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Sexually Transmitted Disease and Health
Psychology
Michael Morgan
Forest Institute of Professional Psychology
Springfield, MO
Definition of Disease/Condition:
Taber's Cyclopedic Medical Dictionary defines STD as
"disease acquired as a result of sexual intercourse with an
infected individual" (Thomas, 1997, p. 1748). The term STD,
then, is more descriptive of the means of transmission rather
than of etiology. Of over 20 diseases which are most commonly
transmitted by sexual contact, the top five in order of
prevalence are Chlamydia, gonorrhea, human papillomavirus,
genital herpes, and syphilis.
Chlamydia, caused by the bacterium Chlamydia trachomatis, can be
easily cured once diagnosed. Untreated, Chlamydia can cause
pelvic inflammatory disease (PID) in up to 40% of the women it
infects and, thereby, lead to a potentially fatal tubal
pregnancy. Chlamydia in men typically causes urethral infection
and may result in swollen and tender testicles (Centers for
Disease Control and Prevention, 1998d).
The gonococcus bacterium that causes gonorrhea multiplies quickly
in moist, warm areas such as the cervix, urethra, mouth, or
rectum. Gonorrhea is highly contagious, the early symptoms are
usually mild, and some individuals never develop symptoms.
Untreated gonorrhea can spread to the bloodstream and infect the
heart, the joints, or the brain. The most common complication is
PID.
Only a few types of human papillomavirus (HPV) can cause genital
warts, which are most often spread by sexual contact and are very
contagious. As with other viruses, HPV is impossible to
eradicate. Researchers have found an association between some
types of HPV and the development of anal cancer, penile cancer,
cervical cancer, and vulvar cancer (CDC, 1998c).
Genital herpes is an STD caused by the herpes simplex virus
(HSV). Once an individual is infected with HSV, they remain that
way for life. Sores and other symptoms do not have to be apparent
for genital herpes infection to be passed from one individual to
another. It is often transmitted by asymptomatic people who do
not know they are infected (CDC, 1998a).
Syphilis, caused by the bacterium treponema pallidum, has a
variable clinical course and is a complex and highly contagious
STD. Its primary stage is characterized by open sores at the site
of infection. In spite of old superstitions, syphilis cannot be
contracted by contact with toilet seats and door knobs. Nor can
it be contracted by using swimming pools, hot tubs, or eating
utensils (CDC, 1998e).
Incidence/Prevalence:
Among first-world nations, the U.S. continues to have the highest
rates of STDs, 50-100 times higher than other first-world nations
such as Sweden and France. There are an estimated 12 million new
cases of STDs in the U.S. every year. This includes each year an
estimated 4 million new cases of Chlamydia, 800,000 new cases of
gonorrhea, 500,000 to 1 million new infections of HPV, 200,000 to
500,000 new cases of symptomatic genital herpes, and 101,000 new
cases of syphilis. It is likely that there are more than 24
million Americans infected with HPV, and as many as 30 million
Americans may now carry the herpes simplex virus. (CDC, 1998b).
Estimated dollar cost to public health:
As a conservative estimate, STDs add $17 billion to the United
States' health care costs each year. The unfortunate children
born with congenital birth defects as a result of a mother's STD
infection will add greatly to the national health care bill due
to their medical complications. When the complications of those
children are disabling into adulthood, their earning power is
lost to society. The $17 billion represents a conservative
estimate of the up-front cost of STDs; the hidden costs are
likely many times that (CDC, 1998b).
Morbidity and mortality:
Untreated, STDs often have severe health consequences such as
infertility, tubal pregnancy, various forms of cancer, fetal
wastage, low birth weight, and congenital or perinatal infection.
Many problems brought about by STDs are often fatal. Syphilis in
its tertiary stage, for instance, can bring about blindness,
dementia, and cardiovascular problems. In addition, a pregnant
woman infected with syphilis has about a 40% chance of having a
syphilitic stillbirth or of having a baby who dies immediately
after birth (CDC, 1998e). Also, HPV is the single most important
risk factor for cervical cancer, which kills about five thousand
women each year in the U.S. (CDC, 1998b).
Medical costs which could be offset by psychological
interventions:
Psychologists can help reduce STD related health care costs by
dealing with issues such as compliance with screening and
treatment. Another way psychologists can help is by educating
health care providers and government funding bodies. An example
is the treatment of Chlamydia, the most frequently occurring STD
in the U.S. More than $2 billion is spent annually to treat it
and its consequences in this country. By CDC's estimate, for
every dollar spent on screening and treatment, $12 is saved by
avoiding the complications which result from untreated Chlamydia
(1998d). Canada and Sweden have virtually eliminated infectious
syphilis, and Sweden's gonorrhea rates are approximately 100
times lower than those in our country. When effective screening
programs are used in the U.S., STD rates will drop dramatically
also.
New treatments and breakthroughs in this disease/condition:
The latest advance in treatment is through more available
screening. A joint effort between the CDC and the Office of
Population Affairs has worked through public health laboratories,
primary health care programs, STD health care programs, and
family planning clinics to start an STD related infertility
prevention program. Where the effort has been able to fully
implement screening programs, significant progress has been made
(CDC, 1998d).
For the prevention and treatment of Chlamydia, new urine tests
have been developed which make testing of males less
uncomfortable. Another recent advance is single-dose antibiotic
treatment. The treatment of penicillin-resistant gonorrhea is
evolving with other antibiotics. Since gonorrhea often occurs
with Chlamydia, health care providers often prescribe a
combination of antibiotics in order to treat both diseases. The
U.S. Food and Drug Administration (FDA) recently approved
imiquimod cream to treat genital warts, a prescription medication
which the patient can apply to the affected area. Recent research
on the combined use of interferon therapy and laser surgery has
produced promising results in controlling the course of this
disease (CDC, 1998c).
Marketing plan for psychologists to include this area of
expertise in their practice:
Professional guidelines encourage psychologists to be educators
of the public, and to make their services known, rather than to
actively solicit customers. Word of mouth is the best form of
advertisement. Once established as an expert in the field, one is
only limited to what the market will bear. Establishing contacts
with other health care professionals can be as easy as sending
them business.
Business principles apply to the psychological profession as well
as to any other profession. One must take the care to develop an
ability to fulfill the demand for a service, and then be
available. Prevention through behavior modification is currently
the most effective method of treating the problem of STDs. No
other group of professionals is better qualified to fulfill the
need for behavior modification than psychologists.
References:
Thomas, C. L. (Ed.). (1997). Taber's Cyclopedic Medical
Dictionary (18th ed.). Philadelphia: F. A. Davis.
Centers for Disease Control and Prevention. (1998a). Genital
herpes [On-line]. Available:
http://www.cdc.gov/nchstp/dstd/Genital_Herpes_facts.htm
Centers for Disease Control and Prevention. (1998b). Guidelines
for treatment of sexually transmitted diseases [On-line]. MMWR,
1998;47 (No.RR-1). Available:
http://www.cdc.gov/nchstp/dstd/fact_sheets_home.htm
Centers for Disease Control and Prevention. (1998c). Human
papillomavirus and genital warts [On-line]. Available:
http://www.cdc.gov/nchstp/dstd/Genital_Warts_facts.htm
Centers for Disease Control and Prevention. (1998d). Some facts
about chlamydia [On-line]. Available:
http://www.cdc.gov/nchstp/dstd/chlamydia_facts.htm
Centers for Disease Control and Prevention. (1998e). Syphilis
facts [On-line]. Available:
http://www.cdc.gov/nchstp/dstd/Syphilis_Facts.htm
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