Introduction

Sexually Transmitted Diseases are a substantialpublic health problem and remain a critical public health concern in America. This is despite it being largely preventable. According to Healthy People 2020, Sexually Transmitted Diseases refer to at least 25 infectious organisms which are spread predominantly via sexual contact.  The most common of these are human immunodeficiency virus, chlamydia infection, hepatitis B, gonorrhea, syphilis, trichomoniasis, genital herpes and chancroid. This diverse collection of infections is groped together because sexual contact is one of their major methods of transmission. Major chronic sequelae of STDs include genital and other cancers, reproductive health problems, pregnancy related problems including transmission to offspring, and a variety of other complications related to chronic infections such as chronic liver disease, acquired immune deficiency syndrome and tertiary syphilis.

Healthy People 2020 recognize the criticality of STD’s and has taken various steps; policy and medical; to ensure that the rates of new infections are minimized, while current infections are addressed to ensure a health American society that is free from sexually transmitted disease. These efforts will go a long way in ensuring that the health bill of the American is reduced and more people are productive in terms of work productivity and engagement in economic activities.

History of STDs

Sexually Transmitted Diseases were long ago recognized as being spread by sexual contact, and where therefore referred to as “VenerealDiseases.” Syphilis is the earliest of STDs to be identified and peoplewho were found to be infected were spurned. Up until the 1960s, only gonorrheaand syphilis formed the only STDs known. In the early 1970s,chlamydia tranchomatis became known as being the causal factor of urethritis, cervicitis, and PID. In the 1980s, HSV-2 became epidemic and was incorrectly thought to be the etiological cause for cancer of the cervix. It is also in the 1980s that the AIDs Virus was identified with the human immunodeficiency virus being identified as the etiological agent. Since the 1980, other forms of STDs have continually been identified and various steps taken by the Center for Disease Control and Prevention taking steps towards addressing these infections.

Statistics on STDs

According to the world health organization, every day, more than 1 million people acquire an STD and 500 million people become infected with one of the STDs(World Health Organization, 2013). According to healthy people 2020 statistics, it is estimated that in the United States, 19 million new cases of STDs are reported annually. Half of the cases occur in young people between the ages of 15 to 24. 1.1 million American citizens are infected with the HIV virus, and 1 out of 5 persons infected with HIV are not aware that they are infected (Healthy People 2020, 2014).

The Center for Disease Control and Preventionadds that chlamydia is the most common STD with 1,401,906 new cases reported in 2013, the rate translating to 446.6 infections per 100,000 persons. However, theCDC notes that the 2013 chlamydia rates represent a decrease of 1.5% relative to 2012.Gonorrhea is the second most rampant STD with 333,004 casesreported in 2013, representing 106.1 infections per 100,000. Overall this represented a 0.6% decrease in new gonorrhea rates.These decreases in infections can be attributed to the various preventive initiatives that were undertaken to address STDs infections. On the other hand, Syphilis,both the primary and secondary strains, had 17,375 reported cases in 2013 representing a 10% increase. While, congenital Syphilis had a 4% increase in new reported cases since 2012. However, it is worth noting that the increase was only among men, in particular bisexuals and gay men.The Center for Disease Control and Prevention (2014) notes that most cases of STDs are among young men and women between the ages of 15 to 24 years. This meant that most people within this age group are sexually active, do not use protection, and they also do not seek medical attention, hence the spread of STDs among people of this age group. Itis therefore critical that health efforts are directed towards people of these ages if new cases of STDs are to be reduced.

Current Prevention Efforts

With the increasing new rates of STD infections, Healthy People 2020 has outlinedprevention efforts that are meant to reduce the prevalence of Sexually Transmitted Diseases in the United States. The prevention efforts include: the initiation of a sexually transmitted diseases treatment guidelines that provides a framework of how cases of STD are to be handled; initiation of a gonorrhea screening initiative of men and women at low risk; use of quadrivalent HPV vaccine in males; screening of syphilis for non-pregnant persons; and the creation of a clinical guide for sexually transmitted infections counselling. Current prevention efforts have also included the use of expedited partner therapy, and increased public education on sexually transmitted diseases.

Another key STD prevention effort that is being undertaken by CDC division of STD prevention is the STD Assessment, Assurance, Policy Development, and Prevention Strategies (STD AAPPS), which provides funding for various states to decrease the burden and long term health effects of sexually transmitted diseases. This program has been coupled with the STD-Related Reproductive Health, Prevention, Training, and Technical Assistance Centers program, which is a network of centers that provide STD-related reproductive health, prevention, training and technical assistance to various American states with the aim of strengthening program management and delivery of STD services and improvement of reproductive-health-related STD services.

Future Goals for Prevention.

Healthy People 2020 has set in place various objectives that are meant to address health issues that are related to sexually transmitted diseases. The objectives include: reduction of new and current cases of chlamydia tranchomatis infections among adolescents and young adults between the ages of 15-24; increase the number of sexually active young adults enrolled in Medicaid plans screening program;  reduce the prevalence of gonorrhea among young adults; reduce domestic spread of secondary and primary syphilis. Other objectives of healthy people 2020 with regards to addressing STDs include reducing the proportion of women with HPV infections, and reduction of the number of people between the ages of 15 to 24 with genital herpes infection due to herpes simplex.

The future goals of preventionof STDs has two components: Technical and Advocacy. The technical strategy concerns itself with channels to encourage healthy sexual behavior, effective and accessible care for stis, protective barrier methods, as well as upgrading of monitoring and evaluation of STI control programs. This strategy concentrates on a public health approach based on sound scientific evidence and cost-effectiveness. The advocacy strategy aims at mobilizing high-level political commitment that forms the foundation for an accelerated response.

Nurses Role in Education and Prevention

In the United States, STDsrates have reached epidemic levels and they represent high cost to the health care system. Healthcare providers, especially nurses see clients on a variety of acute and community setting and this places them in an opportune position to lead the fight againstSTDs.They have a unique opportunity to discuss STDs and their prevention. It is therefore important that nurses remain up to date with regards to knowledge on each of the diseases.  They need to take the front line in evaluating the community and their clients risk of acquiring STDs and come up with particular preventive techniques to the individual needs.

Nurses play an integral role in identifying and preventing STDs. They have a unique opportunity to educate the public about this serious public health issue by communicating the methods of transmission and symptoms associated with each condition, tracking the updated CDC treatment guidelines, and offering clients strategic preventive measures to reduce the spread of STDs. Regardless of the challenges to prevention of STDs, nurses must continue to educate and to meet the needs of all women to promote their sexual health. Successful teaching approaches include giving clear, accurate messages that are age-appropriate and culturally sensitive(Hoeman, 2008).

To prevent the spread of STDs, it is not enough to screen for and treat infections; community nurses also need to be able to help individuals change their behavior by counseling about how to prevent infections and reinfections. Screening and treating infection are effective for a current infection, but unless individuals can be helped to change their behavior, they may continue to behave in ways that put them at risk for further infections.Some of the roles that nurses can play in the prevention of STDs include: increasing the seeking of appropriate health care; improving patients’ adherence to medication and cooperation with efforts to notify their partners of possible infection; reducing the rate of partner change; and lowering the number of sex partners (Thomas, Schubert, & Hitchcock, 2003). A nurse also has a role in increasing the consistent and correct condom use in their patients, as well as offer effective counseling interventions that are targeted at behavior change (Blue & Ivanov, 2008).

Community programs/ organizations/ support groups

Community support is essential for the development of public health initiatives. They play a critical role in informing, educating, and empowering communities. Mobilization of community partnerships is integral to public health. One of the most obvious impacts of STD control programs is the shift towards increasing collaborations between community-based organizations and local public health agencies. Community based organizationshave become key in defining how STDs are controlled. The empowerment of community-based organizations has been an STD prevention strategy, and their value is increasingly being recognized and felt, thereby, increasing the role they play in the community (Smith & Maurer, 2012).

In addition to collaborations with community groups, many STD control programs have community advisory boards and community partners group that advice and shape STD control policy and programs. Some programs require that community-based committees review educational and promotional materials to assure that the images and messages are appropriate for the target community. This involvement of community members on advisory boards, planning groups, review committees in STD control programs is meant to ensure that STD prevention strategies are able to meet the needs of the community, and in extent reduce STD cases.

Conclusion

STDs form a huge component of the federal budget bill. This coupled with the loss in individual productivity implies that the overall economic loss that is attributable to STDs is overwhelming. It is therefore imperative that efforts towards reducing the current prevalence of STDs while additional efforts are channeled towards ensuring no new infections are reported. This can be achieved through increased public education and prevention efforts that can be led by community nurses who have first-hand access to the community and infected persons.

References

Blue, C., & Ivanov, L. L. (2008). Public Health Nursing: Policy, Politics & Practice. Cengage Learning.

Center for Disease Control and Prevention. (2014). Reported STDs in the United States: 2013 Fact Sheet. Center for Disease Control and Prevention.

Healthy People 2020. (2014). Sexually Transmitted Diseases. Retrieved 2015, from Healthy People 2020: http://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases

Hoeman, S. P. (2008). Rehabilitation Nursing: Prevention, Intervention, and Outcomes (illustrated ed.). Elsevier Health Sciences.

Smith, C. M., & Maurer, A. F. (2012). Community/Public Health Nursing Practice: Health for Families and Populations. Elsevier Health Sciences.

Thomas, S. A., Schubert, P. E., & Hitchcock, J. E. (2003). Community Health Nursing: Caring in Action, Volume 1. Cengage Learning.

World Health Organization. (2013, November). WHO Fact Sheet on Sexually Transmitted Diseases (STIs). Retrieved March 2015, from World Health Organization: http://www.who.int/mediacentre/factsheets/fs110/en/

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