STD Awareness: The Good, the Bad, and the Ugly

Sexually transmitted diseases (STDs) have been with us since the dawn of time — or at least since the dawn of sex. And, as we continue to hone our approach to preventing and treating them, STDs will always grab headlines, whether the news is bad or good.

The Good

Can the HIV epidemic be stopped?

For more than a decade, AIDS, the illness caused by HIV, was seen as a death sentence. It wasn’t until the mid-’90s that antiretroviral drugs kept the virus in check, prolonging lifespans for people with access to these medications and transforming the infection into a chronic disease. Now, those dreaming of an end to HIV are seeing reasons for optimism. No, a cure isn’t in the works — but many researchers believe we can end the epidemic through prevention.

Ending HIV transmission will take money and an efficient health care infrastructure, but we have the tools to do it. It starts with expanding access to HIV testing — an estimated 15 percent of Americans with HIV are unaware of their status. The next step is to ensure that everyone testing positive has access to antiretroviral drugs. When used correctly, these medications keep viral levels so low that the chances of transmission are virtually nonexistent. More recently, medications called PrEP — pre-exposure prophylaxis — enable people without HIV to protect themselves from infection. Condoms, of course, are a time-tested prevention tool. Gathered together, we have a pretty mighty arsenal. Here in the United States, we could stop HIV transmission in its tracks in just a handful of years. Of course, people all around the world will need access to testing and treatment to halt this scourge on a global level.

Is there some good news about gonorrhea on the horizon?

Gonorrhea has also been earning a lot of negative publicity lately, thanks to its evolutionary superpowers that has allowed it to mow down every antibiotic we’ve thrown in its path. Now that it’s showing resistance to the last two drugs we have to treat it, researchers worry that the days of untreatable gonorrhea will soon return. But we might be able to buy ourselves some time with a new antibiotic called zoliflodacin, which has recently completed Phase 2 clinical trials. That means it has been shown to be safe and effective in a relatively small group of patients — the next step is to pass Phase 3 trials, which are larger and more stringent. Successful Phase 3 trials can lead to FDA approval.

Unfortunately, so far, this antibiotic doesn’t seem very effective in curing oral gonorrhea. Oral gonorrhea is notoriously difficult to treat, and drugs that can cure gonorrhea below the belt — in the urethra or rectum — can only cure oral gonorrhea in much higher doses. Many cases of oral gonorrhea go undetected and untreated, and researchers think these stealth infections are what drive a lot of antibiotic resistance in the first place.

The Bad

Syphilis is affecting a record number of U.S. infants.

After we drove it to near extinction at the turn of the century (in the United States, anyway), syphilis has been making a comeback. Congenital syphilis, in which a baby is born with syphilis after being infected in the womb, is on the rise as well, ballooning to a 20-year high in 2017. Last year, there were 918 documented cases of the disease, which included 64 stillbirths and 13 infant deaths.

When a pregnant person has syphilis, the bacteria that cause it can cross the placenta to infect the fetus — and will do so 70 percent of the time. As many as 40 percent of babies infected with syphilis during pregnancy will be stillborn or will die soon after birth. It can also cause rashes, bone deformities, severe anemia, jaundice, blindness, and deafness. Congenital syphilis is especially tragic because it’s almost completely preventable with adequate prenatal care and penicillin. About a third of mothers who give birth to babies with congenital syphilis had no prenatal care, raising a huge red flag for the sad state of health care access in many U.S. populations.

The Ugly

The search for a herpes vaccine has been plagued by scandals and deaths.

Earlier this year, we shared the stories of two scandals in the herpes world. The first, which occurred in February at a biohacking conference, involved Aaron Traywick taking off his pants in front of an audience and injecting his thigh with a syringe containing a never-before-tested herpes treatment. Criticism around this stunt centered on the dubious ethics of offering experimental drugs to desperate patients with no regulatory oversight. The strange story took a dark turn in April, when Traywick was found dead in a sensory-deprivation tank. His passing was caused by drowning, not the experimental drug.

The other scandal involved William Halford, who before dying of cancer in 2017 conducted “off the grid” human trials of a herpes vaccine — injecting volunteers in hotel rooms rather than in clinics, and without the oversight of a university ethics board or the FDA. He circumvented regulations by recruiting patients through a members-only Facebook page, and many subjects were given the experimental vaccine in the Caribbean, specifically to evade FDA involvement. Patients did not receive informed consent forms, which is standard practice in trials for investigational drugs. Many of his test subjects can’t be tracked down, meaning we might never learn about the true potential of his vaccine — though many of those who received it have experienced distressing side effects.

Cases like Traywick’s and Halford’s lay bare the tension between those who think too much regulatory oversight hampers medical research, and those who believe too little oversight allows for the abuse of patients.

You can get tested and treated for STDs at a Planned Parenthood health center, as well as other clinics, private health-care providers, and health departments. You can also drop by to ask questions about safer sex or to pick up condoms. Some Planned Parenthood health centers offer prenatal care, while others offer referrals to local resources.

Click here to check out other installments of our monthly STD Awareness series!