healthcare providers

ASHA Board member Edward W. Hook, III, MD, offers his thoughts on a national campaign to promote sexual health and encourage patients and providers to discuss this important health topic.

It is my belief that transition from a disease focused orientation for sexually transmitted infection (STI) control efforts to a sexual health-based perspective would ultimately lead to improved STI control through both permissive encouragement of improved health care seeking by persons at risk for STI, through improved diagnosis of STI by clinicians and through enhanced STI screening as the stigma surrounding STIs dissipates.

People should not have to enter into sexual relationships with a fear that to do so might lead to untoward effects such as transmission of infection to a loved one (including children born to infected mothers), disease and life-course altering disease complications (infertility, ectopic pregnancy, malignancy, the Acquired Immunodeficiency Syndrome, etc), or with fear of judgment by others as somehow being unclean and socially unacceptable.

Studies showing the remarkably widespread prevalence of viral STIs such as human papillomavirus or herpes simplex infections, or that 1 in 4 U.S. adolescents can be expected to have an STI, clearly demonstrate that STIs are widespread throughout the population and not “someone else’s” problem. Further, the long intervals which often separate STI incidence which tends to occur early in a person’s sexual life course from a diagnosis of the consequences of these infections (AIDS, cervical cancer, infertility are among the obvious examples) further serve to remind us that promotion of sexual health will not only serve the nation’s health needs but will also help to prevent disproportionate penalization of persons who have made youthful errors in judgment as they relate to STD risk far later in their lives.

A national campaign based on sexual health rather than one focused on disease would allow for institution of educational programs incorporating sexual health as one element of health promotion.

STI clinicians and thought leaders within the field of STD could also do much to begin to shift consideration of their efforts from disease-related to health promoting considerations. For instance, by measuring STIs treated rather than diagnosed, they would be in a position to celebrate having taken steps to prevent possible unintended transmission to others, to state that the treatment may have also reduced their clients’ risk for complications and the consequences of STI. Such an approach would also make it easier to encourage persons with STIs to extend the benefits of diagnosis and treatment to their sexual partners, thereby addressing another important element of STI control efforts. To do so would be a useful, readily accomplished step towards making the job of STI control more effective and more easily accepted.

The changes suggest above would not come simply, but in my opinion, might contribute ultimately to lasting improvement in STI control, a widely shared goal by all participants in STI management efforts at all levels.

-Edward W. Hook, III, MD