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More partners, more STDs
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BY RIDGELY OCHS
STAFF WRITER

March 2, 2004

The major health concerns for many women in their 20s and 30s are avoiding
sexually transmitted diseases and unintended pregnancies. And though there have
been some advances in contraception, the situation involving STDs is far more
troubling, experts say.

"HPV is the epidemic right now," said Dr. Margaret Polaneczky, an
obstetrician-gynecologist at New York-Presbyterian Hospital in Manhattan. Her
reference was to human papillomavirus, which causes genital warts, cervical
cancer and other genital cancers. Polaneczky, like others interviewed, said she
is seeing more young women who are having more and more sexual partners over
time. "It's the whole 'Sex and the City' thing," she said.

And that puts them at risk for viruses like HPV, herpes and HIV: None of them
can be cured, but only treated for their symptoms.

"If you get pregnant, we know how to take care of you. But with HPV and other
viral STDs, there are simply no cures," said Dr. Jill Rabin, chief of ambulatory
care and head of urogynecology for Long Island Jewish Medical Center, part of
North Shore-Long Island Jewish Health System.

Alarming numbers

And the numbers infected are not small. The Centers for Disease Control and
Prevention says that HPV is "likely the most common STD among young, sexually
active people," affecting 20 million in the United States at any one time. Every
year, about 5.5 million acquire an HPV infection, according to the CDC. There
are 30 known types of HPV. Most cause no problem; some cause genital warts,
which are unsightly but otherwise benign. But a few types can lead to cervical
cancer. The virus is undetectable in about 90 percent of women after two years,
but studies have found that in some women the types that lead to cervical cancer
can persist. Constant reinfection from multiple partners greatly raises the
chance of this.

Herpes also is a major concern; about 45 million Americans have had herpes,
according to the CDC. Caused by the herpes simplex virus, the infection produces
blisters in the genital area that usually disappear in two or three weeks. But
the virus remains in the body for life and the sores may recur. The virus may be
passed on when even the person is asymptomatic, said Dr. Judith Morris de Celis,
a clinical associate professor of obstetrics and gynecology at New York
University Medical Center in Manhattan.

And then there is the potentially lethal HIV. In 2002, there were more than
56,000 women in the United States with either HIV or AIDS which they had
acquired through heterosexual sex, according to the CDC.

The problem is that many women think that condoms are a sure-fire protection
against sexually acquired infections. Although condoms reduce the risk of
transmission, they don't eliminate it. Condoms aren't always used properly and
some tear or leak.

And Morris de Celis pointed out that both HPV and herpes can be transmitted via
the scrotum, which is not covered by a condom.

But all doctors interviewed said that aside from abstinence, condoms remain the
best way to reduce transmission of sexually acquired infections. And lacking any
cures, they agreed that women need to have frank conversations with their sexual
partners and their doctors.

"It really is about finding that middle ground between living a full and joyous
life but also remembering you're the only one who is really responsible for your
own life and health and you have to take ultimate control," Rabin said.

Taking greater control

In another area of their life - birth control - women may indeed be finding more
control than they have had.

Both the patch, on the market for several years, and the vaginal ring are
essentially the birth control pill in a different delivery system. A woman
replaces the patch each week for three weeks, followed by a period. The vaginal
ring, available a little more than a year, is inserted and worn for three weeks.
Polaneczky believes both are more effective than the pill because there's little
chance of forgetting to use them. "The pill is only as effective as the person
taking it," she said. "That's the big advantage with these new methods."

For women who don't want a monthly period, either because of endometriosis - a
disease involving the lining of the uterus - or menstrual-induced migraines or
simply to avoid the hassle, there is Barr Laboratories Seasonale, a daily
estrogen-progestin pill approved last year that will give a woman a period only
four times a year. "I don't see it as a panacea," said Morris de Celis, who said
that it has potentially more side effects because the hormones are taken
continuously for a longer period of time. But she said it is nevertheless an
option for some women.

Depo-Provera, a progesterone shot given at the doctor's office every three
months to suppress ovulation, is also popular, said Rabin, who runs the prenatal
Care Assistance Program at Long Island Jewish Medical Center. Some women
experience spotting from the shot for the first six months but many go on to
have no periods, she said. Some have problems becoming pregnant for a year or so
after stopping its use, and some studies have found that it is associated with
bone density loss, although the women regained their bone density once they
stopped using it. It has been available since 1992.

IUDs, or intrauterine devices, are also useful for the right person, doctors
agree. There are two available in the United States: ParaGard, a copper IUD,
available since 1988, and Mirena, a progesterone-releasing IUD, since 2001.
ParaGard can work for 10 years and Mirena for 5 years, Polaneczky said. But with
the Dalkon Shield-related pelvic infections and deaths of the '70s, doctors are
cautious about whom they prescribe an IUD to.

"I would recommend it to someone who is married and has had children and may not
want to have more children," said Morris de Celis. Because the IUD sets up a
mild inflammatory process, the risk of a complication from an STD is great -
another reason to ensure that the right person uses it, she said.

And in December an advisory panel recommended that the Food and Drug
Administration make the so-called morning-after pill available over the counter.
If the FDA goes along with the recommendation, a packet of two high-dose oral
contraceptives would be available without a prescription from a doctor - as it
is currently - to prevent pregnancy in cases when a woman has had unprotected
sex.

But none of these birth control methods protects a woman from a sexually
transmitted disease. Because condoms also don't always work, Polaneczky said,
her advice is to "limit your number of partners. Keep it low."

Copyright (c) 2004, Newsday, Inc.

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This article originally appeared at:
http://www.newsday.com/news/health/ny-spread13691500mar02,0,3034113.story

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