Roundups Sexual Health

Sexual Health Roundup: New Mexico Health Official Fired for Condom Stance and Vatican Criticizes Nun for Views on Masturbation

Martha Kempner

New Mexico's Chief Medical Officer is fired hours after suggesting condoms could prevent STIs among the state's teenagers; the United Kingdom sees an increase in STIs after the government pulls funding for social marketing campaigns; and the Vatican takes aim at a nun who believes masturbation, same-sex behavior, and same-sex marriage is okay.

New Mexico Health Official Fired Hours After Advocating for Condoms, Coincidence?

In a television interview at the end of May, New Mexico’s Chief Medical Officer Erin Bouquin was asked about the rising rates of gonorrhea and Chlamydia which are up 50 percent among teenagers in the state. Dr. Bouquin replied by saying that she advocates for an “ABC approach — Abstain, Be Faithful, and Use Condoms.”  She explained: “Condoms are very, very important in controlling sexually transmitted diseases.” An hour later she was summoned to the office of Catherine Torres, the Secretary of the Department of Health and asked to resign. 

Both the department and the governor’s office maintain that the interview had nothing to do with her departure arguing that Bouquin was considered a probationary employee because she had only been on the job for four months, that she had “not met the expectations of the governor,” and that her resignation was part of a larger reorganization of the department.

Bouquin sees it differently, saying: “On the day I was asked to leave, I said the word condom three times on the news.” She believes that her comments conflicted with the direction that the health department and the governor are taking toward STI prevention and sex education. She said the department is becoming more political and notes that it recently applied for funding under the resurrected federal Title V abstinence-only-until-marriage grant program.

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The governor’s office replied to allegations by saying:

“the governor is a proponent of taking a balanced and multi-pronged approach to controlling the spread of sexually transmitted diseases; there is nothing in Dr. Bouquin’s interview that would conflict with that approach.”

We may never know the real reason she was let go but it would not be surprising if a public health official were dismissed for advocating condom use for teens — many adults and certainly many politicians would prefer to pretend teens have no needs for condoms.

STIs on the Rise in the United Kingdom

The United Kingdom is seeing a major rise in Sexually Transmitted Infections (STIs). The Health Protection Agency’s (HPA’s) annual report, released last week, found a two percent increase in newly diagnosed cases of STIs from 2010 to 2011 with a total of 427,000 new cases. This reverses a small decline that had been seen in previous years. Cases of Gonorrhea rose by a whopping 25 percent from 16,835 cases in 2010 to 20,065 cases in 2011. Cases of syphilis were up ten percent, genital herpes five percent, and genital warts one percent.

The only STI that saw a decline was Chlamydia; newly-diagnosed cases of this infection dropped two percent. However, public health professionals believe that this is due to a drop in Chlamydia screening and not a true drop in the number of people who became infected.  Undiagnosed Chlamydia is a serious problem because if left untreated it can lead to Pelvic Inflammatory Disease (PID) and infertility.

The increase in STIs is particularly notable in young heterosexual individuals and men who have sex with men. Over half of all STIs diagnosed in 2011 (57 percent) were among young people under 25. Health officials say this is a direct result of young people not using condoms. The largest rise in new diagnoses in 2011, however, was among men who have sex with men. In this population, gonorrhea increased by 61 percent, Chlamydia by 48 percent, and syphilis by 28 percent. Dr. Gwen Hughs, the head of STI surveillance for the HPA said:

“The data in young, heterosexual people and MSM is very concerning. Too many people are practising unsafe sex…. We think it is crucial that work to reduce STIs continues with a focus on at-risk groups.”

Many in the U.K. suggest that the government’s recent cut in funding for social marketing campaigns is behind these new numbers. According to the Guardian:

“When the coalition government came to power, it temporarily froze all spending on social marketing, although funding for campaigns such as the anti-obesity drive Change4Life has resumed. The onus under the health reforms will now be on local authorities, who will be expected to champion the public health initiatives needed in their own area.”

Experts fear that this cut in campaigns has meant that fewer people are now aware of the risk of STIs. Two sexual health charities in the U.K. issued a statement saying these numbers demonstrate:

“exactly why safer sex messages and campaigns that young people and gay men will listen to and take action on, are absolutely necessary. Testing and treatment services are vital, but alone they are not enough to change people’s behaviour.”

Vatican Takes Aim at a Popular Book by an American Nun

In April, the Vatican issued a scathing report criticizing American nuns. The report investigated the Leadership Conference of Women Religious an organization that represents about 80 percent of the 57,000 nuns in the United States. It declared that the organization had “serious doctrinal problems” and promoted “radical feminists themes incompatible with the Catholic faith.” Many were outraged by this and noted that these nuns (whose median age is 74) had dedicated their lives to helping the sick and the poor.  The public outcry seems not to have stopped Vatican which took aim today at one nun who authored a popular book about sexuality.

Sister Margaret A. Farley is a member of the Sisters of Mercy, a professor emeritus of Christian ethics at Yale University, and the author of Just Love, a Framework for Christian Sexual Ethics. Since it was published in 2007, the book was hailed by the Jesuit order’s weekly magazine as “an important message in a time in which sexual abuse and violence are rampant and the Catholic Church has failed to protect children from sexual exploitation.” It also received the 2008 Louisville Grawemeyer Award for books on religion.

The Vatican, however, has a different opinion of the book. Its Congregation for the Doctrine of the Faith issued a “notification” in which it criticized Farley saying her writing showed a “defective understanding of the objective nature of natural moral law.” It went on to ban the use of her book in Catholic education. Specifically the Congregation objects to what Farley writes about masturbation, same-sex sexual behavior, and gay marriage.

For example, Farley writes that masturbation (especially for women) “usually does not raise any moral questions at all” and that it “actually serves relationships rather than hindering them.” This contradicts the Church’s view that masturbation is “an intrinsically and gravely disordered action.” She also writes that “same-sex oriented persons as well as their activities can and should be respected.” The Vatican, in contrast, stated in its notification that homosexual tendencies are not sinful but homosexual acts are “intrinsically disordered (and) contrary to the natural law.”

In the end, the Vatican says that Farley’s views, which include believing that acknowledging same-sex marriage would help end stigma against gays and lesbians, “are in direct contradiction with Catholic teaching in the field of sexual morality.”

It will be interesting to see how the public reacts to this latest criticism of a nun and to see who the Vatican targets next.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

Commentary Sexual Health

Fewer Teens Are Having Sex, But Don’t Pop the Champagne Yet

Martha Kempner

The number of teens having sex may be less important than the number having protected sex. And according to recent data from the Centers for Disease Control and Prevention, condom use is dropping among young people.

Every two years, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health (CDC-DASH) surveys high school students to gauge how often they engage in perceived risky behaviors. The national Youth Risk Behavior Surveillance (YRBS) is wide ranging: It asks about violence, guns, alcohol, drugs, seat belts, bicycle safety, and nutrition. It also asks questions about “sexual intercourse” (which it doesn’t define as a specific act) and sexual behaviors.

Started in 1991, this long-running study can provide both a picture of what high school students are doing right now and a historical perspective of how things have changed. But for more than a decade, the story it has told about sexual risk has been the virtually the same. Risk behaviors continually declined between 1991 and 2001, with fewer high school students having sex and more of them using condoms and contraception. But after the first 10 years, there has been little change in youth sexual risk behaviors. And, with each new release of almost unchanging data, I’ve reminded us that no news isn’t necessarily good news.

This year, there is news and it looks good—at least on the surface. The survey showed some significant changes between 2013 and 2015; fewer kids have ever had sex, are currently sexually active, or became sexually active at a young age. More teens are relying on IUDs and implants, which are virtually error-proof in preventing pregnancy.

In 2015, 41 percent of high school students reported ever having had sexual intercourse compared to 47 percent in 2013. The researchers say this is a statistically significant decrease, which adds to the decreases seen since 1991, when 54 percent of teens reported ever having had sexual intercourse.

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Another change is in the percentage of students who had sex for the first time before age 13. In 2015, 4 percent of high school students reported this compared to almost 6 percent in 2013. This is down from a full 10 percent in 1991. As for number of overall partners, that is down as well, with only 12 percent of students reporting four or more partners during their lifetime compared to 15 percent in 2013 and 19 percent in 1991. Finally, the percentage of students who are currently sexually active also decreased significantly between 2013 (34 percent) and 2015 (30 percent).

These are all positive developments. Delaying sex can often help prevent (at least temporarily) the risk of pregnancy or STIs. Having fewer partners, especially fewer concurrent partners, is frequently important for reducing STI risk. And those teens who are not currently having sex are not currently at risk for those things.

While I want to congratulate all teens who took fewer risks this year, I’m not ready to celebrate those statistics alone—because the number of teens having sex is less important to me than the percentage of teens having sex that is protected from both pregnancy and sexually transmitted infections. And that number is lower than it once was.

Among sexually active teens, there were no significant positive changes in measures of safer sex other than an increase in the number of sexually active high school students using the IUD or implant (up to 4 percent from 2 percent in 2013).

Moreover, some results indicate that today’s teens are using less protection than those who were teens a decade ago. The most telling finding might be the percentage of teens who used no method of contraception the last time they had sex. This decreased between 1991 and 2007 (from 17 percent to 12 percent), inched up to 14 percent in 2013, and stayed the same in 2015 (14 percent). There was also little to no change in the percentage of high school students who say that either they or their partner used birth control pills between 2013 (19 percent) and 2015 (18 percent) or those who say they used the contraceptive shot, patch, or ring (5 percent in 2013 and 2015).

For me, however, the most distressing finding is the backward progress we continue to see in condom use. The prevalence of high school students who used a condom at last sex went up from 45 percent in 1991 to 63 percent in 2003. But then it started to drop. In 2015, only 57 percent of sexually active high school students used condoms the last time they had sex, less than in 2013, when 59 percent said they used condoms.

It’s not surprising that teens use condoms less frequently than they did a decade ago. In the 1990s, the HIV epidemic was still front and center, and condoms were heavily promoted as a way to avoid infection. As this threat waned—thanks to treatment advances that now also serve as prevention—discussions of the importance of condoms diminished as well. The rise of abstinence-only-until-marriage programs may have also affected condom use, because these programs often include misinformation suggesting condoms are unreliable at best.

Unfortunately, some of the negative messages about condoms inadvertently came from public health experts themselves, whether they were promoting emergency contraception with ads that said “oops, the condom broke”; encouraging the development of new condoms with articles suggesting that current condoms are no fun; or focusing on teen pregnancy and the use of highly effective contraceptive methods such as long-acting reversible contraceptives (LARC). The end result is that condoms have been undersold to today’s teenagers.

We have to turn these condom trends around, because despite the decreases in sexual activity, young people continue to contract STIs at an alarming rate. In 2014, for example, there were nearly 950,000 reported cases of chlamydia among young people ages 15 to 24. In fact, young people in this age group represented 66 percent of all reported chlamydia cases. Similarly, in 2014, young women ages 15 to 19 had the second-highest rate of gonorrhea infection of any age group (400 cases per 100,000 women in the age group), exceeded only by those 20 to 24 (489 cases per 100,000 women).

While we can be pleased that fewer young people are having sex right now, we can’t fool ourselves into believing that this is enough or that our prevention messages are truly working. We should certainly praise teens for taking fewer risks and use this survey as a reminder that teens can and do make good decisions. But while we’re shaking a young person’s hand, we should be slipping a condom into it. Because someday soon (before high school ends, for more than half of them), that teenager will have sex—and when they do, they need to protect themselves from both pregnancy and STIs.