by S. Todd Stolp MD
©March 2009
Based upon the high quality education bestowed upon us by the endless stream of crime scene investigation mysteries on television, we learn that one of the first lessons for those trying to catch crooks is to think like the criminal. If the suspect is a sailor, stake out the marina. Similarly, when considering how to best find the culprit in an infectious disease, it is helpful to think like the virus or bacteria in question. What would I do if I were an STI?
Consider what characteristics can lead a germ to end up on the “Ten Most Wanted” list. First, it is important to recognize that germs are much more likely to create an epidemic if they avoid calling attention to themselves and do not kill their host. When an illness announces its arrival with large red spots on the face or causes life-threatening symptoms, it can hardly avoid being discovered and arrested.
Similarly, an organism that kills its host is destroying its own meal ticket. Sometimes this strategy works, but only when the victim showers the environment with germs as the illness progresses.
Causing an infection which allows the victim to go about his or her business while being attracted to and expressing affection for others is an ideal way to guarantee success as a germ. This is the successful strategy employed by the mononucleosis virus which is also known as the “kissing disease.”
Another germ that takes advantage of this tactic is the Chlamydia bacteria, the most commonly reported infectious disease to health departments in California. Chlamydia is a sexually transmitted infection (STI) which usually causes very few symptoms. Chlamydia may cause burning with urination in males or females, or crampy pain and mucous discharge from the vagina in females. The devastating inflammation that it stirs up in the female organs is the most common cause of female infertility in the U.S. By causing inflammation in the genital tract, Chlamydia also increases the likelihood that other infections like HIV/AIDS can be transmitted.
For a germ to be successful, it must procure a means of transportation that is dependable. West Nile Virus found just such a transportation system in the mosquito population. What better way to assure a trip from host to host than to hitchhike on a vehicle as readily available as mosquitoes in the summer?
The most dependable way to avoid becoming a victim of the germs that cause STIs is to abstain from sexual contact. Conveying this message to those confused by the discovery of new attractions is, of course, the full time occupation of the parents of adolescents. From the perspective of the STI, depending upon the gravitational forces that from time to time develop between two human beings is as reliable a method of transmission as there is.
In people who are sexually active, condoms have been shown to reduce the transmission of infection, although different studies have found that the risk of infection is diminished differently for different infectious organisms. Also, the amount of protection afforded by condoms is very dependent upon proper condom use. Because reading the package insert is not often a priority at the moment of passion, it is important to learn such things ahead of time.
A second way to prevent STIs from inflicting permanent damage upon the population is to test for the presence of the germs in any person who is sexually active. This can be done at the time of a routine physical, at the time of a visit to the family planning clinic, or in response to symptoms experienced by a patient. The test can now be done for the two most common STI germs, Chlamydia and Gonorrhea, simply by collecting a urine specimen.
Another way to protect the public from the effects of STIs is to vaccinate against the Human Papilloma Virus (HPV). The new HPV vaccine provides protection against four strains of the HPV virus that are responsible for 70% of cervical cancer. We screen for cancer of the cervix with the Pap Smear obtained every three years after age 21. After 30 years of age, women should personalize their cervical cancer screening recommendations by discussing it with their health care providers. The HPV vaccine consists of a series of three doses given after nine years of age.
The surest way to decrease the discovery of crime is to stop looking for criminals and ignore the existence of misconduct. Infectious organisms would love for the health care system to give up on screening the population for STIs and stop encouraging the use of condoms for people who choose to be sexually active. Unfortunately, such a course will not make these villains go away.