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  • Title: The changing pattern of sexually transmitted diseases in adolescents.
    Author: Donald WH.
    Journal: Practitioner; 1979 Mar; 222(1329):383-5. PubMed ID: 582209.
    Abstract:
    The factors associated with the rising incidence of sexually transmitted diseases in adolescents in England and Wales are both social and medical. Among the social factors is the large part played by sex in periodicals, advertisements, the theater, radio, and television. Also playing their part are increased mobility of populations, particularly moves from rural to urban areas, increased affluence, increased alcohol comsumption and leisure time together with greater personal freedom. The medical factors include the prevalence of asymptomatic infection mainly in women but also in men, the high incidence in homosexual men who may be asymptomatic and very promiscuous, and the fact that modern treatment is simple and effective reduces the fear of infection. Furthermore, modern contraceptive techniques such as the IUD and oral contraceptives (OCs) offer no barriers to infection unlike the condom and diaphragm. Syphilis is no longer a problem in the UK, as the incidence has remained at a low level of 2-3 cases/100,000 population for the past 20 years. Gonorrhea has become a problem in its place reaching almost epidemic proportions by 1975, although the incidence is now showing some sign of leveling off. Nonspecific urethritis in men and nonspecific genital infection in women, and the virus condition of herpes genitalis and genital warts have all continued to increase in incidence. In most clinics 40-50% of female patients with gonorrhea are under the age of 20. Changing patterns of sexual behavior have altered the pattern of disease. Oral coitus, both fellatio and cunnilingus, have become more prevalent and can lead to pharyngeal gonorrhea which can be symptomless in both heterosexuals and homosexuals. Rectal gonorrhea occurs in women as well as in male homosexuals and can be a cause of failure of initial treatment. The diagnosis of gonorrhea is a bacteriological diagnosis, and smears and cultures must be taken from the urethra and cervix in the female. It is gradually becoming routine pratice in many clinics to swab the rectum and pharynx as well as the genital tract to exclude gonorrhea in those areas. Complications of gonorrhea have become common again. Salpingitis has increased in incidence. Gonococcal arthritis has reappeared. Nonspecific genital infection in both sexes is a considerable problem. In men, the incidence of nonspecific urethritis is greater than that of gonorrhea. In women, nonspecific vaginitis, cervicitis, and salpingitis increases in incidence year by year and can be difficult to treat. As many as 40% of all women suffering from gonorrhea also have an infection with Trichomonas vaginalis, which will cause symptoms. Virus infection continues to be on the increase. This is particularly the case with genital warts and herpes genitalis, which have doubled in incidence over the past 10 years. It is always important when dealing with these conditions to examine the sexual partner, or partners, for evidence of a similar infection.
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