CDC reported that it costs the United States $16 billion annually to treat eight STDs—HIV, syphilis, gonorrhea, hepatitis B, chlamydia, trichomoniasis, herpes, and human papillomavirus (HPV). CDC’s most recent comprehensive data (2008) estimates there are 19.7 million newly diagnosed sexually transmitted infections each year, and that half of these infections occur among young people ages 15 to 24. The most common diagnosis is HPV, which has been linked to throat, cervical, and penile cancers. The report estimates 110 million total sexually transmitted infections among US men and women of all ages.
CDC Epidemiologist Catherine Satterwhite, an author of one of the reports, stated that young people—especially young women—have always been disproportionately affected by STDs because many lack good insurance or easy healthcare access. Satterwhite noted that all STDs are preventable, most are curable, and all have existing treatments. Techniques for preventing STDs include abstinence, condom use, and mutual monogamy for couples. CDC recommends boys and girls have vaccination with Merck’s Gardasil to prevent HPV. In spite of increased incidence of HPV-related cancers, use of HPV vaccine remains low.
HIV is the most expensive STD because it requires life-long treatment. Curable STDs cost $742 million annually. The most common curable STD is chlamydia. To lower prevalence, Satterwhite recommended increased testing, especially for young women, and urged all sexually active people to be tested at least once for HIV.
The full report, “Sexually Transmitted Infections Among US Women and Men: Prevalence and Incidence Estimates, 2008,” was published in the journal Sexually Transmitted Diseases (2013; doi: 10.1097/OLQ.0b013e318286bb53).
The full report, “The Estimated Direct Medical Cost of Selected Sexually Transmitted Infections in the United States, 2008,” was published in the journal Sexually Transmitted Diseases (2013; doi: 10.1097/OLQ.0b013e318285c6d2).
The country of Georgia is struggling with high rates of hepatitis C. The official statistics show that 200,000 of its people are infected with the hepatitis C virus (HCV), which translates to 6.7 percent of the population compared to 2.5 percent of individuals in the United States and less than 1 percent in northwestern Europe. Only approximately one in 10 Georgians with HCV infection receives treatment because of the high cost of treatment. Patients are offered one of the two antiviral drugs, interferon and ribavirin. The four-week treatment course with either drug costs US $6,000, a large amount of money in a country where the average monthly wage is 700 laris (US $415). A full examination costs almost twice that amount at 1.6000 laris (approximately US $966).
David Sergeenko, Georgia’s health minister, acknowledged that there is no money in the state healthcare budget to cover the costs of treatment for that many people. He said that approximately 20 percent of the 200,000 individuals with HCV infection need antiviral treatment, which would cost the health department 800 million laris. Also, 1,000 people need liver transplants, which have to be done abroad at a cost of 300,000 to 500,000 euros each. However, even if the country spent its entire 650 million laris healthcare budget on treating HCV infection, it still would not meet its need.
Some doctors believe that the statistics of 200,000 HCV cases is incorrect as it is based on data from 2004, and that the number of cases is even higher. Georgia receives some help from international donors, but they only fund treatment for HIV patients who are coinfected with HCV.
Michigan State University researchers report that pregnant women treated in emergency rooms (ERs) often do not receive needed care for chlamydia and gonorrhea because laboratory results are not available before the women leave. The study based its conclusions on the records of 735 STD-infected women who were treated in three Grand Rapids hospital ERs. Half of these women received antibiotics for chlamydia or gonorrhea in the ER, but ER physicians prescribed antibiotics for only 20 percent of the 179 pregnant women who had gonorrhea or chlamydia.
Although inexpensive and effective antibiotics are available for these STDs, hospital staff is frequently unable to contact women after they leave the ER and tell them their laboratory results show gonorrhea or chlamydia infection. Medical student Roman Krivochenitser stated that on-the-spot testing would help staff provide immediate treatment for STD-infected pregnant women who come to the ER.
Diagnosing chlamydia and gonorrhea in pregnant women in the ER can be difficult, according to Krivochenitser, because some degree of abdominal discomfort is common during pregnancy. However, a mother’s untreated STD increases the risk of low birth weight, pre-term delivery, and passing the infection along to the baby. Women with untreated STDs also rarely develop pelvic inflammatory disease.
CDC currently restricts antibiotic prescriptions to prevent the growth of drug-resistant bacteria. The Michigan study recommends more research on rapid testing for chlamydia and gonorrhea, improved contact and follow-up with ER patients, and permission for physicians to treat pregnant women with antibiotics based on a clinical assessment.
The full report, “Underrecognition of Cervical Neisseria Gonorrhoeae and Chlamydia Trachomatis Infections in Pregnant Patients in the ED,” was published in The American Journal of Emergency Medicine (2013; doi:10.1016/j.ajem.2012.11.017).
Massachusetts Institute of Technology (MIT) recently concluded its Health and Wellness Innovation 2013.This 11-day event, better known as MIT Media Lab’s Health and Wellness Hackathon, is a program in which “hackers” seek ways to work with established companies in the healthcare sector to help bring about needed change. Engineering and medical faculty and students—together with companies such as Humana, Novartis, and Pharmiweb Solutions—worked to construct commercially ready products using MIT Media Lab’s open-source CollaboRhythm platform and open standards.
According to Dr. John Moore, organizer of the hackathon, the program by itself cannot make change, but it provides an opportunity to expose important groups such as pharmaceutical companies, insurers, medical diagnostics companies, startup entrepreneurs, and consumer electronics companies to what is available and to the value of using and contributing to the platforms. Moore contends that it is not often that these different groups converge, but now that they have met they can collaborate, which will hopefully result in big innovations when they see how they can benefit each other. One requirement was participants had to use open-source software, including the MIT-developed Indivo X personalized heath records system for building health trackers and other digital health tools to foster interoperability.
The six teams met from January 22 to February 1, and each developed its own products. Developed products included hiVIVA, a gaming app that helps individuals with HIV/AIDS remember to take their medications; and Beacon, an open-source variation on the home hub for capture and transmission of data from wireless, home-based sensors and medical devices for monitoring patients with congestive heart failure.
For 2012, Davis County, Utah, has reported a significant rise in the number of communicable disease cases because of health screenings for incoming Davis County Jail inmates, the steady climb of STDs, and a national pertussis outbreak. According to Davis County Health Department Epidemiologist Brian Hatch, the county recorded 363 more cases in 2012 than in 2011, with 315 of those associated with STDs, hepatitis C, and pertussis. The number of cases is 27 percent more than the 2011 numbers. Hatch disclosed these findings February 12 at a Davis County Board of Health meeting.
In Davis County, chlamydia was the highest reported communicable disease in 2012, with 862 chlamydia cases out of 1,732 communicable disease cases reported. In 2011, Davis County reported 739 chlamydia cases out of 1,369 communicable disease cases. Because of the high chlamydia count, STDs comprised approximately 54 percent of all Davis County cases reported in 2012. Also, gonorrhea cases more than doubled from 2011, according to Hatch. Davis County reported 18 gonorrhea cases in 2011 compared to 40 cases in 2012. Hatch declared, “Half of our time is spent on STDs here,” further saying that in Utah, there is a lack of public health education dealing with disease prevention aimed at young adults between the ages of 18 and 29—the demographic group that mostly contracts and spreads STDs.
Hepatitis C virus (HCV) cases found at incoming jail inmates’ health screenings also contributed to the high communicable disease case numbers. The jail used a grant awarded to the county to conduct HCV testing for incoming inmates. The jail screened 753 inmates for HCV, with 60 testing positive. Hatch explained that many of those testing positive were unaware of their infection. The county provided counseling, encouragement for the inmates to get confirmatory testing, and community resources upon their jail release. Visit www.daviscountyutah.gov/health for the full county health’s communicable disease report for 2012.
In February, Planned Parenthood of West and Northern Michigan began distributing more than 6,000 free Valentine's Day-themed "condom pops" to the community in observance of National Condom Week and National Condom Month. Communications Director Julie McKeiver said the campaign encourages sexually active individuals to speak to their partners about using condoms for protection against unintended pregnancies, HIV/AIDS, and other STDs. Each multicolored "condom pop" contains two condoms, a lollipop, safe sex information, and the slogan "Wear. No matter what,” which McKeiver states is a play on Planned Parenthood’s new slogan, “Care. No Matter What.” The campaign is part of an ongoing community basket program that began in May 2012. Community Outreach Educator Melissa Ferguson refills condom baskets every three weeks in locations such as hair salons to reach sexually active women. Planned Parenthood highlights condom use in places where women gather because biological factors contribute to more severe health consequences for women and place women at greater risk of infection than men.
Due to a manufacturer’s shortage of Tubersol, the Lincoln County Health Department announced on February 11 that it will not be able to offer routine tuberculin skin testing until further notice. In a press release, the North Carolina Tuberculosis Program recommended that all local health departments prioritize the testing to include only those persons who are considered the highest public health risk according to state guidelines. The program also advises health departments to defer routine testing until the shortage is resolved, which officials expect could be several months. For those health departments that cannot defer testing, the Lincoln County Health Department will provide an alternative blood test. This test is significantly more expensive than skin testing, but is appropriate for screening purposes. For availability, pricing, and clinic times, call (704) 735–3001. The health department will notify the public when skin testing can resume.
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