Study: STDs Go Undiagnosed, Untreated

If you are a sexually active adult who has not been recently tested for gonorrhea or chlamydia, there is a chance that you may be carrying one of these diseases without knowing it.

In a study of 579 adults aged 18 to 35 years living in Baltimore, Md., researchers found that nearly one in 12 people (7.9 percent) in this age group was infected with either gonorrhea or chlamydia; 5.3 percent had untreated gonorrhea infections while 3.0 percent had chlamydia.

Left untreated, these infections can cause serious complications that can lead to infertility in both sexes.

The study, in this week's Journal of the American Medical Association, reports that most of the people who were carrying the infections were unaware that they had the diseases because they did not experience the characteristic disease symptoms.

For example, among the carriers, only 2 percent reported burning during urination and 4.7 percent reported discharge.

"A lot of folks have said that Baltimore has some rather unique issues in terms of STD rates and socio-economics," says Dr. Peter Leone, assistant professor of medicine in the division of infectious disease at the University of North Carolina, Chapel Hill and co-author of the study. "But I do think it still raises the question about how [often] these diseases [go undiagnosed] in the general population."

A Nationwide Problem?

Approximately 650,000 people in the United States are infected with gonorrhea each year, according to the Centers for Disease Control and Prevention.

The rates for chlamydia are much higher, and in 1997 only one-sixth of the estimated three million cases of chlamydia were reported. Experts say this is most likely due to underreporting based on a lack of symptoms.

"I think it is safe to anticipate that all urban areas have substantial rates of undetected gonorrhea or chlamydia," says Dr. Dennis Fortenberry, author of an accompanying editorial and associate professor of pediatrics and medicine at the Indiana University School of Medicine in Indianapolis.

It has been known that anywhere from one-half to three-quarters of chlamydia infections can occur without noticeable symptoms, but experts say that prior to this study, this was not thought to be true of gonorrhea.

"The view has always been that the majority of gonorrhea out and about wasn't asymptomatic," says Leone. However, in the current study, it was.

Symptom Free? Experts Say Screen Anyway

Experts say that the findings of this study stress the importance of routine screening.

"[The people with untreated STDs] didn't really fit into what we would consider to be high-risk groups of individuals where we typically find diseases," adds Leone. "It really implies that for a person's well-being, if they're sexually active, they may really need to consider getting an annual test."

The test used in this study allows STD detection using a urine sample, which may even pave the way for home testing, rather than the traditional method of obtaining swab samples from the inside of the vagina or penis which requires a full medical examination.

However, Leone acknowledges that cost may be a deterring factor against more widespread testing. The technology used in the current study, while more convenient, is three to five times more expensive than previous tests used to detect these STDs.

Yet other experts say that ultimately this research could be used to help determine the efficacy of gonorrhea and chlamydia prevention programs, which may save money in the long run.

"On the one hand it costs money to do this kind of screening," says Dr. Marvin Bittner, an infectious disease experts and associate professor at Creighton University School of Medicine in Omaha, Neb. "On the other hand, if you don't stop to evaluate how well your program is working, you might be wasting a lot of money." Of course, experts say that practicing safer sex by using a condom with every sexual encounter will go a long way toward preventing infection and spread of disease.