These are confusing times for the sexually active.
On one hand, we have the "Amazon Prime" of STD testing, making it easier (and more private) than ever to get screened. On the other, rates of STD infections are the highest they've ever been, and they're only climbing.
"STDs are certainly not going away," says Jonathan Zenilman, program director of the Johns Hopkins Center for STD Research, Prevention, and Training. "They are probably the most important infectious disease problem for people of reproductive age in terms of numbers, impact, and morbidity."
But as dire as the situation is, it's not hopeless. Zenilman, who just got back from the World Health Organization's STI and HIV World Congress, had a lot to say about what he and his fellow advocates and researchers are working on right now.
Zenilman says there's a good deal of interest in vaginal gels that change pH—not a microbicide (which kills pathogens or acts as a barrier between pathogens and cells to protect against STIs), but a substance that actually alters the pH of the vagina itself, making it more acidic and therefore creating an environment that can help prevent against infection. He explains that in women who have bacterial vaginosis, which is also increasingly resistant to antibiotics—how fun!—the pH goes up, which is seen as a risk factor for acquiring other STDs and HIV. These gels would buffer that pH.
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"There's also a lot of interesting work in vaccines," he says. His best advice for everyone—man or woman, gay or straight, sexually active or not just yet—is to get the HPV vaccine, the latest version of which, Gardasil-9, is the most effective yet. There's new research to suggest that it could prevent nearly every kind of cervical cancer. Pharmaceutical company Genocea is currently in phase three clinical trials for a herpes vaccine, which, if approved, would be the first drug of its kind and could even tame active herpes. "And I know there's been a lot of excitement about potential for a gonorrhea vaccine," Zenilman adds, "something which was thought to be very, very difficult."
He explains that after an early 2000s meningitis outbreak in New Zealand, a large number of people got a very specific meningococcal vaccine. Just last month, a study among those who got it versus those who didn't found that there was a 30 percent lower incidence of gonorrhea than in the group that did. As it turns out, the bacteria that causes meningococcal meningitis, neisseria meningitidis, is closely related to neisseria gonorrhoeae, which is—you guessed it—the bacteria that's responsible for gonorrhea.
It's not a surefire correlation, but it is cause for hope—an indirect suggestion that maybe there could be a vaccine. Zenilman says there's a good deal of interest in the study from pharmaceutical companies, and that this it's likely to be a big area of focus moving forward.
Elsewhere in maybe-we-can-stop-gonorrhea news, a study out of UCLA indicates that some people who have contracted the STI could be treatable with the antibiotic Cipro—at least in certain populations.
Using Cipro to treat gonorrhea hasn't been encouraged since 2007, when the CDC stopped recommending it due to increased resistance. But study co-author Jeffrey Klausner, a professor of medicine and public health at the UCLA David Geffen School of Medicine, explains that 80 percent of cases could be treated with the drug—if we could identify the patients for whom it would work beforehand. That's where their DNA test comes in. "We're engaged in a clinical trial with the NIH to show that the test will predict cure 100 percent of the time," Klausner explains. He says the university is 10 percent of the way through those trials.
Klausner is currently in El Salvador, helping build an infrastructure that will help the country combat STIs. And he says a promising piece of development there is that the country has 14 clinics specializing in STI treatment for "key populations," including men who have sex with men and sex workers. That's something he'd like to see more of in the United States, where there are just a handful of specialized centers in metropolitan areas like LA, Chicago, and New York. The only sex worker-specific clinics in the country are in San Francisco, Klausner tells me. "We really feel that countries that have these specialized clinics will make much faster headway in their efforts to control any STI, and in particular, drug-resistant STIs," he explains.
When fighting drug-resistant STI strains, the best way to go about treating them is to prevent their spread in the first place, and Zenilman underscores the importance of getting screened appropriately by someone who knows what they're doing. Clinics that cater to a specific population are a great way to ensure high-quality care.
Because while vaccines and DNA testing show a lot of promise, they're still in preliminary trials and are far from being standard. Zenilman explains that one barrier is that, with these types of vaccines, researchers aren't yet sure how long the effects will last. (He compares it to getting measles boosters as a kid; we know how long that vaccine keeps working, but that's not data we have for STD vaccines, and it's data we likely won't have for quite some time.)
Plus, he adds that—especially here in the US—getting them approved will be an uphill battle. There's still an enduring misconception that access to STD vaccines will cause people to have sex earlier or engage in riskier behaviors. "Whereas in reality, the research is very clear: when it comes to an adolescent's decision to have sex or not, being vaccinated or unvaccinated is low down on the list of what the drivers are," he says.
One thing we do know for sure, Zenilman says, is that better access to healthcare can slow the spread of STDs. If people don't have access to it, they're far less likely to get screened. And if 20 million or more people were to, say, lose their insurance due to some sort of healthcare reform, that could have some pretty significant implications, STD-wise.
"I think things look good. I've been doing this for a long time, and things look much more promising than they have in a very long time," Zeniman says. "Our ideal is to put ourselves out of business."
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