Once again, with feeling…er, with condom

The blogosphere has once again taken note of the shameful rise in sexually transmitted disease rates in the U.S. This space has more than once mentioned that lack of sex education does not equal lack of sex. In fact, less sex education tends to equal more sex, more disease, and more pregnancy. Included in “less sex education” are so-called “abstinence programs“, which are little more than lie- and myth-filled mandates funded by the government to appease fundies. Do I sound a little fed up?

When I say “shameful”, I do not mean to imply that people who get STDs should be ashamed—they should be more careful. We, as a society, should be ashamed that we are not taking a rational approach to fight a major public health problem. In an ideal world, free of harmful religious ideologies, could we actually wipe out STDs? Probably not, but let’s explore.

Disease eradication is an interesting concept. We’ve done it before—smallpox is gone (hopefully). Polio is largely controlled. So what makes a disease more or less easy to eradicate?

First, humans should be essential to the life-cycle of the bug–preferably the only host. That way, once the disease is eliminated in humans, it can’t sneak back from an animal reservoir somewhere. (Malaria is an example—it’s very treatable in humans, but there are other hosts, so wiping it out in humans is meaningless—we’ll just get bit by more mosquitoes.)

Second, it should be easily and accurately diagnosed.

Third, the disease should be easily controlled in individuals, either by prevention (such as vaccination), or easy and effective treatment.

How do STD’s fit into this schema?

Let’s concentrate on a few STDs, say gonorrhea, chlamydia, syphilis, and HIV—you know, the big ones.

1. Humans are pretty much the only reservoir for these diseases. There are types of chlamydia that are sort of independent of humans, but it’s complicated, so for the sake of argument, we’ll say that all of these bugs are human-only.
2. Diagnosis: these diseases are very easy to diagnose—if the patient knows that they have it and seeks medical care. Many of them are either asymptomatic, or have long asymptomatic periods (such as HIV). The way to make up for this problem is regular screening of ALL individuals. Practical? Maybe. Expensive? Definitely. Worth it? Perhaps.
3. Disease control: Gonorrhea, chlamydia, and syphilis are all very easy to treat (basically). All four of these STDs are preventable by behavior—no vaccines are available. Ideally, prevention should be passive, and not have to rely on decisions made by individuals; that is, the person should not have to think about it. Unfortunately, “not thinking about it” is what contributes to most cases of STDs. Since vaccines are not available for these diseases, education is critical to prevention.

So, STDs probably are not eradicable. They are, however, controllable. Screening, education, treatment, prevention. With a strategy based on science rather than ideology, the rates of these illness could drop considerably. Let’s hope the next administration bases scientific decisions on science more than ideology.