Talk on Sexual Diseases
by Tamar Lewen
Adapted from The New York Times Company, Copyright
1997, and the Henry J. Kaiser Family Foundation, New Release, Monday, September 15, 1997.
Although more than 12 million new cases of sexually transmitted
diseases are diagnosed each year, three million of them among teenagers alone, a recent
survey of women from 18 to 44 years old found that most did not discuss such diseases in
their first visits with a new gynecologist or obstetrician.
According to the survey, conducted for the Kaiser Family
Foundation and Glamour Magazine, only 15 percent of the 482 women polled had discussed
sexually transmitted diseases other than AIDS in their reproductive health visits.
The women raised the topic 3 percent of the time, and the
doctor or other health professional raised it in 12 percent of the visits.
AIDS and HIV, the virus that causes the disease, were
discussed somewhat more frequently, being raised in 21 percent of the visits, by the
patient in 2 percent and by the doctor in 19 percent.
By comparison, breast self-examinations and Pap smears were
discussed in three-quarters of the visits, birth control in more than half and alcohol use
in a quarter (Table
1). "I think you can summarize the whole
reason people don't talk about sexually transmitted diseases with the word shyness,"
said Dr. Felicia H. Stewart, the director of reproductive health programs at Kaiser.
"Patients are shy about raising the issue and
clinicians are shy about asking the questions, so you get a vicious circle of 'don't ask,
don't tell.' The end result is a dangerous dont know."
A telephone survey was conducted by Market Facts Inc. in
May and June, with a national sample of women who had been to a new gynecologist or
obstetrician for the first time within the previous year.
The margin of sampling error was plus or minus five
percentage points. According to the survey, only 3 percent of the women believed
themselves to be at risk for sexually transmitted diseases. However at the current rates
of infection, from 25 percent to 50 percent of all Americans will contract a sexually
transmitted disease at some point in their lives.
Most of the women surveyed said it should be up to the
health professional to initiate the topic of sexually transmitted diseases.
The two most common sexually transmitted diseases are
chlamydia, which infects approximately four million people a year, and trichomoniasis,
which infects an estimated three million. Both, left untreated, can cause serious
reproductive difficulties. Both are now more prevalent in the United States than in any
other industrialized nation.
Unfortunately, according to a previous Kaiser survey, few
women are aware of either of the diseases, or their consequences. Less than a quarter of
the women, when asked what sexually transmitted diseases they were aware of, could name
chlamydia, and only 2 percent could name trichomoniasis. The majority of the women were
unaware that such infections increased susceptibility to HIV infection.
Kaiser's surveys have also found that many women believe
erroneously that they are automatically tested for a wide range of sexually transmitted
diseases as part of their regular gynecological examinations.
The American College of Obstetricians and
Gynecologists 1996 Guidelines for Womens Health Care recommends evaluation and
counseling on sexually transmitted diseases as part of the routine assessment of all women
According to Peggy Northrop, Senior Health Editor, Glamour
Magazine, "Women need to take more responsibility for their sexual health, but health
care providers must get over any reluctance to address these issues. If they dont,
too many women will remain in the dark about their risks and end up going untreated for an
STD, which could compromise their fertility."
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and Laboratory Capacity for Infectious Diseases
The Bureau of Epidemiology, Communicable Disease Control
Program has received $203,537 from CDC to support the "Epidemiology and Laboratory
Capacity for Infectious Diseases" cooperative agreement. Funding from CDC will allow
the Division of Epidemiology and Laboratory Services to expand testing for enteric
diseases and emerging pathogens by implementing pulsed-field gel electrophoresis (PFGE)
and rapid screening for foodborne pathogens. In addition, the Bureau of Epidemiology will
develop an electronic reporting system for laboratories, establish a surveillance system
for infections caused by antibiotic resistant organisms and improve electronic
communication systems for surveillance, outbreak control and disease reporting.
Equipment is being purchased and new staff are expected to
be hired by November 1997. If program objectives are met, the grant can be extended over a
five year period.
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Burns Surveillance Project
Work-related burns are a leading cause of occupational
injury in the United States. Approximately 1.4 million persons in the United States
sustain burns each year, of which approximately 54,000-108,000 are hospitalized. Of all
serious burns, 20-25% are work-related. In Utah, from 1992 to 1995, there were a total of
10,352 work-related burns (thermal and chemical) reported to the Industrial Commission of
Utah, of which a total of 167 required hospitalization. Work-related burns accounted for
20% of all serious burns requiring hospitalization in Utah between 1992 and 1995. Of the
167 hospitalized cases reported in Utah, 6% occurred among adolescent workers aged 15-19
years old, and 88% occurred among workers 20-54 years old.
The Bureau of Epidemiology, Environmental Epidemiology
Program, was recently awarded a 5 year grant from the National Institute for Occupational
Safety and Health to conduct state-wide surveillance of work-related burns. This grant,
which began September 30, will be used to develop an ongoing occupational disease and
injury surveillance program for work-related burns and allow the Environmental
Epidemiology Program to strengthen the infrastructure of current surveillance projects.
The goal of this project is to develop a complete registry
of work-related burn cases in Utah, and to use the information from cases to develop and
implement intervention activities. Interventions will include education and consultation
to employers where burn hazards are present, education for cases and workers, as well as
broader industry-wide studies and research. Cases will be identified from a variety of
sources including hospital reporting of work-related burns, hospital discharge data,
workers compensation data, Utah Occupational Safety and Health Division (UOSHD) and direct
reporting from physicians. Medical, demographic and sociologic information will be
collected from cases to identify appropriate interventions.
The surveillance system for work-related burns will help
assure that affected workers are identified and receive the appropriate medical and
environmental follow-up, and appropriate prevention activities are directed toward
targeted industries. Data collection and analysis on a statewide basis will be used to
identify high risk areas and activities associated with elevated injuries in Utah workers
and ensure that direct intervention efforts reduce injuries associated with work-related
The information obtained through these surveillance
activities will be disseminated to the National Institute for Occupational Safety and
Health, other government agencies, researchers, medical providers and other interested
persons. These efforts will help to direct efforts by federal, state, and local public
health officials seeking to reduce work-related injuries as the result of burns.
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