A drive to find out why the United States has the highest rates of treatable sexually transmitted diseases in the developed world has been the career focus of one University of Alabama at Birmingham infectious disease expert.
Edward W. Hook III, M.D., professor and chief in the Division of Infectious Diseases, says the uneasy silence between doctors and patients hampers prevention and treatment and that a matter-of-fact approach to sexual health is just what the doctor ordered to slow down rates of infection.
In a recent Journal of the American Medical Association Viewpoint article, Hook and co-authors say that conversations about sexual health between physicians and patients need to become more prevalent.
Not only are sexually transmitted infections among teens and young adults higher in the United States than in other developed nations, they also are considerably higher among certain racial and ethnic minorities and in different geographic regions in the nation, according to the Kaiser Family Foundation.
"Our nation's focus on STIs/STDs for more than 100 years has been devoted to the idea that STIs are diseases that result from socially unacceptable behavior and something people don't want to have," Hook said. "Because these diseases occur in the context of people's most personal behaviors, it's stigmatizing to talk about; but the fact is, STIs most often are transmitted by people who do not know they have them. Further, many people who get STIs, including most women with infection, become infected while involved in monogamous relationships."
Often, Hook says, patients hesitate to ask their doctors questions about prevention, and doctors in turn often hesitate to perform recommended testing or to even take a sexual history.
"Everyone ends up not paying attention to these devastating diseases. So it occurred to us — and it has been done elsewhere in the world — instead of focusing on disease, which nobody wants to have, we should focus on health, which is what everyone wants," Hook said. "There's so much we can do to promote sexual health, and we believe sexual health is one element of health, just like nutritional and cardiac health, that everybody needs to pay attention to."
Hook points to data that shows more than 80 percent of sexually active Americans have the STI that causes cancer in women, the human papillomavirus, which is preventable through vaccination. Also, Hook says, the hepatitis vaccine prevents STIs, and every woman under 26 years old should be tested for chlamydia regardless of marital status.
"Testing doesn't change whether someone is infected or not, but it gives providers the ability to do something about it for the patient if they are infected," Hook said. "We believe that promoting this — not looking for disease or someone to blame it on — is important because sex is a part of life, and we want people to be healthy in the context of their sexual lives."
Hook and his co-authors believe awareness is an effective intervention against stigma, which is a huge impediment to health care.
"What's come from my interest and devotion to this topic is something I incorporate in my patient care. I used to say to patients, 'I'm sorry you have an STI'; but now I tell physicians we should never apologize for making an STI diagnosis or otherwise," Hook said. "If they are infected, I can treat it and improve their health, and if they're not infected, I can help them avoid infection. There's no reason not to talk about it."
Hook hopes both patients and health care providers will remove the hesitation to discuss sexual health, in an effort to curb the numbers.
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