Emerging Sexually Transmitted Diseases
“Part of the problem, of course, is that characterizing an infection as sexually transmitted automatically makes it stigmatizing. It’s a social issue without easy or quick resolution, stemming from the problems most societies have with sex and sexuality in general.”
- Dr. Hunter Handsfield, Professor Emeritus of Medicine, Center for AIDS and STD, University of Washington
In the U.S., there are nearly 20 million new cases of sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) each year. (STD and STI mean the same thing—infections that get passed from one person to another during sex.) In order to shed light on the enormous impact that STDs have on the lives of millions of Americans, the Centers for Disease Control and Prevention (CDC) has designated April as “Sexually Transmitted Diseases Awareness Month.”
Of the more than 20 types of STDs, including syphilis, gonorrhea, chlamydia and herpes, a large majority were recognized well before 1967 as unwanted consequences of unsafe sex. My focus in this week’s Germ Gems post is on three important STDs that are considered “emerging infections”— infections that are new, newly recognized, or infections with a geographic range that has expanded since 1967— HIV/AIDS, Monkeypox, and Mycoplasma genitalium.
HIV/AIDS. In 1981, the CDC issued its first warning about a relatively rare form of pneumonia that was killing young gay men—the disease was ultimately called AIDS. (HIV/AIDS was the subject of my January 29, 2020 Germ Gems post, “Ending the HIV/AIDS Syndemic.”) AIDS is a chronic immune disease caused by the human immunodeficiency virus (HIV). While AIDS can be contracted through contaminated blood, such as occurs with injection drug use, the vast majority of HIV/AIDS cases are STDs.
According to the CDC, there is no cure for HIV/AIDS. But effective anti-retroviral drugs are available to treat the disease and prolong life. (In recent years, researchers have reported five patients with HIV/AIDS who were likely cured through stem cell transplants.)
Nonetheless, HIV/AIDS has exacted and continues to exact a devasting toll on human life. The World Health Organization (WHO) reports that HIV/AIDS has killed approximately 40.1 million people globally to date. In the U.S. today, there are more than 1.2 million people living with HIV/AIDS and more than 35,000 new infections each year. Thus, in the public health arena, HIV/AIDS has an ongoing high priority status.
Monkeypox (mpox). Like about 60% of all emerging infections, monkeypox is zoonotic, that is, the pathogen was transmitted at some time from animals to humans. (See also my August 3, 2022, Germ Gems post, “Monkeypox: Now a Global Concern. What You Need to Know.”) In 1970, researchers identified the first human case of monkeypox, but it wasn’t until 2022 when a massive outbreak swept through more than 100 countries that the WHO declared monkeypox a “global health emergency.” (To reduce stigma, the WHO renamed the disease “mpox” in November.) The cases in this outbreak involved mainly men who have sex with men.
Researchers initially equivocated whether mpox was a STD given that the virus can be spread by exposures unrelated to sexual activity. They have now resolved the issue: mpox is an STD.
In August 2022, the U.S. Department of Health and Human Services (DHHS) declared mpox a “public health emergency” because there were more than 7,500 cases confirmed. The CDC quickly orchestrated a vaccination and treatment program. This action combined with change in behavior, particularly in LGBTQ communities, helped curb the spread of mpox. By December 2022, the DHHS decided not to renew the public health emergency status of mpox in 2023.
Mycoplasma genitalium. M.gentialium (MG for short) is an emerging pathogen that is actually not all that new. Scientists have known about MG since the 1980s, and the CDC identified it as an emerging STD in 2015. In July 2018, obstetrician and gynecologist, Dr. David Soper called attention to MG in his article “STD called MG is a new kid on the block.” In this article, he reported that MG is rapidly becoming an important cause of pelvic pain and infertility in women.
MG is considered to be very contagious, and astonishingly, it’s estimated to affect more people in America than gonorrhea. MG infections are usually asymptomatic, but they it can cause a variety of symptoms, including vaginal or penile itching and discharge, and painful sex.
Health care providers can overlook the diagnosis of MG or misidentify it as another STD. And, untreated MG can lead to some serious consequences, such as pelvic inflammatory disease, infertility, and arthritis. But when it is detected, there is effective antibiotic treatment (usually azithromycin). More information about MG for both women and men can be found on the CDC’s Mycoplasma genitalium Basic Fact Sheet.
Prevention of emerging STDs. The CDC provides a wide range of tools not only for the prevention, testing, and treatment of STDs but also for reducing the stigma, fear, and discrimination that may result from a an STD. The CDC’s website, “How You Can Prevent Sexually Transmitted Diseases,” identifies five steps for prevention of all STDs whether they are “emerging STDs” or not. They are:
Abstinence. The most reliable way to avoid infection is to not have sex (i.e., anal, vaginal or oral).
Vaccination. Vaccines are safe, effective, and recommended ways to prevent hepatitis B and HPV.
Reduce Number of Sex Partners.
At the end (beginning and middle) of the day, it is of paramount importance to practice safe sex to prevent all STDs.