As STD epidemic rages, the sexually active scorn a familiar protection

condoms1-150x150In some not-so-great news for the nation’s sexual well-being, the rubber has hit the road for too many guys.

The familiar and oft-ridiculed prophylactic could play a significant role in battling an epidemic of sexually transmitted diseases (STDs) that has engulfed the nation, the Washington Post reported. But condom use has declined significantly, for example, as a leading means for family planning, falling in opinion surveys from 75% in 2011 to 42% among men polled.

Public health experts confront multiple challenges in trying to slash the soaring tide of chlamydia, gonorrhea, and syphilis, partly because medical advances with HIV-AIDS mistakenly have the sexually active, especially young men, believing that they can forgo condoms and be safe, the newspaper reported:

“Scientists have recently discovered that HIV-positive people cannot spread the virus if they adhere to treatment that reduces their viral load, spurring a campaign known as ‘undetectable equals untransmittable’ to focus on treatment as a form of prevention. The advent of daily pills and injectable medication taken as pre-exposure prophylaxis, known as PrEP, to prevent HIV infection also enabled people to have condomless sex with a drastically lower risk of contracting HIV, while still leaving them susceptible to other diseases that spread through fluids and skin-to-skin contact. Health officials are up against a perception that syphilis, chlamydia, and gonorrhea are nuisances that can be treated, even though those infected risk lasting complications including infertility and organ damage.”

The STD rates are beyond concerning, as the Washington Post reported:

“The United States recorded nearly 2.5 million cases of chlamydia, gonorrhea, and syphilis in 2021, more than doubling in the past two decades, according to preliminary data from the Centers for Disease Control and Prevention. About half of new infections last year were in young people between the ages of 15 and 24 … Multiple studies have found a rise in unprotected sex among men who have sex with men. The percentage of high-schoolers who said they used a condom the last time they had sex declined from 63% in 2003 to 54% in 2019, according to an annual government survey.”

The New York Times reported that public health officials may need to shift their views on how to increase use of safer sex practices, including condoms. Negative messaging about disease aversion and protection against unwanted pregnancies is not as effective as tweaking campaigns to persuade people that safeguards, including condoms, also can be sexy and can be made part of pleasurable sex. As the newspaper reported:

“Research shows that when safe sex campaigns acknowledge pleasure — by talking about sex as something that makes life good or showing how condoms can be erotic — more people use a condom the next time they have sex. That is what the World Health Organization and a small nongovernmental organization called the Pleasure Project found when they reviewed the results of safer-sex trials and experiments over the past 15 years. They assessed more than 7,000 interventions for their treatment of pleasure (and lack thereof). The peer-reviewed findings were published in the journal PLOS One. ‘Sexual health education and services have traditionally promoted safer sex practices by focusing on risk reduction and preventing disease, without acknowledging how safer sex can also promote intimacy, pleasure, consent and well-being,’ said Lianne Gonsalves, a co-author of the paper and an epidemiologist who researches sexual health with the WHO. ‘This review provides a simple message: Programs which better reflect the reasons people have sex, including for pleasure, see better health outcomes.’”

In my practice, I not only see the harms that patients suffer while seeking medical services, but also the clear benefits they may enjoy by staying healthy and far away from the U.S. health care system. It is, according to research conducted in pre-coronavirus pandemic times, fraught with medical errorpreventable hospital acquired illnesses and deaths, and misdiagnoses.

Sexual health, and the maintenance of same, is an important part of our well-being that can’t be ignored. We should discard unworkable notions, like abstinence-only sex education initiatives for the young (they don’t work), and finger-wagging and forgoing of vaccinations against the human papilloma virus (HPV) for teens (these are proven to reduce throat and cervical cancers).

We need to fund public sexual health programs appropriately and fully — and not just when worrisome outbreaks occur, as happened in recent months with monkeypox.

The nonprofit, independent Kaiser Health News service has provided a well-reported look at the skepticism with which consumers should regard at-home test kits for STDs. These private, convenient screens soon may improve patients’ sexual wellbeing, allowing them to learn quickly and more easily if they should seek medical treatment for exposure to and infection with STDs. For now, though, the tests are pricey and unapproved by the federal Food and Drug Administration, KHN found:

“The issue for regulators is whether sampling kits can be reliably adapted for in-home use. Unlike rapid antigen tests for Covid, which produce results in 15 to 20 minutes, the home STD kits on the market require patients to collect their own samples, and then package and mail them to a lab for analysis.”

We have much work to do to quell the STD epidemic and to ensure the health and wellbeing of the sexually active.

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