The pernicious nature of STDs

Chicago

- From the sexual proclivities of senior citizens to the continuing spread of HIV, the state of sexually transmitted diseases (STDs) worldwide is more dire than casual observers would guess, says one expert.

"Anybody who walks into your office, whether they’re young, middle-aged or over the hill, could develop a sexually transmitted disease," says Theodore Rosen, M.D., professor, department of dermatology, Baylor College of Medicine.

According to a March 2008 publication from the Centers for Disease Control and Prevention, in a representative U.S. sample of 838 teenage girls, 26.5 percent had at least one STD, with human papilloma virus leading the pack. Dr. Rosen says the youngest patient he’s treated for an STD was nine years old. Accordingly, he advises, "The habits we form in childhood don’t make a small difference - they make all the difference."

At the other end of the spectrum, nearly one-third of Americans aged 45 to 60 years are single, according to an AARP survey. And around one in five Americans over age 50 reports weekly sexual activity, according to Clinics in Geriatric Medicine. However, Dr. Rosen says, "The vast majority of them wouldn’t even think about using barrier protection (condoms). As a consequence, as a surrogate marker, the number of AIDS cases in U.S. patients over the age of 50 has grown dramatically between 1990 (16,000) and 2005 (more than 100,000)."

As for cutaneous manifestations of STDs, Dr. Rosen says, "You can’t just look at them and diagnose them." Many STDs often mimic each other, and non-sexually transmitted diseases - such as genital ulcerations and other conditions - may look like STDs. "The moral of this story is you almost always must use some ancillary diagnostic tool such as thorough patient histories, serologic testing and appropriate cultures."

Dermatologists also must be aware of more obscure STDs, such as lymphogranuloma venereum, Dr. Rosen tells Dermatology Times.

Although it’s still somewhat uncommon worldwide, its pattern has changed dramatically in recent years. "Almost all the new cases are seen in men who have sex with men. They tend to be somewhat older and mostly Caucasian, although I believe that reflects the countries it’s been reported from." Rather than presenting as adenopathy, these cases usually present as proctitis, which is best treated with doxycycline or minocycline, he says.

Disclosure: Dr. Rosen serves on speakers bureaus for GlaxoSmithKline and Graceway and receives honorary from these companies.