Measures to reduce STIs include comprehensive sexuality education; STI and HIV
testing and pre- and post-screening counseling; condom promotion; interventions
targeted at vulnerable populations and people who inject drugs; and counseling to
improve people’s ability to recognize the symptoms of STIs.
Safe and highly effective vaccines are available for two STIs: HPV and hepatitis B. The vaccine against hepatitis B is included in infant immunization programs in 93% of countries worldwide. Male circumcision
reduces the risk of penile cancer, heterosexually acquired HIV infection in men
by approximately 60%, and provides some protection against other STIs, such as
herpes and HPV.
Many STIs, including chlamydia, gonorrhea, hepatitis B, HIV, HPV, HSV2, and
syphilis, can also be transmitted from mother to child during pregnancy and childbirth.
All sexually active women age 24 or younger and older women at risk should
be screened for gonorrhea and chlamydia infection, according to the U.S. Preventive
Services Task Force (USPSTF) Recommendation Statement. When used correctly
and consistently, condoms offer one of the most effective methods of protection
against STIs, including HIV. There is less evidence about the effectiveness of
female condoms, but they too appear to be effective and safe.
In the U.S., the estimated incidence of HIV is slowly declining, and becoming HIV
positive is no longer a death sentence thanks to the availability of antiretroviral drug
treatment (ART). About 38,739 new HIV infections occurred in 2017.95 More than
1.1 million people in the United States are living with HIV infection, and about 15%
are unaware of their infection. Some groups are much more likely to be affected
by HIV than others. Men who have sex with men (MSM) account for two-thirds
of new infections, and Blacks continue to be disproportionately affected. The CDC
reports that although Blacks represent approximately 14% of the U.S. population,
in 2017, they acquired an estimated 43% of new HIV infections with the greatest
incidence among men who have sex with men.
Transmission of HIV can be reduced by ART that reduces the viral load of those
with infections, by use of condoms and other safe sex practices, and by avoiding
the sharing of drug injection paraphernalia among those addicted to opiates and
other drugs that are injected. There is good evidence that when the HIV virus is
suppressed with ART to the point that it becomes undetectable, it only rarely can be
sexually transmitted. This may take six months of ART treatment and requires
careful adherence to taking ART. Another key element of prevention is the use of
ART drugs for preexposure prophylaxis (PrEP) by those at risk of becoming infected.
101 If taken daily, PrEP, which contains two antiretrovirals, has been shown to be
86% effective in preventing new HIV infections.
Those aware of their HIV infection but not in regular care contributed to more than
40% of new cases. Those unaware of infection contributed to more than one-third,
and those receiving treatment but not virally suppressed contributed to about
20%. This data is one reason the USPSTF recommends screening for HIV infection
in adolescents and adults aged 15 to 65. Younger adolescents and older adults
who are at increased risk of infection should also be screened. The USPSTF recommends
screening for HIV infection in all pregnant women, including those who
present in labor or at delivery whose HIV status is unknown.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel.
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