Despite massive efforts at outreach and education, many sexually transmitted diseases are on the rise throughout the United States and globally, Dr. Theodore Rosen said at the annual Hawaii dermatology seminar sponsored by Skin Disease Education Foundation in Maui.
Studies from 2006 to 2008 confirm that about 500 million new cases of STDs occur annually, with the United States contributing more than 20 million. While about half occur in patients younger than 25 years, age is no protection, said Dr. Rosen, professor of dermatology at the Baylor School of Medicine, Houston.
"The 'geriatric' population is increasingly at risk for STDs," Dr. Rosen said. A 2006 study that was commissioned by AARP tied the STD boom to America's high divorce rate53% of marriages end in court. About 30% of adults aged 4560 years are single, and while sexual activity does fall off with age, about 20% of those over the age of 50 years have sex weekly, and 50% indulge at least once a month (Clin. Geriatr. Med. 2003;19:63755).
As fear of pregnancy diminishes with age, so does the use of condoms, putting sexually active individuals at risk. "More than 60% of the over-50 group does not use condoms," he said.
"There has been a significant rise in AIDS among patients over age 50 [years]from 16,288 cases reported in 1990 to 114,981 in 2005," according to Dr. Rosen. Dermatologists need to remember to educate not only the young about the risk of STDs and HIV, but also older, single adults.
Herpes remains the most prevalent STD in the United States, and it's on the rise, he said. A recent World Health Organization bulletin put the country's annual new case load at 1 million, with a prevalence of 50 million (2008[doi:10.2471/07.04628
Initial visits to physicians' offices for genital herpes have risen from about 20,000 per year in 1966 to 300,000 per year in 2006, with no sign of a reversal in that trend.
Compliance with the prescribed treatment regimen is crucial to both suppressing recurrent outbreaks and to diminishing transmission, Dr. Rosen said. Acyclovir (400 mg twice daily), valacyclovir (5001000 mg daily); and famciclovir (250 mg twice daily) are all equally effective methods to establish chronic suppression.
Genital warts have plowed a similar path through the American landscape since the 1960s, with about 70,000 cases diagnosed in 1966 and more than 450,000 in 2006, according to the National Disease and Therapeutic Index. Surgical ablation and imiquimod have similar clearance rates (80% and 70%, respectively), while the combination of both delivers a one-two punch that clears more than 90% of infections and demonstrates a lower recurrence rate.
The combination of trichloroacetic acid and imiquimod is another good option, and more cost effective than either of those treatments used alone. On average, combination therapy clears warts with just two treatments, while using either independently takes longer. Patients prefer combination therapy because it means fewer visits and it takes less time, Dr. Rosen said.
And although syphilis showed a sharp U.S. decline from 1991 to 2001, it's on the upswing again (Am. J. Pub. Health 2007;97:107683). "Incidence rates increased by 57% from 2001 to 2007, with 64% of new cases occurring in men who have sex with men," Dr. Rosen said.
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