Sex, Alcohol and Sexually Transmitted Diseases: A National Survey.(Statistical Data Included)

The analysis of a representative national survey of households provides strong evidence that alcohol overshadows illicit drug use as a risk factor for sexually transmitted diseases (STDs). Men and women who report a history of STDs are significantly more likely to have a history of problem drinking, independent of high-risk sexual activities and demographic characteristics. However, a high rate of change in sexual partners over the past five years also increases the chance of STD infection. Sexual orientation is a major STD risk factor among men but not among women. Although both black men and black women are at greater risk of STDs than are those in other racial or ethnic groups, results indicate that black women's greater likelihood of having sex with men who have multiple partners, rather than their own rates of partner change, makes the crucial difference between their risk and that of white women.

(Family Planning Perspectives, 26:257-263, 1994)

Much attention is being paid to the increase in sexually transmitted diseases (STDs) in the United States. Unlike other industrialized nations, where STD prevalence rates have remained low, America is currently experiencing a rapid rise in the incidence of the "classic" STDs, such as gonorrhea, syphilis, chlamydia and genital herpes. In 1990. an estimated 12-13 million cases of STDs were diagnosed, including four million new cases of chlamydia, three million of trichomonas and 1-2 million each of genital herpes and warts. (1) Although rates of infection with Neisseria gonorrhoeae have continued the decline that began in the 1970s, the number of gonorrheal infections involving strains resistant to antibiotics has accelerated recently, (2) and current estimates indicate that more than 10% of gonorrheal infections nationwide are resistant to penicillin. (3)

Perhaps most striking is the astronomical rise in cases of syphilis during the past few years, specifically the increase between 1985 and 1989 from 11.4 reported cases per 100,000 population to 18.4 per 100,000. (4) According to recent prevalence estimates, at least 30 million Americans are infected with genital herpes, and 24-40 million people are infected with human papillomavirus, the virus that produces genital warts. Asymptomatic chlamydial infection occurs in up to 5% of women and about 10% of men, and 2.5 million women are estimated to contract chlamydia each year. (5) Gonorrhea and chlamydia are especially dangerous to women, since they are often asymptomatic or produce ambiguous symptoms: One study found that 80% of women diagnosed for chlamydia were asymptomatic. (6)

One reason for the renewed concern about STDs is the mounting evidence of a direct biomedical association between STDs and human immunodeficiency virus (HIV) infection. Infection with STDs that create ulcers (i.e., syphilis, chancroid, herpes and perhaps chlamydia), as well as possibly the discharges from gonorrhea, chlamydia and trichomonas, are thought to increase one's vulnerability to HIV infection. (7) There is also strong evidence that STDs and HIV infection share the same cofactors, especially among heterosexuals. In fact, the World Health Organization Global Programme on AIDS recently made STD tracking and prevention a major priority.

A second reason for the increased focus on STDs is their serious implications for women's reproductive health. Between 10% and 40% of women with an untreated chlamydial or gonorrheal infection can develop pelvic inflammatory disease, which in turn can lead to infertility, tubal pregnancy and fetal wastage, as well as to infections in the offspring of infected mothers. Syphilis increases a woman's risk of miscarriage and stillbirth and leads to syphilis infection of the newborn. In fact, if rates of congenital syphilis are added to current rates of syphilis infection, overall syphilis rates are even higher. (8) Even when it is asymptomatic, genital herpes can be transmitted to the newborn and can infect the infant's central nervous system. An estimated 65% of untreated infected infants will die and fewer than 10% of surviving infants with central nervous system infection will develop normally. (9)

The role that frequent change of sexual partners plays in STD transmission is well established: Having a greater number and variety of sexual partners increases one's likelihood that any randomly chosen partner will be infected, especially a partner who can be considered a member of a "core group" of those who transmit STDs. Increases in STD rates in the general population have been attributed to the behavior of subgroups of individuals who have more than the average number of sexual partners.