Diseases: The 21st Century Plague

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Introduction

Sexually-transmitted diseases (STDs) are a serious public healthcare issue affecting millions of individuals worldwide. According to the reports of the World Health Organization (WHO), over one million sexually-transmitted diseases are acquired by individuals daily. The numbers are truly staggering, as it is estimated that half a billion people around the world have herpes simplex virus (HSV), over 290 million people have been infected with human papillomavirus (HPV), and 37 million people suffer from HIV/AIDS (WHO).

These diseases, as well as many others, totaling 30 in number, cause immense amounts of harm to individuals, families, and communities at large. STDs are notoriously difficult to cure, meaning that many do not have the means to afford treatment. This results in reduced lifespans, greater morbidity, and social stigma associated with the diseases. Ostracism and isolation often lead to depression and suicide. Children born in families with STDs are very likely to inherit the illnesses and die in infancy.

Although the epidemiology of STDs indicates that the majority of the cases are limited to Africa, South America, and South-East Asia, the number of infected individuals in economically prosperous regions, such as North America and Western Europe, continues to grow. In the US alone, over 2.3 million cases have been reported in 2017 for chlamydia, gonorrhea, and syphilis (Harris).

The country is notorious for having the largest STD rates out of all industrialized countries in the world (WHO). The report states several reasons for these developments, such as the continuous cuts to the healthcare budget, the rising poverty, the decrease in economic output, and the general unawareness of the population. Combined, these factors can affect the state of affairs even in a large and economically powerful country.

The number of underreported or undiscovered cases ought to be even higher due to a lack of awareness and social stigmatizing. This constitutes a major healthcare issue both inside and outside of the US. The purpose of this paper is to investigate the scope of the issue, its racial and socio-economic underpinnings, and propose intervention in line with the core values of the University of Saint Leo.

History of STDs

Sexually-transmitted diseases are as ancient as humanity itself. The first descriptions of STDs can be found in the scripts and clay tablets of the Mesopotamian civilization, dating further than 1800 BCE. Indications of sexually-transmitted ailments were found in ancient Mesopotamian myths as well as their medical notes and legislative documents (Hammurabi’s code of laws) (Gruber et al. 2).

In ancient times, sexually-transmitted diseases were associated with brothels and prostitution, and the most common ailments were chlamydia, gonorrhea, and herpes. They were treated with a combination of herbal medicine and magic, which was said to exorcize the malignant demons out of the body. Similar scriptures were found in other ancient civilizations, such as ancient Egypt, Greece, Rome, and China. The Mediterranean civilizations are notable for taking a more academic approach to treatments, following the teachings of Hippocrates, Dioscorides, and Celsus. However, at that moment in humanity’s history, STDs were largely perceived as punishments from the Gods associated with promiscuous lifestyle and a lack of virtue.

During the Medieval times, the number of STDs saw a decline due to the widespread popularity of Christianity, which forbade promiscuity, infidelity, and polygamy, which were popular during the decadent ages of ancient antiquity. At the same time, the state of science and medicine saw a significant downturn as well, due to the influence of the Church on medical practices. Most illnesses were treated as matters of faith and spirit rather than material issues.

Nevertheless, on a legislative level, STDs were first acknowledged as a public health issue. The London Act of 1161 forbade entrance to brothels to women who suffered from “the burning of the genitals” (Gruber et al. 5). At the same time, the spreading of STDs was associated with wars and poverty, as various armies and bands of soldiers required entertainment, which was provided by the local brothels, “camp ladies,” and others. The authority to provide remedies was largely in the hands of the Church, which saw the creation of the first hospitals to treat the afflicted.

Nevertheless, the primary killers during medieval times were diseases born of poor hygiene rather than sexual intercourse. The Great Plagues of the 8th, 9th, 11th, 12th, 14th, 15th, and 16th centuries caused massive casualties among civilian populations. An interesting fact about the Great Plague in London is that there was a belief that syphilis would protect against the development of the plague. While entirely unfounded, it forced many desperate Londoners to purchase the services of syphilis-ridden prostitutes in an attempt to stave off a greater threat.

During the late Medieval and Early Renaissance periods, there was an increase in popularity for a chirurgical approach towards the treatment of sexual diseases, namely syphilis, condylomata, ulcer dura, gonorrhea, and ulcers million. Bernard Gordon advocated the use of bloodletting, baths, and emetics for treating gonorrhea, whereas Abbess Ildegard claimed that surgical intervention could remove “a certain form of leprosy” from “lustful men” (Gruber et al. 7). The association between sexual activities and the spreading of STDs was acknowledged and confirmed by the majority of medical authorities of the time.

The late 19th – early 20th century saw the revolution in both medical and pharmaceutical practices. It enabled a greater understanding of the diseases and saw the development of cures to various STDs, such as syphilis, chlamydia, and gonorrhea, which were (and still are) the most prominent diseases of the time. At the same time, the gradual increases in the quality of life, the appearance of available contraception, and the growing globalization of the economy provided easier ways for STD migration. In the 1970s, the outbreak of a new disease called HIV/AIDs saw the first STD pandemic. That period also saw rigorous campaigning against the disease, seeking to inform the general populations about the dangers of the new threat, as well as the benefits of protected sex.

Most Common Types of STDs

According to WHO, there are over 30 different infections and diseases that could be transmitted through sexual contact (WHO). Out of that list, only eight are responsible for the majority of incidents around the world. These diseases are as follows:

Chlamydia – symptoms are often unnoticeable, severe cases cause pain, discharge, and vaginal bleeding.
Gonorrhea – similar symptoms to chlamydia, only greater in scope. Pain, discharge, bleeding. Tissues might be affected as well.
Syphilis – caused by sexual contact, results in sores and cracks in the skin along the genital tract, lips, or the anal ring.
Trichomoniasis – a relatively benign infection that causes light sores and inflammation in the affected areas.
Herpes Simplex Virus (HSV) – the symptoms are usually unseen in most individuals that have contracted the virus. In some cases, HSV causes painful blisters around the genital area.
Hepatitis B – an acute disease that affects the patient’s liver. Can be transmitted through sexual contact or blood infusion.
Human Papillomavirus (HPV) – results in warts and precancerous lesions.
Human Immunodeficiency Virus (HIV) – causes progressive failure of the immune system by attacking the individual’s CD4 cells. As a result, the patient is much more vulnerable to opportunistic infections and is more likely to develop cancers.

Out of these diseases, four are curable. However, HSV, Hepatitis B, HPV, and HIV does not have a vaccine or a cure. The existing remedies are aimed at reducing the symptoms and enabling a modicum of living for those afflicted. Because of this fact and a multitude of superstitions surrounding the issue, the carriers of these four infections are often stigmatized, which leads to underreporting and refusal of treatment by patients.

Common Myths About STDs

There are several persistent myths about STDs that are persistent throughout various communities. They are typically born of ignorance or misunderstanding of the available information. The most common myths about STDs are as follows:

Only poor people get STDs. While it is true that poor people are disproportionally affected by STDs, these diseases do not discriminate between the rich and the poor. Practicing good judgment and contraception is equally important for everyone.
STDs are visible to the naked eye. While some diseases have visible external signs that can be spotted, the majority of STD infections are transmitted without either partner knowing of their presence. Condoms are effective only as a preliminary measure.
Contracting an STD once gives you immunity from all STDs. A flawed perception is based on the improper understanding of how the immune system works. While it is possible to develop antibodies against some of the less threatening diseases, a good half of them will remain in a person for life.
Oral and anal sex can help prevent STDs. This myth is based on the assumption that all STDs affect only the organs of sexual reproduction. In truth, some diseases require skin to skin contact alone, while others can enter the bloodstream through small lesions in the mouth or anus.
STDs can be transmitted through handholding, eating from the same dish, using the same toilet seat, and kissing. While other diseases can be transmitted in the following way, STDs are called this way because the mechanism of their transmission explicitly involves the use of sexual organs, which is where the highest concentration of infectious agents is located. This myth is the main reason for the ostracizing of infected patients.
Anti-pregnancy drugs can prevent STDs. This assumption is blatantly wrong for a variety of reasons. The mechanisms of pregnancy are different from the mechanisms of STD transmission. The only anti-pregnancy tool that also serves as protection against STDs is the condom.

STDs Among Different Populations in the US

The USA is represented by different populations vulnerable to contracting and developing STDs. These populations vary by gender, race, and socio-economic status. According to Horberg et al., several groups are particularly vulnerable to the effects of these diseases, namely young patients, blacks, Latinos, and women (582). These populations are more likely to engage in unsafe sexual behavior, contract various STDs, including HIV/AIDs, and show smaller retention rates in ART treatments compared to others.

These findings are supported by Reif et al., who says that black people are disproportionally affected by STDs when compared to white and Asian-American populations (355). The research by Reif et al. also indicated that 57% of all patients with STDs are black, with Latino patients scoring second, at 28% (355). According to the study, the reasons for such developments included poor socioeconomic status and high unemployment rates, especially among individuals with no college education, single mothers, and otherwise disabled or disadvantaged individuals.

Burch et al. explore the connections between different socio-economic parameters in their connections to the development of STDs in vulnerable populations (1147). According to the research, the higher concentration of the infected individuals is in the southern US states, which have been notoriously poorer when compared to their northern and northeastern counterparts. Higher poverty in southern communities also results in poorer hospital services and less effective healthcare coverage.

As a result, the efficiency of any interventions aimed at reducing the rate of STDs is automatically lowered as well. The researchers recommend a combined package of medical, political, and socio-economic measures to inform the political process in the region as the only way of achieving a long-lasting change and improving healthcare for its population in the long-term perspective.

Effects of Educational Interventions Against STDs

The primary intervention against various STDs is education. In many parts of the world, such as Africa, the level of knowledge about sexually-transmitted diseases is very low due to mass illiteracy and the poor state of public education. In the US, there is some level of knowledge about how STDs are transmitted, but the poorer communities typically show lower regard for safety when it comes to sexual intercourse. Because of these factors, educational interventions are often expected to have the highest yield, as it is much easier to prevent infections than it is to treat them.

Fonner et al. evaluated the effectiveness of educational interventions at the school level (1). The interventions covered by their meta-analysis included the provision of educational materials about various STDs, their symptoms, dangers, treatments, and mechanisms of pathogenesis. Other interventions were aimed at reducing risky behavior, educating children and parents about safety measures during sex, and controlling the number of sex partners. According to Fonner et al., the majority of educational interventions were beneficial in improving the knowledge of STDs in the community, which led to a subsequent reduction in the total number of contracted STDs the following year (16).

Fu et al. have evaluated the efficiency of educational interventions in facilitating other anti-STD programs, namely the HPV vaccination (1905). In the US as well as in other countries around the world there is a strong anti-vaccination lobby, which is often based on superstitions, rumors, and malpractices that often undermine vaccination efforts. The evaluation of 18 interventions suggested that the rate of HPV vaccination increased in all 18 instances. However, there is no sufficient data to recommend some types of educational interventions over others.

Lastly, Garcia-Retamero and Cokely suggest that educational interventions can be facilitated through powerful imagery on TV and the Internet to promote the use of condoms and other safe sex procedures (35). The studies used a plethora of positive and negative-framed images to facilitate an intellectual and emotional response. The study found that there is no difference in effectiveness between positively and negatively framed messages. Also, Garcia-Retamero and Cokely state that the use of imagery in combination with the provision of STD-related information improves the quality of learning in patients, thus advocating for the utilization of brochures as some of the primary means of STD education (39).

Other Types of Interventions Against STDs

Vaccination and pharmacological treatment are the two primary interventions against STDs that do not focus on patient education. Vaccination is a preventative action that enables patients to develop immunity to the diseases they are likely to contract. Pharmacological treatment, on the other hand, focuses on relieving the patients after the infection has already occurred, either by curing them completely or reducing the symptoms of the disease. The effectiveness of these interventions varies, as a good half of the primary STDs are incurable, meaning that the effectiveness of dedicated interventions is diminished.

Nevertheless, the vaccines currently available show effectiveness against certain types of STDs. Namely, Lehtinen et al. report that the effectiveness of the HPV-16/18 vaccine in patients aged between 15 to 23 years of age is remarkable, as it helps prevent both the development of HPV, as well as the associated cancers (1290). Vaccines against other infections, however, are only in development stages as of yet.

Hafner et al. report significant progress on the development of effective vaccines against Chlamydia, which is the most widespread sexual disease in the world (1565). According to the report, the T cell is driven IFN-g and Th17 responses, which are critical for clearing infection, would play the primary role in the new vaccine (Hafner et al. 1563). The current state of affairs states that the existing antibodies can eliminate the infection in vitro, but that alone is not enough to constitute success.

The effectiveness of HIV vaccines being developed leaves much to be desired. As it stands, there are no significant breakthroughs. Fauci et al. state that there are modest findings in regards to the effectiveness of the poxvirus vector prime in enveloping the protein boost strategy (49). However, two potential vaccine types have also shown that such a process may backfire and increase the vulnerability of patients to HIV. Thus, it is unlikely for a vaccine to appear soon, short of any breakthrough.

Data Evaluation

After evaluating the academic sources presented in this paper, it became clear that the primary and the most cost-efficient method of preventing STDs lies in educational interventions. The studies have utilized and reviewed a great number of them, ranging from school education, parental education, TV and internet flashcards, and brochures. Although there is no clear definition of which interventions are the most effective, all of them showed a modicum of success. Vaccination and curing efforts, while also promising, are much less suitable for small-scale community efforts and individual initiatives by nurses and nursing students. Therefore, the intervention should be an educational one.

As it was also indicated by the academic literature, not all population groups are equally exposed to the dangers of contracting and transmitting STDs. Namely, blacks and Latinos, as well as individuals living below the poverty line, are the ones most likely to suffer from these diseases. Educational interventions must be aimed, first and foremost, at these vulnerable populations. This excludes interventions in predominantly white schools, as there is unlikely to be a significant black or Hispanic population found in these educational facilities.

Thus, the intervention should be aimed at predominantly black and Hispanic communities. Female education should be made a priority, as in their case, STDs are also followed by unwanted impregnations, abortions, and single parenthood. Children suffer major complications from STDs, which increases morbidity and financial strain on the family.

As evidenced by various sources reviewed in this paper, the intervention should consist of several parts, covering the basic details about how STDs are contracted as well as the major symptoms, the ways of effective contraception, and the necessity of vaccination and prompt treatment to avoid long-term complications. The intervention should address the issue of stigmatizing individuals with STDs, as it is one of the main reasons for underreporting diseases and refusing treatments. It also should seek to dispel the most common myths about sexually-transmitted diseases and inspire cooperation rather than ostracizing within the target community.

The intervention could use religious grounds to promote a safer and more responsible sexual life, especially among teenagers. As it was evidenced in the history section of the paper, Christianity opposes polygamy and irresponsible sexual behavior. However, such an approach should be considered very carefully, as it might cause issues of intolerance, especially towards gay, lesbian, and transsexual patients.

Saint Leo Core Value Integration

Saint Leo University is a Christian medical learning facility that seeks to promote quality healthcare in the US and abroad by training individuals to become nurses, doctors, and pharmacists of the highest caliber. The university’s core value of excellence seeks to develop the character, teach skills, and assimilate the knowledge to become morally-responsible leaders. The first step to achieving that goal is working with the local communities to improve their health and well-being. STDs are dangerous diseases that have the potential to destroy families and communities as a whole. Educational intervention is a simple and cost-effective way of reducing the number of STDs by helping troubled individuals make conscious choices.

The proposed intervention will be conducted in the following manner:

The target communities need to be identified. Based on the economic map of the city and the statistics available from the local government agencies, it would be possible to locate the areas, which are the poorest and least covered by the healthcare industry.
Within the targeted communities, the focus would be on low-income families, black families, Hispanic families, and children. These populations are deemed the most vulnerable and the most disproportionately affected by STDs.
Interventions would be conducted in schools, homeless shelters, and hospitals where there would be plenty of opportunities for lecturing and material distribution.
The information about STDs will be provided through brochures and personal education sessions.
The intervention would not require a large resource base and can be conducted by students.

Conclusions

STDs are a serious healthcare issue that has been plaguing humanity for over millennia. They were mentioned in ancient texts and are rigorously studied in modern medicine. Chlamydia, Gonorrhea, Syphilis, Trichomoniasis, HIV, HSV, HPV, and Hepatitis B constitute the plague of the 21st century. Although humanity found ways to cure and prevent some of these diseases, the rest of them remain incurable, thus presenting the ultimate challenge for modern medicine. Unfortunately, until solid and cost-efficient ways of vaccinating and treating them are found, STDs will continue to affect a good portion of humanity.

Evidence showed that poverty, race, age, and gender are directly connected to the likelihood of contracting the disease. In poor countries of Africa, South America, and South-East Asia, STDs are prevalent on a grand scale. Among industrial countries, the US is in the lead due to a wide range of poverty among its citizens, poor education and healthcare coverage, as well as social and racial stereotypes that continue to affect the country’s present state of affairs.

Sexual education remains one of the primary ways of lowering the number of STDs in poor and neglected communities. The proposed intervention is based on scientific evidence, is relatively easy to conduct, and does not require much in terms of resources, time limits, and personnel. Brochures and educational sessions with individual patients are likely to result in a better understanding of the situation, the promotion of effective contraception methods, and the propagation of family planning.

Even though the effort of one or even several students might be considered negligible in the great scheme of matters, the ocean is made out of droplets of water. Every person that receives a brochure about STDs is less likely to engage in risky sexual behavior, which is what makes the difference, on a smaller scale.

Works Cited

Burch, Lisa S., et al. “Socioeconomic Status and Response to Antiretroviral Therapy in High-Income Countries: A Literature Review.” AIDS, vol. 30, no. 8, 2016, pp. 1147-1162.

Fauci, Anthony S., et al. “Immune Activation with HIV Vaccines.” Science, vol. 344, no. 6179, 2014, pp. 49-51.

Fu, Linda Y., et al. “Educational Interventions to Increase HPV Vaccination Acceptance: A Systematic Review.” Vaccine, vol. 32, no. 17, 2014, pp. 1901-1920.

Fonner, Virginia A., et al. “School-Based Sex Education and HIV Prevention in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.” PlosOne, vol. 3, no. 9, 2014, pp. 1-18.

Garcia-Retamero, Rocio, and Edward T. Cokely. “Simple but Powerful Health Messages for Increasing Condom Use in Young Adults.” The Journal of Sex Research, vol. 52, no. 1, 2015, pp. 30-42.

Gruber, Franjo, et al. “History of Venereal Diseases from Antiquity to the Renaissance.” Acta Dermatovenerologica Croatia, vol. 23, no. 1, 2015, pp. 1-11.

Hafner, Louise, M., et al. “Development Status and Future Prospects for a Vaccine Against Chlamydia Trachomatis Infection.” Vaccine, vol. 32, no. 14, 2014, pp. 1563-1571.

Harris, Richard. “Record High Number of STD Infections in U.S., as Prevention Funding Declines.” National Public Radio. 2018. Web.

Horberg, Michael A., et al. “The HIV Care Cascade Measured Over Time and by Age, Sex, and Race in a Large National Integrated Care System.” AIDS Patient Care and STDs, vol. 29, no. 11, 2015, pp. 582-590.

Lehtinen, Matti, et al. “Characteristics of a Cluster-Randomized Phase IV Human Papillomavirus Vaccination Effectiveness Trial.” Vaccine, vol. 33, no. 10, 2015, pp. 1284-1290.

Reif, Susan S., et al. “HIV/AIDS in the Southern USA: A Disproportionate Epidemic.” AIDS Care, vol. 26, no. 3, 2014, pp. 351-359.

WHO. “Sexually Transmitted Infections (STIs).” World Health Organization. 2016. Web.

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