United Press International - August 1, 2003
Katrina Woznicki, UPI Science News

A national team of researchers led by Dr. Kimberly Yarnall, associate clinical professor at the department of community and family medicine at Duke University Medical Center in Durham, N.C., surveyed 1,210 women by telephone. The women were sexually active, unmarried, not pregnant, heterosexual and between the ages of 18 to 25. Some were college-educated and others were not.

Yarnall's team asked the women about lifestyle behaviors such as binge drinking, condom use, vaginal sexual history, prior sexually transmitted disease history, such as chlamydia, syphilis, gonorrhea, genital herpes -- a viral disease that lasts the remainder of life -- and human papillomavirus, which causes cervical cancer. Survey participants also were asked about their perceived risks of contracting STDs from their sexual partners.

Both groups -- college-educated and non-college alike -- reported the same rates of unprotected sex in the previous three months. More than 75 percent of all the women surveyed said they considered themselves at low-risk for acquiring STDs in the coming year.

"We didn't ask why they didn't think they were at risk," Yarnall told United Press International. "People don't get worried about STDs because not too many people die of syphilis or gonorrhea. I think they're more concerned about not getting pregnant than not getting an STD. I think they feel you can just treat (an STD) and it's no big deal."

Women in both groups who were taking oral contraceptives also were less likely to use condoms, the researchers report in the August 2003 issue of Preventive Medicine. Yarnall said among both groups, women were less likely to use condoms if they were older, white, on birth control pills or had sexual partners who did not regard condoms as important. Among the non-student women, Yarnall said binge drinking was associated significantly with unprotected sex, a finding not seen among the students. College students often have access to educational programs about the dangers of binge drinking, while non-students typically do not.

The college students appeared to be more careful about their sexual activity.

"The non-college students had more risky behaviors," Yarnall said. The non-students were just as likely to have unprotected sex with a boyfriend or steady sexual partner as they were with someone they had just met at a party or bar. The college students were less likely to have unprotected sex with someone they had just met. Both groups scored poorly in protecting themselves, with many women in the survey thinking they did not have to worry about STDs when they were involved in a monogamous relationship, even if that relationship included a partner with an extensive sexual history.

"I think what women use to make them feel safe is serial monogamy," Yarnall said. "If you're monogamous with a string of men, there's really no difference risk-wise than having them all at once."

STDs not only can cause cervical cancer, but it also can cause pelvic inflammatory disease and impair fertility. Men and women carrying the bacterium or viruses behind STDs may not know it because many of these illnesses remain dormant, sometimes for years.

"People don't understand the concept that people can be infected with no symptoms," Dr. Katherine Stone, a medical epidemiologist in the division of sexually transmitted disease prevention at the Centers for Disease Control and Prevention in Atlanta, told UPI. "Say if they have a new boyfriend or sex partner and they are truly faithful, one of them could have been infected in the beginning before the relationship. The reason women may have a flippant attitude is that they may not know how incredibly common these infections are."

The CDC estimates, as of 2001, for men and women combined there were 781,000 cases of chlamydia, more than 361,000 cases of gonorrhea, and 6,100 cases of syphilis. Another 20 million carry HPV. The CDC also estimates 45 million people over age 12 have genital herpes, although the agency said there are no definitive data because people with the condition can be asymptomatic for lengthy periods of time. Also, cases are grossly underreported because many people are not aware they carry infection.

Women are more vulnerable to STD infection than men. The tissue lining the vagina is more pliable and porous, like the tissue lining the inside of the mouth, Stone explained. The tissue on the outside of the penis is tougher and less porous, like the tissue on the hands. Another problem is seminal fluid carrying any infection can remain two to three days inside a woman's body after sexual intercourse, Stone said.

Dr. Jeffrey Waldman, medical director of Planned Parenthood of Shasta Diablo, Calif. said public health advocates are circulating the message warning young women of STD risk and how to protect themselves. Waldman said he thinks there is a lapse between individuals who say they are getting the message and what they actually do privately in the bedroom.

"I think there's a disconnect in their perception," Waldman told UPI. "That's where I think the problem is." A youthful, insouciant attitude that "STDs won't happen to me," might be at the root of why young people are not practicing safe sex, he explained.

"When we give out oral contraceptives or any other hormonal contraceptives, patients are specifically told these do not protect you from STDs," he said.

Also, "I think people do have a false sense of security from the fact they say they're monogamous."

Dr. Yvonne S. Thornton, vice chair of obstetrics and gynecology at Jamaica Hospital Medical Center in New York, and author of the book "Woman to Woman: A Leading Gynecologist Tells You All You Need to Know About Your Body and Your Health," said the media gratuitously shows highly glamorized sexual material without ramifications for sexual behavior, such as contracting an STD.

"Any sort of weekly (media) program that involves men, women, what have you, there are no consequences," Thornton told UPI. "No one really dies of STDs.

There aren't the visualizing disturbing images that were once in the media," during the 1980s AIDS scare, she explained, when television and print showed images of gaunt AIDS patient dying.

"We have a false reality," Thornton said. "This is the logic or illogic that young women go through. (Women think) why should I go through the extra convenience of putting on a condom or asking someone about their sexual history?"

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