Sexually Transmitted Diseases

A New Paradigm for Assessing STD Risk

Most personal health STD prevention programs focus largely on individual behavior as the basis for risk reduction. Many of these programs emphasize safer sex or abstinence from sexual intercourse as their preferred preventive approach. Public health STD prevention programs typically emphasize community health interventions such as free and confidential testing and treatment centers, needle exchange programs, and sociomarketing campaigns to promote condom distribution and family planning services. While both approaches have merit, each falls short of offering a comprehensive analysis of STD risks.

A more effective way to view STD risk is to conceptualize it as pyramidal in nature. A pyramid of risk model describes the interaction between personal and community risks and has four levels of risk factors: demographic, sexual/medical history, sexual lifestyle, and sexual behavior. Each level builds upon and is interpreted on the basis of risks associated with the previous one.

Level 1 Risks: Demographic Variables

Seven major demographic variables form the base of the pyramid and contribute to STD risk: age, gender, sexual orientation, injectable drug use (IDU), geography, socioeconomic status (SES), and race/ethnicity.

There are more cases of STDs distributed throughout the 15- to 25-year-old age group than in any other. Because more cases exist in this age group, the risk of acquiring an infection is greater for someone in this group or who has sex with persons from this age category. Sexually active teenagers have the highest rates of infection of most STDs. For example, teenage girls have the highest risk of becoming infected with gonorrhea. Rates for females in the 15- to 19-year-old age groups are 610.9 cases per 100,000 people. This is more than 5 times the national rate of 113.5 per 100,000. Young women in this age group are approximately 20 times more likely to be infected with gonorrhea than females 30 years of age and older. Young men have a similarly high risk compared to older men.

[Page 850]The risk of acquiring an STD varies by gender. Gender risks are related to the genetic, anatomical, and physiological differences between men and women. Women face a greater risk than men for both acquiring a sexually transmitted disease and developing complications for several reasons. Heterosexual women are receptive sexually—vaginally, orally, and anally. This greatly increases their risks for initial infection by exposing a greater surface area of mucosal tissue. Once infected with most STDs, heterosexual women tend to be asymptomatic more often than heterosexual men. Most heterosexual men notice initial symptoms of infection, whereas about half of women are asymptomatic. Because of the asymptomatic nature of most STDs in women, more women than men do not seek treatment during the initial stages of infection. This delayed access to treatment results in progression of the disease and a greater likelihood of developing complications. About 15 percent of women develop complications associated with gonorrhea or chlamydia, compared to less than 1 percent of men.

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