Every year more than 12 million cases of sexually transmitted diseases (STDs) are reported in the United States. These infections result in billions of dollars in preventable healthcare spending. In addition, the health impact of STDs is particularly severe for women. Because the infections often cause few or no symptoms and may go untreated, women are at risk for complications from STDs, including ectopic (tubal) pregnancy, infertility, chronic pelvic pain, and poor pregnancy outcomes.
CDC is working to prevent STDs and their complications among women and the spread of STDs through early diagnosis and treatment. To meet these goals, CDC cooperates with health departments and non-governmental organizations to provide professional education, public information, prevention activities, research, and support.
Chlamydia is the most common bacterial sexually transmitted disease in the United States. We are only beginning to realize the importance of this disease. It causes an estimated 4 million infections annually, primarily among adolescents and young adults. In women, untreated infections can progress to involve the upper reproductive tract and may result in serious complications. About 75 percent of women infected with chlamydia have few or no symptoms, and without testing and treatment the infection may persist for as long as 15 months. Without treatment, 20-40 percent of women with chlamydia may develop pelvic inflammatory disease (PID). An estimated 1 in 10 adolescent girls and 1 in 20 women of reproductive age are infected.
Pelvic Inflamatory Disease
PID refers to upper reproductive tract infections in women, which often develop when STDs go untreated or are inadequately treated. Each year, PID and it's complications affect more than 750,000 women. PID can cause chronic pelvic pain or harm to the reproductive organs. Permanent damage to the fallopian tubes can result from a single episode of PID and is even more common after a second or third episode. Damage to the fallopian tubes is the only preventable cause of infertility. As much as 30 percent of infertility in women may be related to preventable complications of past STDs.
One potentially fatal complication of PID is ectopic pregnancy, an abnormal condition that occurs when a fertilized egg implants in a location other than inside a women's uterus -- often in a fallopian tube. It is estimated that ectopic pregnancy has increased about five-fold over a twenty year period. Among African-American women, ectopic pregnancy is the leading cause of pregnancy-related deaths. The economic cost of PID and its complications are estimated at $4 billion annually.
Gonorrhea is a common bacteria STD that can be treated with antibiotics. While gonorrhea rates among adults have declined, rates among adolescents have risen or remained unchanged. Adolescent females ages 15-19 have the highest rates of gonorrhea. An estimated 50 percent of women with gonorrhea have no symptoms. Without early screening and treatment, 10 to 40 percent of women with gonorrhea will develop PID.
Consistent and correct condom use is very effective for preventing a variety of STDs. Instructions on correct use of condoms are available by calling the CDC National AIDS Hotline, at 1-800-CDC-INFO, or the National STD Hotline, at 1-800-227-8922.
Human Immunodeficiency Virus
Human immunodeficiency virus (HIV) is the virus that causes AIDS. The risk of a women acquiring or transmitting HIV is increased by the presence of other STDs. In particular, the presence of genital ulcers, such as those produced by syphilis and herpes, or the presence of an inflammatory STD, such as chlamydia or gonorrhea, may make HIV transmission easier. A separate fact sheet is available on women and HIV/AIDS.
Herpes Simplex Virus (HSV)
Genital herpes is a disease caused by herpes simplex virus (HSV). The disease may recur periodically and has no cure. Scientists have estimated that about 30 million persons in the United States may have genital HSV infection. Most infected persons never recognize the symptoms of genital herpes; some will have symptoms shortly after infection and never again. A minority of those infected will have recurrent episodes of genital sores. Many cases of genital herpes are acquired from people who do not know they are infected or who had no symptoms at the time of the sexual contact. Acyclovir is a drug that can help to control the symptoms of HSV but it is not a cure. HSV is frequently more severe in people with weakened immune systems, including people with HIV infection.
Human Papillomavirus (HPV)
HPV is a virus that sometimes causes genital warts but in many cases infects people without causing noticeable symptoms. Concern about HPV has increased in recent years after several studies showed that HPV infection is associated with the development of cervical cancer. Approximately 25 types of HPV can infect the genital area. These types are divided into "high risk" and "low risk" groups based on whether they are associated with cancer. Infection with a "high risk" type of HPV is one risk factor for cervical cancer, which causes 4,500 deaths among women each year. No cure for HPV infection exists.
Syphilis is a bacterial infection that can be cured with antibiotics. Syphilis cases increased dramatically from 1985 to 1990 among women of all ages. An analysis of 1993 data has shown that rates of syphilis were higher among female than among male adolescents: rates among females were more than twice as high as rates among males in the 15-19 age group. African-American women have syphilis rates that are seven times greater than the female population as a whole.
More than 3,000 cases of congenital syphilis were reported in 1993. Such infections among infants are largely preventable if women receive appropriate diagnosis and treatment during prenatal care. Death of the fetus or newborn infant occurs in up to 40 percent of pregnant women who have untreated syphilis.
Condom Effectiveness and Reliability
When used consistently and correctly, latex condoms are very effective in preventing a variety of STDs, including HIV infection. Multiple studies have demonstrated a strong protective effect of condom use. Because condoms are regulated as medical devices, they are subject to random testing by the food and drug administration. Every latex condom manufactured in the United States is tested electronically for holes before packaging. Condom breakage rates are low in the United States, no higher than 2 per 100 condoms used. Most cases of condom failure probably result from incorrect or inconsistent use.
Primary-Care Physicians and STDs
A 1992 nationwide survey of primary-care physicians has revealed that while 94 percent "usually" or "always" asked new adult patients about cigarette smoking, fewer than 50 percent asked questions concerning the patient's sexual history. Questions about STDs, condom use, and number of sexual partners were reported to be somewhat more common when the patient was an adolescent.
The Department of Health and Human Services has set a goal for increasing the number of healthcare providers who screen and treat for STDs and provide STD counseling.
For more information on STDs as a women's health issue, contact the American Social Health Association at 1-800-227-8922 or P.O. Box 13827, Research Triangle Park, NC 27709. or contact your health provider.
For further information contact:
Office of Womens Health
Centers for Disease Control and Prevention
1600 Clifton Road, MS: D-51
Atlanta, GA 30033
Phone: (404) 639-7230
Fax: (404) 639-7331