Rates of STD Infection in the U.S. Continue to Rise

The rates of infection of most STDs rose again in 2016, according to the CDC. Compared to 2015, chlamydia infections were up 4.7%, syphilis infections increased 17.6%, and gonorrhea was up by 18.5%. The increases are part of a trend that started about a decade or so ago.

The only good news is that rates of HIV infection have been trending slightly downward over the past five years. Compared to 2015, the rate of HIV infection declined by 0.1% in 2016.

The dramatic increases in syphilis and gonorrhea infections in 2016 are cause for concern, of course. Sexually active individuals should be aware of these trends and seek to protect themselves accordingly.

HPV Vaccination Rates are (Finally) Rising

Vaccination rates against the HPV virus responsible for most cases of cervical cancer have been rising (finally), according to a recent CDC report.   Currently, more than 60 percent of teens have received at least one of the two recommended doses of the vaccine; that compares favorably to the 30% who had received the vaccine just ten years ago.

In 2016, the Advisory Committee on Immunization Practices (ACIP) updated its vaccinations recommendations to include a two-dose schedule instead of the previous three, making it easier for teens to be fully vaccinated.  Nearly 50% of all 17-year-old girls and 38% of all boys are now fully vaccinated, according to the new two-dose schedule.

Health officials are encouraged, but there is still room for improvement in vaccination rates. More than 40% of Americans aged 18-59 are infected with genital HPV.  There are nearly 40,000 new cases of cancers each year in areas of the body where the HPV virus is found (cervix, vagina, vulva, penis, anus, rectum, and oropharynx), according to the CDC.  Nearly 80% of these cancers could be prevented by vaccination.

Sexual Transmission of the Zika Virus

In healthy adults, the Zika virus causes only mild flu-like symptoms.  80% of infected adults never even know they are infected. However it's a dangerous virus nonetheless, because women who are infected during their pregnancies can give birth to infants with a birth defect called microcephaly.

When Zika first appeared in South America, it was believed that the virus was transmitted exclusively by mosquitoes that thrive in South American countries with warm, humid climates. However we now know that the Zika virus can be sexually transmitted. Until yesterday, all 14 documented cases of sexually transmitted infections in the U.S. had been caused by Zika-infected men (who infected their partners, either male or female). But now the CDC has reported the first documented case of transmission from an infected woman to her male partner in the U.S. The significance of sexual transmission is that it raises the possibility of an outbreak of Zika virtually anywhere in the world, not just in areas in which the Zika-transmitting mosquito is found.

Scientists are working feverishly on a vaccine to prevent Zika infections. It will take some time before one is available. In the meantime, pregnant women (and their male partners) should be aware of the dangers of traveling to countries where the Zika-transmitting mosquito is common.

Sexual Transmission of the Zika Virus

A recent case of Zika virus infection in a man whose sexual partner returned from Venezuela with a Zika virus infection raises the distinct possibility that it may be possible for the virus to be transmitted sexually. How easily it is transmitted via sexual contact, and at what point during an infection it may be transmitted, isn't known. But the finding is cause for concern because it means that an outbreak could spread beyond areas in which the Zika-transmitting mosquito is found. The World Health Organization (WHO) will be following this latest development closely.

In related news, laboratory tests have detected the Zika virus in the saliva and urine of at least two people with Zika virus infections. Most people don't come in direct contact with urine, but person-to-person saliva contact is another matter. At this time it isn't known whether Zika infection via contact with saliva is even possible. Nevertheless, revelers at Brazil's annual street festival known as Carnival are being urged to forego the common practice of kissing total strangers, just as a precaution.

We need to know a lot more about this virus, that's for sure.

FDA Lifts Lifetime Ban on Gay Men Donating Blood

Since 1983 the Food and Drug Administration (FDA) has had a policy of not allowing gay men to donate blood, ever. That policy (of a lifetime ban) has been rescinded. Under the new policy, men who have had sex with other men within the past year will still not be allowed to donate blood, potentially eliminating most gay men anyway. But at least the ban is not permanent.

Empirically, gay men are at higher risk of contracting HIV infections than heterosexuals. So back in 1983, when HIV testing was not as accurate as it is today, it was considered prudent to ban gay men from donating blood. Today a lifetime ban is not considered necessary. However, the 1-year ban remains because a newly infected person may not test positive for HIV for up to six months.

The one-year ban also applies to women who know that their male partners have had sex with a man within the past year.

Gardasil Vaccination Rates are Below Expectations

In 2006 the FDA approved Gardasil, the first vaccine against the sexually transmitted human papilloma virus (HPV). HPV is responsible for most cases of cervical cancer. The hope was that most girls would be vaccinated against HPV at about age 11, before they began sexual activity.

At first, Gardasil seemed destined for widespread acceptance (see this blog, Oct. 14, 2010). But more extensive data show that the rate of vaccination has remained lower than expected. According to the most recent data from the Centers for Disease Control and Prevention (CDC), only 35% of all girls 13 to 17 years of age have received all three of the required shots. And an article in Pediatrics this month reports that the number of parent planning to have their girls vaccinated is declining, rather than increasing.

The new findings are of concern to health officials. No one knows why vaccination rates are still so low. Possibilities include the uneasiness of parents to address the issue of sexual activity in girls as young as 11; concerns about vaccine safety; the need for three shots rather than just one; the fact that Gardasil is not administered at the same time as all other childhood vaccinations; even the cost ($400-$500).

Health officials are struggling with how to encourage parents to have their pre-adolescent girls vaccinated. Ideas include providing more education about the value of the vaccine in preventing cancer; lowering the cost of the vaccine; making vaccinations more convenient by requiring only the first dose to be delivered in a health care setting (the others could be given in schools or at pharmacies). Only time will tell which if any of these strategies will work. But it’s a shame that we now have a vaccine that would prevent about 4,000 deaths per year from cervical cancer, and a lot of girls just aren’t taking advantage of it.

The HPV Vaccine and Sexual Activity

The vaccine against the HPV virus responsible for most cases of cervical cancer has been somewhat controversial ever since it first came out in 2006. The vaccine, called Gardasil, needs to be given before the onset of sexual activity to be completely effective because the HPV virus is sexually transmitted.  Generally the recommendation has been that it be given to girls at about age 11 or 12.

And that’s what has fueled the controversy; some parents have objected to the virus being given to girls that young because they believe it may encourage sexual activity at an age when it really isn’t appropriate.  As a result, many girls have not been vaccinated against the virus when they should be.  Are the parental concerns justified?

Shortly after the vaccine became available, several studies reported that administration of the vaccine did not seem to encourage sexual activity.  However, the early studies were based solely on sexual activity surveys, admittedly not the best way to collect accurate data.  Now a new study published in the journal Pediatrics confirms the earlier studies with data that are independent of self-reports.  The authors of the study examined the medical records of nearly 1,400 girls aged 11 through 12 for up to three years, looking for indirect evidence of sexual activity such as pregnancy, sexually transmitted infection, or contraceptive counseling.  The authors found no evidence of increases in any of these measures in girls given the vaccine at age 11 or 12, versus girls of the same age not given the vaccine.  So at least by these measures, there is no evidence that girls given Gardasil are more likely to engage in sexual activity at an early age.

Hopefully this will relieve some parents and encourage them to have their girls vaccinated.  Currently only about half of all 13- to 17-year-old girls have been vaccinated against HPV; far less than have been vaccinated against non-sexually transmitted diseases such as tetanus and diphtheria, and whooping cough.

Antibiotic-Resistant Gonorrhea On the Rise

Last year I reported on this blog that there were signs that gonorrhea was becoming resistant to all known classes of antibiotics (this blog, July 14, 2011). This month the World Health Organization (WHO) reported that cases of the antibiotic-resistant gonorrhea have shown up in six countries – Norway, Sweden, Britain, France, Japan, and Australia.

The WHO is calling for more research into new treatment options. It also plans to monitor the use of antibiotics in an effort to encourage their correct use.

Gonorrhea used to be treatable with all known classes of antibiotics. It’s on its way to becoming virtually untreatable, or at least very difficult to treat. And that would be a problem for the more than 100 million people who become infected with the gonorrhea each year.

CDC Panel Recommends Gardasil for Boys

An advisory panel of the CDC recommended this week that boys between the ages of 11 and 12 should be vaccinated against Human Papilloma Virus (HPV) with Gardasil. Previously, the recommendation was that only girls should be vaccinated.

HPV is now the most common sexually transmitted disease - over 70% of all adults will be infected at some time in their lives. Most people recover without any ill effects, however chronic infection in some people can lead to cancer. Gardasil was recommended for girls when it became available in 2006, because chronic HPV infection was known at the time to be a leading cause of cervical cancer. But new information reveals that HPV is responsible for some cancers in men, too, including cancers of the penis, anus, and throat.

Health officials don’t expect a huge rush to vaccinate boys, however. Only about 30% of the girls of eligible age are fully vaccinated so far, despite the fact that the vaccine has been available for six years. Gardasil sparked controversy from the very start – it’s a vaccine against a sexually transmitted disease, and some parents worried that it encourages the notion of sexual activity at too young an age. Other parents are against all vaccinations. In addition, Gardasil is expensive – more than $400 for the full series of three required shots.

What do YOU think - should Gardasil be part of the standard vaccination regimen for all children?

The HPV Vaccine and the Presidential Debates

Governor Perry of Texas was criticized by Congresswoman Michelle Bachmann at the Republication presidential candidate’s debate last night for signing an executive order in Texas mandating that young girls be vaccinated against HPV, the sexually-transmitted virus that is responsible for most cases of cervical cancer. The vaccine is effective if it is given BEFORE a woman is sexually active. Health officials believe that if all women were vaccinated before becoming sexually active, cervical cancer rates would drop dramatically.

Congresswoman Bachmann took the position that the vaccine is unsafe. There is no evidence to support her claim, and her stance on the vaccine’s safety cost her some credibility today. However she did score some points when she reported that Governor Perry has received campaign funds from the drug company that makes the vaccine.

Congresswoman Bachmann also took the position that the government should not force vaccinations on citizens who don’t want them. That’s a valid position, of course. But she missed the fact that governor Perry’s “mandate” is actually not a firm mandate at all; parents can still choose to have their daughters opt out if they wish. And to his discredit, governor Perry failed to point the opt-out provision to her during the debate.

Ah, the presidential debates. Usually I’m bored by them, but perhaps this year will be different.

Preventing HIV Infection

Nearly three years ago on this blog (see “A Daily Pill Against HIV Infection”, Aug. 10, 2008) I reported that research was underway to determine whether HIV infection could prevented in healthy people by giving them AIDS drugs before they became infected, not after. It’s called pre-exposure prophylaxis (PrEP), and according to a news release from the CDC, there is now convincing evidence that it works!

In one study by researchers from the University of Washington in conjunction with the CDC, a daily pill comprised of two known AIDS drugs (or a placebo) was given to nearly 5,000 “discordant couples” in Kenya and Uganda (one partner HIV-infected, the other not). Uninfected partners who took the daily pill had a 73% lower chance of becoming infected, compared to those who received the placebo. The study was stopped early because the results were so clear-cut that it was deemed unethical to continue withholding the drug from the control group. A second study by the CDC of 1,200 sexually active young adults in Botswana revealed that those who took a daily PrEP pill had a 63% lower chance of infection, compared to those who did not.

Given these recent findings, PrEP is likely to become a new standard of prophylaxis for healthy, at-risk individuals who request it. However, it should be noted that the PrEP pill has not yet been tested in pregnant women, so it may not be for everyone.

Antibiotic-Resistant Gonorrhea

One of the more common sexually transmitted diseases – gonorrhea – is now resistant to three of the four classes of antibiotics traditionally used against it, and is showing signs of increased resistance to the fourth. Gonorrhea became resistant to penicillin and tetracycline in the 1970s and 1980s. In just the past 10 years gonorrhea has become so resistant to the fluoroquinolones that the CDC no longer recommends this class of drugs for treatment of gonorrhea. And now a CDC report reveals that gonorrhea is showing signs of increased resistance to the last class of drugs still generally effective against it, the cephalosporins.

So far, cephalosporin drugs have failed to effectively treat gonorrhea in only three persons – two men in Norway and a woman in Japan. But in U.S. laboratories, the percentage of samples of gonorrhea that show signs of increased resistance to cephalosporins has gone up substantially since 2000. In the Western U.S., for example, 3.3% of the samples showed signs of increased resistance in 2010, compared to 0% in 2000. The numbers vary by state and by region, but the trend is definitely toward increased resistance.

More than 350,000 new cases of gonorrhea are diagnosed in the U.S. each year. A cyclosporine-resistant strain of gonorrhea would be a real problem.

HPV Vaccination Rates in College Women

It’s been more than three years since the FDA approved Gardasil, the vaccine against the sexually transmitted Human Papilloma Virus (HPV) that is responsible for most cases of cervical cancer. How is the vaccine being accepted by young college-age women?

To find out, researchers conducted a survey of 972 female college students at a large Midwestern state university. Most of the women were freshmen or sophomores. Sixty-five % of the women reported being sexually active, and by the Spring of 2009 57% had already received at least the first of the three shots required by the vaccination protocol for Gardasil. (The vaccine was available on request at the university student health center, at a cost of $360).

Vaccination coverage of 57% in this age group within three years of vaccine availability is welcome news, considering that these college-age women were already 15 or 16 years old when the vaccine first became available. Current recommendations are that girls should be vaccinated as early as 11-12 years of age. Significantly, young women who believed that their mothers would approve of their receiving the vaccine were more likely to have been vaccinated or to have an interest in being vaccinated.

More than a third of the women reported having had three or more sexual partners, and over 25% had had vaginal sex with a casual partner (not a serious or steady dating partner) without using protection against sexually transmitted diseases. All the more reason they should be vaccinated…

Gardasil and Irresponsible Journalism

Last Monday the CBS Early Show ran a story about a 14-year-old girl named Jenny who is now nearly completely paralyzed by a degenerative mucle disease of unknown cause. It just so happens that she received Gardasil, the vaccine against human papillomavirus (HPV) 15 months ago, like so many other girls her age. Her parents spoke to CBS News with the hope that coverage of Jenny’s plight would help them find “comparables” - other patients with the same symptoms, so that her doctors could discern the actual cause of her disease. Nevertheless, CBS chose to run the online story with the more sensationalist headline, “HPV Vaccine Linked to Teen’s Paralysis?” (CBSNews.com, July 7).

Four days later, FOX news went one step further with a story entitled “HPV Vaccine Blamed for Teen’s Paralysis” (foxnews.com, July 11).

This is biased journalism at its worst. Who exactly is blaming Gardasil for Jenny’s disease - Fox News? In fact the Fox News article is full of errors. For one, the article attributes to Jenny’s parents a statement made by a spokesperson for Merck, Gardasil’s manufacturer. In addition, the article uses the word “casually” in place of “causally”. For the record, what a Merck spokesperson actually said was, “We’re aware of this case and based on the facts that we’ve received, the information doesn’t suggest that this event was causally associated with vaccination.”

On their blog site on July 7 (see www.jenjensfamily.blogspot.com), the parents expressed disappointment with the CBS news coverage, saying “The family believes that there may be a link between Jenny’s health and the HPV vaccination……” “But, there is no medical consensus on whether this hypothesis is stronger than other possible explanations.”

Jenny’s parents are obviously scientifically literate. They know how to distinguish between a hypothesis and a scientifically justifiable conclusion. As you’re discussing the importance of being scientifically literate in your classroom, Jenny’s parents’ blog site and the two news articles would make interesting topics for discussion.

One final thought: Do you think that the biased news coverage of Gardasil could be intentional, given that conservatives don’t like the idea of a vaccine against a sexually transmitted disease being given to young girls? What do your students think?