The new study about the prevalence of STDs among teenage girls (and Kristen's subsequent STD rant) brought up a lot of questions about STDs in America, which we posed to Dr. Kate:

Em & Lo: Why do a test like this and only limit it to girls?

Dr. Kate: Unfortunately, the worst consequences of STDs only happen to women.  Men can't get PID, and their fertility isn't threatened by an STD.  So it's girls and women's health that researchers focus on.  Which of course, ignores the fact that females are getting these diseases from MEN.

Are researchers trying to find ways to test males for carrying HPV? Or is there no money for it because of some subconscious sexism (the way erectile dysfunction always seems to trump female sexual dysfunction) -- guys don't show symptoms or suffer from HPV, so it's not a priority?...

The HPV virus is a tricky one to detect.  It lives in the skin, but doesn't show up as a blister that can be cultured (like herpes), and doesn't appear in the blood (like HIV or syphilis).  And the cells in the vagina and cervix--how women get tested--are different than the cells on the penis and genital skin.  Tests for guys are in the works; though we likely won't see them for awhile, the challenge is due to lab techniques, not sexism.  I hope.

Why do you think African-American girls are more at risk?

It's likely a lot of factors.  STDs are more common in urban areas, rather than rural ones--there's more folks around to get up close and personal with.  There are also socio-economic factors at play, and poorer urban women have less access to health care in general, so fewer opportunities to get screened and treated.

How likely is it that treating the partner of diagnosed women will become standard procedure?

It's an idea that's taking root slowly.  Several states (including New York) tacitly allow for women's doctors to give prescriptions or actual tablets for the male partners.  This method is easier and cheaper (and probably more reliable) than the man having his own visit with a provider...but has the obvious risks of a doctor treating a patient without seeing him.  Doctors fear not knowing about the guy's drug allergies (though they're rare) or any serious side effects of the meds (again, not common).  

That approach would definitely save money in the long-run--if we can reduce the incidence of PID and infertility from STDs among women, everybody saves money in the end.  But politicians don't tend towards long-term thinking.  And Americans in general don't have a preventative mind-set--we're not exactly pro-active on health care (see: abstinence-only education, McDonalds, Marlboros).

The story mentioned sending reminders to subjects who participated in the exam part but didn't call in to get their results. Why would someone participate and then not call?

Total denial.  And I see it ALL the time.  It's actually difficult to track some patients down to give them their test results.  Some women are really afraid of bad news and what it means, for their health and their relationship ("If I have an STD, it means he's cheating on me").

HPV is the obvious front-runner here, so what are your thoughts on Gardasil? We went to a women's day of workshops held by a local Planned Parenthood chapter and when we asked the registered nurse covering the topic of birth controls and STD protection what she thought of Gardasil, she said she wouldn't give it to her daughter  because it was too new and the long term effects weren't known yet....?

I'm a huge Gardasil fan.  It's the first chance we've had to actually prevent cancer with a vaccine.  And I'd rather protect my daughters from the real, known risks of cancer, than withhold the vaccine for theoretical risks.  I want to vaccinate my stepson, age 11, as soon as the studies of boys are finished!

How do you convince young people, who already think they're invincible, to get tested when they have no symptoms?

I try to stress keeping my patients' insides as beautiful and strong as their outsides.  And I discuss how they may not want kids now, but I want to make sure that they CAN become moms if they want to in the future.  I also joke that I test them for all STDs because I don't know where their partners have been--they can have complete trust in him, but it's my job to not trust their boyfriend.   

Have you seen a waning in young people's dedication to using protection every time, and if so, do you think it's a result of AIDS not making headline news everyday (and scaring the shit out of everybody) the way it did in the 80s or of abstinence-only education not preparing kids for the realities of sex?

Honestly, kids seem as clueless as ever around sex and STDs.  Most are becoming active before ever hearing anything in school or from another reputable source.  And my adolescent and young adult patients don't read the headlines, anyway--if it's not blogged about, or on YouTube, it's not happening.  Maybe we need safe sex announcements on MySpace....