The Cause
What is driving this epidemic? A combination of factors including the initiation of sexual activity occurring at younger ages; a delay in the age of first marriage; and high divorce rates. These changing social norms have increased the number of lifetime sexual partners for many Americans. An increased number of lifetime sexual partners is a very important risk factor for STDs.3 The problem is compounded because many individuals infected with the most common STDs—chlamydia, genital herpes and human papillomavirus—do not experience noticeable symptoms and do not know that they are contagious.

The Impact
Unfortunately, STDs are not “equal opportunity” diseases. Adolescents are at greater risk than adults. The CDC gives several explanations for this increased risk including: adolescents are more likely to have multiple sexual partners; they may select partners at higher risk; and, they may be more susceptible to certain STDs because of their immature anatomy.4

Additionally, STDs disproportionately impact women. Women are known to be more susceptible to infection with certain STDs, particularly, chlamydia and gonorrhea.5 Women with STDs are also more likely to experience significant complications from their infection, including the development of pelvic inflammatory disease, infertility and cervical cancer.

The Fallacy
Though effective antibiotic treatments for bacterial STDs exist, antibiotic resistance is increasing. Even treatment with antibiotics cannot guarantee that later complications will be avoided. Antiviral medications do exist, but are not uniformly effective and even in the best scenarios, not curative. Research to produce vaccines that prevent viral STDs is ongoing, but to date hepatitis B is the only STD with an effective and widely available vaccine. New medical advances to prevent and/or treat viral STDs appear to be years away, and in fact, many never occur.

The Confusion
Condoms continue to be widely promoted as effective in preventing all STDs and unwanted pregnancy, but the scientific evidence suggests otherwise. Condoms can and do fail. For some STDs (those spread by contact with infected skin) condoms are likely to fail if they do not completely cover all infected areas. For STDs spread by contact with body fluids, as well as for pregnancy, the most significant reasons for condom failure are incorrect/inconsistent use and breakage/slippage. And while the risk of condom breakage/slippage for a single act of sexual intercourse may be quite small (2-3%) in most studies), the cumulative breakage/slippage risks when condoms are used as a long-term prevention strategy are significant.

Condoms are not particularly effective when used to prevent pregnancy. In fact, condoms have failure rates of approximately 14 percent during the first year of typical use.6 And these failure rates are even higher in younger users.
In addition, the scientific evidence shows that condoms may not prevent the transmission of most STDs. Consistent condom use (100%) reduces HIV risk by about 85%. For gonorrhea, chlamydia, herpes and syphilis, consistent use reduces risk by 50% at most. Almost no risk reduction is provided for HPV infection;7,8 however, some data suggest that HPV-related conditions occur less commonly in condom users.9 Even in the best of situations, condoms cannot eliminate the risk of STD transmission.

The Solution
Delaying sexual activity until marriage with an uninfected spouse is the only way for teens and single adults to avoid the risk of an STD infection or a nonmarital pregnancy. Adolescents and single adults can successfully postpone sexual activity (become or remain abstinent) if properly instructed and encouraged. According to the National Longitudinal Study on Adolescent Health parents can have an important impact on the sexual behavior of adolescent children. Parents who are “connected” with their children are significantly more likely to have adolescents who delay sexual initiation. Similarly, adolescents whose parents disapprove of teen sexual activity and contraception are significantly more likely to delay having sex.10

For more information about STD's:
visit the Medical Institute.

1 American Social health Association. Sexually Transmitted Diseases in America: How Many Cases and at What Cost? Menlo Park, CA: Kaiser Family Foundation; 1998.
Centers for Disease Control and Prevention. Tracking the Hidden Epidemics—Trends in STDs in the United States 2000. Available at: http://www.cdc.gov/nchstp/dstd/dstdp.html. Accessed on September 20, 2001.
2 Eng TR, Butler WT, eds. The Hidden Epidemic—Confronting Sexually Transmitted Disease. Institute of Medicine. Washington, DC: National Academy Press; 1997.
3 Ibid.
4 Division of STD Prevention. Sexually Transmitted Disease Surveillance, 1999. Department of Health and Human Services, Atlanta: Centers for Disease Control and Prevention (CDC), September 2000.
5 National Institute of Allergy and Infectious Diseases, National Institutes of Health. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention. 2001. Available at http://www.niaid.nih.gov/dmid/stds/condomreport.pdf. Accessed on September 20, 2001.
6 Fu H, Darroch JE, Haas T, Ranjit N. Contraceptive failure rates: New estimates from the 1995 National Survey of Family Growth. Fam Plan Persp. 1999;31:56-63.
7 National Institute of Allergy and Infectious Diseases, National Institutes of Health. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention. 2001. Available at http://www.niaid.nih.gov/dmid/stds/condomreport.pdf. Accessed on September 20, 2001.
8 Wald A. Langenberg AG, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA. 2001;285:3100-3106.

For more information about STD's:
visit the Medical Institute.