Sexually transmitted diseases may reverse the 'revolution'

An unanticipated consequence of the sexual revolution and the advent of reliable contraception has been a dramatic increase in sexually transmitted diseases (STDs) among those with multiple sex partners. It has been estimated that each year in the US there are 3 million cases of chlamydia 200000-500000 new cases of genital herpes and at least 1 million cases each of pelvic inflammtory disease (PID) trichomonal infection and genital warts. Although syphilis cases decreased from 75579 in 1982 to 68000 in 1985 largely as a result of homosexual mens safer sex practices the number of cases of congenital syphilis increased from 239 in 1983 to 370 in 1985. In addition the 6-year trend toward a decrease in the number of cases of gonorrhea was reversed in 1985. Of concern is the reluctance of private physicians to report cases of gonorrhea to the Centers for Disease Control (CDC) or another public health agency so that contacts can be traced. CDC officials argue that the PID and possible infertility that can develop in females infected with untreated gonorrhea is far more important than the right to privacy of male victims. It is further believed that a large proportion of the 70000 ectopic pregnancies seen each year largely in older women are related to PID. Reported rates of gonorrhea and chlamydia are highest among blacks of both sexes in lower socioeconomic groups although the former infection is on the rise on college campuses. Efforts are continuing to develop more sensitive specific tests for the diagnosis of chlamydia. Another focus of research efforts is herpes simplex virus type 2 (HSV-2) infection. Recent data suggest this virus may be transmitted asymptomatically and affect as many as 20-60% of Americans. Controlled trials of anti-HSV-2 vaccines are expected within 2 years. There is growing concern that herpes may be associated with human papillomavirus a factor in a variety of cancers.