Expert Sees Epidemic of Sexual Diseases

The United States is experiencing an epidemic of sexually transmitted diseases increasingly concentrated among the urban poor--an ominous development in light of evidence that such diseases may encourage the spread of AIDS, an expert said Thursday.

Dr. King K. Holmes, speaking at the fifth International Conference on AIDS, attributed the significant rise of diseases like syphilis, gonorrhea and chancroid in inner cities to poverty, the practice of exchanging sex for crack cocaine, and a maldistribution of public health resources.

Increasing the Risk

“It is increasingly apparent that the inner cities of North America are more and more resembling the cities of developing countries,” said Holmes, a University of Washington professor. He urged a new emphasis on diagnosis and treatment--activities he conceded many cities may be unable to afford.

Recent research suggests that genital ulcers of the kind caused by diseases like herpes and syphilis may increase one’s likelihood of catching and spreading the human immunodeficiency virus (HIV). Researchers are also exploring whether sexually transmitted diseases that do not cause ulcers have any effect on the spread of AIDS.

Among the trends in sexually transmitted diseases during the AIDS era cited by Holmes:

- The incidence of syphilis among blacks tripled between 1985 and 1988. Holmes said the rate among black women in 1988 was 50 times higher than among white women.

- The number of babies reported born with syphilis rose from 150 in 1983 to nearly 700 in 1988, Holmes said. He noted that that number is higher than the number of babies reported to have been born with AIDS, which he said rose from 105 in 1985 to 449 in 1988.

- The total number of cases of chancroid, a venereal disease that causes genital ulcers, in the United States rose from 665 in 1984 to 4,800 in 1988--more than a sevenfold rise.

- The rate of gonorrhea, declining steadily in whites, began rising among blacks in 1985. In 1988, the rate was 21 times higher among black women than among white women.

“Thus the face of gonorrhea in the United States today, like that of syphilis and chancroid, is characterized by epidemic or hyper-epidemic spread within core groups,” Holmes said. The victims tend to be poor, young and black or Latino, often with multiple sexual partners and drug habits.

Holmes traced the shifting patterns in part to the rising percentage of blacks and Latinos living in poverty in inner cities. He also blamed a lack of public health resources, which has forced clinics to cut back their hours and turn away increasing numbers of patients.

Diverted Resources

At the same time, resources during the AIDS epidemic have been diverted from sexually transmitted disease programs to AIDS education and patient counseling, Holmes said. Those activities have been focused largely on white gay men and the general population, he said.

“Does it make any sense at all to increase contact-tracing and improve health-seeking behavior when clinics are already turning patients away?” asked Holmes, who added that more money should be put into expanding clinic services. “The last thing we can allow to happen today is continued epidemic spread of those diseases which have been implicated as risk factors for transmission of HIV.”