STDs Regaining Lost Ground

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STDsRegaining Lost Ground

• Tuesday, October 2, 2001
• Washington, D.C.

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The IOM Report of 1997The Hidden Epidemic

• Despite the tremendous health and economic
  burden of STDs, the scope and impact of the STD
  epidemic are underappreciated and the STD
  epidemic is largely hidden from public discourse.
  Public awareness and knowledge regarding STDs are
  dangerously low, but there has not been a
  comprehensive national public education campaign
  to address this deficiency.

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How have we done since the IOM report?

• 1995 5 of top 10 reported diseases are STDs
  
• 1999 5 of top 10 reported diseases are STDs
• 1995 STDs accounted for 87 of all cases
  reported among top 10 diseases
• 1999 STDs accounted for 89 of all cases
  reported among top 10 diseases

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How have we done since the IOM report?

• 1993 estimate 12 million new cases/yr
• 1999 estimate 15 million new cases/yr
• More than 65 million people in US are currently
  living with an incurable STD.

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Evidence that the Hidden Epidemics Remain

• Chlamydia trachomatis
• 3 million new cases per year, current case rate
  highest ever reported
• Possible link with cervical cancer/HPV that needs
  further study
• High cost of sequelae (gt2 billion)
• Demonstrated cost effectiveness of screening and
  treatment, yet
• Screening programs poorly implemented in many
  areas

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Evidence that the Hidden Epidemics Remain

• Gonorrhea
• Case rate is highest of any industrialized
  country 50x that of Sweden 8x Canada.
• After declining steadily to 1996, rates now
  increasing (9 higher than in 1997).
• 94-99, cases more than doubled in MSM
• Drug resistance increasing but few testing

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Evidence that the Hidden Epidemics Remain

• Herpes simplex virus
• 1 in 5 adults in US have herpes (45 million),
  only 10 of these are aware
• Synergy between HSV and HIV promotes more
  efficient transmission, increased shedding of HIV
  
• Preventing spread could help slow the HIV
  epidemic

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Evidence that the Hidden Epidemics Remain

• Human papilloma virus
• Most common STD (5.5 million new cases/yr)
• 20 million currently infected
• 75 of reproductive age people have been infected
• Causes cervical cancer

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Evidence that the Hidden Epidemics Remain

• Hepatitis B
• Majority of infections are sexually acquired
• 6,000 deaths/yr in US from chronic HBV-related
  liver disease
• Among acute HBV cases in sentinel counties in
  1996, 70 had a missed opportunity for
  vaccination in the past 42 of these had been
  treated for an STD.

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Points to consider

• Despite recent dramatic progress in diagnostic
  technology, bringing us molecular-based tests
  that can be used with noninvasive or easily
  obtained specimens, public and private health
  care providers are not fully implementing
  screening programs for STDs.
• Many at-risk women are not being screened for CT.
  
• 32 of physicians in survey said would screen
  sexually active young women
• Four large health plans 2-42 of 15 to 25 yr
  olds screened lt20 compliance with HEDIS measure
  

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Points to consider

• Prevalences of STDs in general among the military
  are higher than those among civilian
  counterparts. Despite demonstrated cost
  effectiveness, there is no routine screening of
  recruits for chlamydial infections at entry into
  the US Army or Air Force. For the first time in
  US history, STDs are not considered to be an
  extremely important priority for military
  medicine, ..not a great threat to the readiness
  status of military forces.

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Points to consider

• Diagnostic testing is available for HSV-2 and HPV
  but has not been widely implemented due to lack
  of knowledge and policy on how to use these
  tests.
• No national surveillance data for Trichomoniasis
  despite this being the most or second most common
  STD.

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Points to Consider

• No national surveillance data and little guidance
  available for bacterial vaginosis, associated
  with sexual activity, PID, AOP, although among
  the most common conditions found in women in
  health care settings.

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Charges to the panels

• Panel 1 STDs- How silent, how deep?
• A focus on the magnitude of the current problems
  and whether rates are increasing or decreasing
  over time.
• Panel 2 STDs- Where are we falling
  short?
• A focus on programs and policies where and why
  these have and have not worked.

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Charges to the panels

• Panel 3 STDs- Wielding the yardstick
• Considering recent reports and milestones, are we
  improving? What is needed for success? What are
  the obstacles?
• Panel 4 STDs- Framing a new horizon
• Is there a better way? How do we get there? Who
  is responsible? Who pays?

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Panel 1 STDs- How silent, how deep?
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Questions to consider

• Who is (and who should be) responsible for STDs
  screening, treatment, counseling?
• Who pays and how?
• Federal vs. local funding?
• Public vs. private?
• How do we increase the stature of STDs on the
  decision agenda for managed care, prisons,
  military, public health clinics, private sector?
• Do STDs have or need an advocate?
• How can we do a better job? What is needed?