Originally published in the Baltimore Sun on April 1, 2013.
Doctors and patients alike are often uncomfortable talking about sexual health and sexually transmitted disease. But a new Centers for Disease Control and Prevention report shows that this squeamishness costs society millions of dollars spent trying to treat or cure diseases that could have been prevented, vaccinated against, screened for or detected at an earlier stage of development.
According to the CDC, about 19 million Americans each year are affected by sexually transmitted diseases and infections. Young people, ages 15-24, are disproportionately affected; they account for 50 percent of all new sexually transmitted infections despite representing just 25 percent of the total sexually active population.
The problem is particularly acute in Maryland, which has some of the highest rates of sexually transmitted infections in the country. Maryland ranks 9th highest among the 50 states in cumulative reported AIDS cases and 5th highest for syphilis, with signs that the problem is getting worse. Maryland has seen an upward trend of syphilis cases since 2002.
Conservative estimates from this CDC report show that the lifetime cost of treating eight of the most common STIs contracted in one year is $15.6 billion. Some STIs, like HIV require life-long therapy, and others, like the human papillomavirus, better known as HPV, can lead to cancer, which also demands costly treatment. Even among the STIs that are curable, the annual cost of treatment is $742 million. Chlamydia is the most common curable STI, with over 1 million cases reported each year.
These costs are almost entirely avoidable, but we also are operating in a culture where talking frankly about sex and its risks is not encouraged enough. The debates over sex education and the distribution of condoms in schools are well known, but a less obvious culprit in the spread of sexually transmitted infections is the failing of the health care system. According to a report from the National Cancer Institute, major hurdles to vaccination for example, are inadequate provider recommendations, a broken reminder system for urging patients to complete their doses, and concerns over cost and coverage.
According to the National Cancer Institute, in 2010 only 30 percent of American girls had received all three CDC-recommended doses of the HPV vaccines. Comparatively, in Canada, 50 percent to 85 percent of girls were vaccinated, and in the United Kingdom and Australia well over 70 percent of girls received the vaccination. These countries make efforts to provide access and affordable coverage but do not require the vaccine. The U.S. should follow suit and actively work to curb health care costs with preventative services. In 2007, Maryland established a task force to make recommendations for a state plan for the HPV vaccine, including possible requirements, cost and education efforts, but nothing came of it, and the task force was disbanded in 2009.
A positive development in the effort to stop the spread of STIs came in November, when the U.S. Preventive Services Task Force, a government-backed panel of scientists and medical professionals, made a new recommendation that every American between the ages of 15 and 65 be tested for HIV. Because the Affordable Care Act requires insurers to cover the preventative services that are recommended by this task force, regular HIV testing will now be covered as part of a routine check-up.
The idea that people would be tested for HIV just as routinely as they are screened for high blood pressure of cholesterol is promising, but it will only work if doctors and patients are willing to have what is often an uncomfortable discussion.
“Talking about [STIs and risk] at all in the ACA is big because it’s often not in the conversation,” said Barbara Conrad, chief of the Center for STI Prevention at the Maryland Department of Health and Mental Hygiene. “People don’t talk about things before they become real problems.”
The onus to change that will be on both doctors and patients, Ms. Conrad said. Patients may be too shy to raise the issue on their own, and doctors, pressured by the time constraints of medical visits, may not bring it up either.
We need to do better. For many, talking openly about sex, even with a doctor, may seem like a taboo. But that taboo hurts our economy and public health.