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WETZSTEIN: STD exams needed early

- The Washington Times - Tuesday, December 1, 2009

A prominent medical group recently suggested that American teenage girls and college-age women avoid getting gynecological exams for cervical cancer until they turn 21.

This is because "women less than 21 years old are at very low risk of cancer," said Dr. Gerald F. Joseph Jr., president of the American College of Obstetricians and Gynecologists. Screening these young women and recommending they get Pap smears "may lead to unnecessary and harmful evaluation and treatment," he said.

I hate to second-guess this esteemed group, but when one in four U.S. teenage girls has a sexually transmitted disease (STD), the advice seems odd to me.

I would think medical professionals would urge every American woman who is single and sexually active to run, not walk, to a doctor's office every few months for a genital checkup. This goes double for teens and college-age girls.

Why? Because (a) there's a strong likelihood such women will acquire a sexually transmitted infection, and (b) because the most commonly reported STD usually doesn't have warning symptoms, and a woman can lose her ability to conceive a baby before she knows it.

Seeing a doctor and getting regular testing is a single sexually active woman's only hope of keeping herself healthy. (Married people whose spouses cheat are at risk for STDs, too, but that's another day's topic.)

How big is America's STD problem?

Well, everyone's worried about swine flu these days, and rightly so. The Centers for Disease Control and Prevention (CDC) recently reported that swine flu has sickened 22 million Americans and led to 4,000 deaths.

But the CDC also estimates that Americans contract 19 million STD cases every year and that almost half are in people younger than 24.

Adults don't die of herpes, of course, but each year about 4,000 women lose their lives to cervical cancer, which is caused by HPV infection, and another 11,000 Americans die from AIDS.

Here's the scarier number: In addition to the millions of new STD cases each year, an estimated 65 million Americans are "living with" incurable infections, such as herpes, HPV, hepatitis B or HIV/AIDS.

Getting regular genital exams is just prudent these days - and with chlamydia cases reported at a record 1.2 million, there's no time to delay.

Chlamydia is curable with antibiotics, said Susan Maloney of the National Chlamydia Coalition. The chlamydia test is easy to do (just a vaginal swab); some doctors are starting to ask women getting Pap smears whether they would like a chlamydia test too.

Of course, if no woman younger than 21 is getting a Pap, the natural opportunity to give her a chlamydia test evaporates too.

My concern is that while it takes years, even decades, for HPV infections to develop into cervical cancer, chlamydia is a fairly fast-moving infection and within months can lead to pelvic inflammatory disease (PID).

No one knows how long it takes for PID to infect and severely scar a woman, but even if it's a year, that's not very long, especially for girls who pick up chlamydia infections in high school. They could be infertile by the time they graduate, not unlike a young woman I know who learned at age 19 that, because of infections in her reproductive tract, she will not be able to conceive a child.

Sexually active young women should ask their doctors for a chlamydia test whether they "feel anything or not," Ms. Maloney said.

Fred Wyand at the American Social Health Association added: Health care providers, please tell young female patients that "even though I'm not seeing you for your Pap maybe until age 21, I still need to talk with you about these other things."

Cheryl Wetzstein can be reached at

cwetzstein@washingtontimes.com.