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    Recent Developments and Treatment of Common STDs

    Sexually transmitted diseases (STDs) continue to be a significant public health problem. It is estimated that more than one in five Americans that's 65 million people -- are infected with an STD, not including human immunodeficiency virus. In fact, the United States has the highest rates of curable STDs among Westernized nations and about 15 million new cases are diagnosed each year.

    While most STDs primarily affect certain population groups, three of them -- chlamydia, genital herpes and genital human papillomavirus (HPV) -- are without boundary and widespread. And, according to one specialist who spoke at the annual meeting of the American College of Physicians/American Society for Internal Medicine in Philadelphia, significant controversies surround recommendations for diagnosis, treatment and prevention of these three highly prevalent STDs.

    Hunter Handsfield, MD, professor of medicine at the University of Washington and director of the STD Control Program in Seattle and King County, gave a presentation outlining recent clinical developments and treatment modalities for genital herpes, chlamydia, and HPV.

    Genital herpes, with 90 percent of cases caused by the herpes simplex virus-2, is believed to infect 22 percent of the American population. Herpes tends to manifest as recurrent outbreaks, ranging from no symptoms to severe ones, and Handsfield reports that most patients are undertreated. Anti-viral agents valacyclovir, famciclovir, and acyclovir are currently the treatments of choice in reducing outbreak symptoms and suppressing recurrence. However, there is no cure for the herpes virus-it can only be controlled.

    Preventing transmission is difficult, because many people believe that they are not contagious during a period of remission. Counseling is recommended to educate the public about subclinical viral shedding, which means that the virus may be present even in the absence of obvious symptoms. Condoms may help in preventing transmission, but their long-term efficacy has not been proven.

    Chlamydia trachomatis is primarily an infection of sexually active youth, transcending all socioeconomic groups to cause three million new infections every year. While it can cause symptoms such as itching or burning when urinating, in most cases it is asymptomatic.

    Since most people don't know when they are infected, Handsfield outlines a screening protocol which recommends testing for sexually active women under the age of 20, and for women between the ages of 21-30 who have symptoms, multiple partners, or are already infected with another STD. Treatment with the antibiotic azithromycin is more expensive than other effective antibiotics, but compliance is better since the patient only needs to take a single daily dose.

    The human papillomavirus is the most serious of the three STDs because certain strains have been directly linked to cervical dysplasia and cancer. There are about 5.5 million new cases every year, and it frequently manifests as genital warts. Like herpes, symptoms can be treated but a cure remains elusive. Once infected, the virus remains in the body.

    Dr. Handsfield reports that it is unclear if condoms can play any role in prevention, or if there are any other sexual safety measures. Research is underway for a vaccine, which may be the only practical approach in the long run.



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