California State Assembly Health Committee's Informational Hearing on

California's Sexually Transmitted Disease Epidemic: Causes, Costs, and Control

February 19, 2008

Agenda

Background

The Hidden STD Epidemic Among California Youth

Testimony provided by Norman A. Constantine, Ph.D., on behalf of the Public Health Institute

Good afternoon Chair Dymally and committee members.

I am Dr. Norman Constantine, a senior scientist with the Public Health Institute, and clinical professor of community health at the UC Berkeley School of Public Health. I direct a research program at the Public Health Institute to study policies and outcomes related to adolescent sexual health in California, especially the prevention of teenage pregnancy and sexually transmitted diseases.

Everyone should have a copy of our most recently published study, which estimates the number of new cases of the eight major STDs among California youth aged 15-24 years, and the medical costs of treating these newly acquired infections. This study is summarized in the one-page handout I’ve provided.

Although 15- to 24-year-olds represent only a quarter of the sexually active population, they acquire more than half of all new STDs every year. STDs are not just inconvenient, they can lead to considerable and long-lasting impacts on the health and quality of life of individuals, including infertility, cancer, and increased susceptibility to HIV.

In this study we used rigorous statistical methods developed at the Centers for Disease Control and Prevention to conduct two analyses. First, we estimated the number of new cases of eight major STDs among 15-24-year-olds in California in 2005. Estimation methods were necessary because most newly acquired infections are not reported to the state’s department of public health. Second, we estimated the medical costs of these new cases.

What we found was that the number of newly acquired STDs among young people in just one year exceeded one million cases -- ten times higher than previously documented.

Over 80% of the estimated new cases involved the three STDs that are not reportable: genital herpes, trichomoniasis, and HPV.

The most commonly used marker for tracking STDs is the number of new cases reported to local health departments. However, as was reinforced by our study (and nationally by the CDC study), the number of new infections reported every year substantially underestimates the true number.

Each year these million newly acquired infections carry an estimated medical cost exceeding 1.1 billion dollars. (Compare this to the $10 million budget of the state’s STD Control Branch.)

Of the total medical costs, HIV accounted for 51%, whereas genital herpes, HPV and trichomoniasis, combined, accounted for 46%.

Despite the progress that has been made over the last decade in screening, detecting, and treating STDs, especially among young people, major obstacles remain, as is evidenced by the stunningly high number and cost of newly acquired infections every year, and the upward trend in the rate of infections among young people as well as adults.

California is already a national beacon for effective teen pregnancy prevention programs and policy. Since 1991, we have led the nation in reducing our teen birth rate. STDs among young people, unfortunately, are a different story. The rate of newly acquired STDs across the United States is high, and increasing every year. California is no exception.

Many STDs initially have no symptoms. Without symptoms, an infection can be diagnosed only through testing, yet most at-risk individuals do not engage in routine testing.

We must do better to raise awareness and to educate the public about prevention, transmission, diagnosis, and treatment of STDs. A greater emphasis is needed on primary prevention, such as comprehensive sex education efforts, as well as screening and monitoring among young people and adults.

We have an epidemic on our hands, one that is largely hidden.

On behalf of the Public Health Institute, I respectfully urge you to give your full attention to efforts on the prevention and control of STDs. Thank you for this opportunity to present our research.

References

Jerman, P., Constantine, N. A. & Nevarez, C. R. (2007). STDs among California youth: Estimated incidence and cost, 2005. California Journal of Health Promotion, 5, 80-91.

Weinstock H, Berman S, Cates W, Jr. (2004). Sexually transmitted diseases among American youth: Incidence and prevalence estimates. Perspectives on Sexual and Reproductive Health, 36, 6-10.

Chesson HW, Blandford JM, Gift TL, et al. (2004). The estimated direct medical cost of sexually transmitted diseases among American youth. Perspectives on Sexual and Reproductive Health 36, 11-19.