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MGH Cox 5
55 Fruit Street, Boston
T, Th, F: 8:30 - 11:00 a.m.
W: 1-3 p.m.

Chelsea Health Center
151 Everett Avenue, Chelsea
T: 1:30- 3:30 p.m.
Th: 3-6 p.m.

Sexually transmitted diseases
Early detection still key to beating the odds

Merilin Castillo, 18, has the next phase of her life pretty much set. She plans to enter Harvard College in the fall to study U.S. history and social science.

At the moment other matters hold her interest — sex. But not the way it sounds. Actually, it’s sex education. Castillo realized that, while she had access to accurate sex information at Milton Academy, many of her peers in the Boston Public Schools (BPS), were not so privileged.

“That’s a health equity issue,” she said. “Not only is it not OK, it’s not fair.”

What’s worse, the incidence of teenage pregnancies and STDs is much higher among teens of color, which make up the majority of high school students in the BPS. “They [the statistics] are about our community,” she explained. “We are the target people.”

In its most current analysis the Centers for Disease Control and Prevention (CDC) finds that more than 19 million new cases of STDs are diagnosed every year in the United States. The CDC estimates that these infections cost the U.S. health care system $17 billion every year.

The impact of STDs is measured in more than just dollars. Untreated infections can result in sterilization in both females and males. Syphilis can lead to neurologic and cardiovascular problems. HIV, the virus that causes AIDS, and the human papillomavirus (HPV), which causes cervical cancer, can be deadly. Pregnant women often pass STDs on to their babies before, during or even after birth, depending on the particular infection.

Though all 50 states mandate reporting of several STDs, providers can report only what they identify. Many infections are silent and go undetected and untreated. In addition, the CDC estimates that only 38 percent of sexually active females aged 25 and younger get screened yearly for chlamydia as suggested, further reducing the accuracy rate of reporting.

Cases of chlamydia are steadily increasing nationwide. When in 2011 the rate of infection in Massachusetts escalated significantly, the Commonwealth, like several other states, invoked the Expedited Partner Therapy (EPT) rule. EPT allows certain health providers to offer prescriptions or medications for each sexual partner of infected patients. The rule allows partners to receive treatment without first seeing a provider.

Merilin Castillo (right) is pictured with Abigail Ortiz at the premier of the film “Sex in School: Does Ignorance Keep us Safe?” Students from the Hyde Square Task Force produced the film. (Lightchaser Photography)
African Americans are hit hard by STDs. Though blacks constitute 14 percent of the U.S. population, they account for more than one third of all reported chlamydia cases, almost half of all cases of syphilis and almost three-fourths of the reported gonorrhea cases.

Many reasons for this disparity are offered, including lack of insurance or access to health care. More probable is the lack of awareness and understanding of the prevalence of STDs and their long-term consequences.

Dr. Alexy D. Arauz Boudreau is a pediatrician at MGH Chelsea, a community health center affiliated with Massachusetts General Hospital. She sees more than her fair share of patients with STDs in her practice. “It’s a very large issue,” she explained. “More attention should be focused on them.”

Boudreau stated that she actually goes beyond the recommended STD screening guidelines of the CDC. Typically she tests teens every six months and screens regardless of gender.

Fortunately, testing has become simplified and painless, especially for chlamydia and gonorrhea. A few drops of urine are enough to make a diagnosis.

More important, Boudreau counsels her patients about safe sex. The main message is on prevention — even before sex begins. What she tries to guard against is impulsiveness. “Think about it before you act,” she advises. “Prepare in advance. Have a conversation with your partner, so they’re more informed.”

Castillo is doing more than her part in spreading the message. She and a group of her cohorts from Hyde Square Task Force and Southern Jamaica Plain Health Center decided to get the word out to teens in a way they could best understand.

They made a video called “Sex in School: Does Ignorance Keep us Safe?” which premiered at the Connolly Library in Jamaica Plain.

In one scene, a young couple realizes they have the house to themselves and their thoughts turn to more amorous activities. A knock on the door disrupts their plans. The intruder is “Chlamydia” who warns the couple of the dangers of engaging in sex without the use of condoms.

Castillo laughed as she explained that the group decided not to make chlamydia — one of the most common STDs among females under the age of 26 — less abstract. “We wanted her to be more ‘in your face,’ ” she explained.

Like most teens, Castillo admitted she did not ask her parents about STDs. “I was too embarrassed,” she said.

Alexy D. Arauz Boudreau
M.D., M.P.H.
Associate Director
Multicultural Affairs Office
Massachusetts General Hospital
And that’s the problem. Young people often do not have enough information about STDs to make informed decisions about sexual behavior.

Since adolescents are the typical victim of many STDs, and may lack awareness of the extent of the problem, schools are potentially a good source of information.

According to the Guttmacher Institute, a nonprofit organization that focuses on sexual and reproductive health, provision of sex education is inconsistent across the country. Only 21 states and the District of Columbia mandate sex education, while 12 additional states require HIV education only. Twenty-six states require that abstinence be stressed.

Yet, high school students should be targeted early. The 2009 Youth Risk Behavioral Surveillance found that nationwide, almost half of high school students reported that they have already had sexual intercourse, and the percentage increases with the grade.

By the time the students reached their senior year, more than 62 percent had been sexually active. The report indicated that almost 6 percent of students had sexual intercourse for the first time before the age of 13.

Most disconcerting about sexual behavior in teens is that almost half admitted that they had not used a condom during their last sexual intercourse and 22 percent had drunk alcohol or used drugs before their last encounter — all examples of risky behavior that can lead to STDs.

Despite their prevalence, many STDs are not only treatable, they are curable. Infections that are caused by bacteria — chlamydia, gonorrhea and syphilis, to name a few — are easily cured with antibiotics. A vaccination is available that protects against the majority of cases of cervical cancer and genital warts.

Of course the fool-proof method is total abstinence. Fool-proof — yes — but not practical for many. Fortunately, it is not necessary to live a celibate life to remain STD-free. Latex condoms, if used consistently and correctly, can prevent most STDs. Some infections, such as HPV, however, can be transmitted through skin-to-skin contact.

In addition, regular screening for STDs is key. The CDC recommends that sexually active women 25 and under as well as older women with new or multiple partners be screened every year for chlamydia. Yearly tests for gonorrhea are advised for women with new or multiple partners.

Sex in School: Does Ignorance Keep us Safe?

Courtesy of Hyde Square Task Force
Pregnant women and men who have sex with men (MSM) should be screened for syphilis, HIV, chlamydia, hepatitis B and gonorrhea. MSM who have multiple or anonymous partners should be screened more frequently.

CDC further recommends that all adults and adolescents be tested for HIV. Those at high risk, such as injection drug users or persons who exchange sex for money or drugs, should be screened for HIV at least annually.

Boudreau laments that most teens find out about STDs from friends and she advises parents that talking about sex is not a license to participate. It’s only to let them know and understand.

And that’s what Castillo and her group of zealots wanted — knowledge.

The group packed City Hall last year to pressure the BPS to offer comprehensive sex education that includes information on STDs and unwanted pregnancies. Apparently, that worked. According to Castillo, the BPS in response opened six health resource centers in high schools, which offer one-on-one counseling and distribution of condoms. The plan is to expand these centers to all BPS high schools within the next few years.

“If sex education is not offered,” said Castillo, “kids will continue to rely on folk tales.”