Duffy* was baffled by the bumps. Suddenly appearing around
her vagina, they looked innocent and harmless enough:
small, round, white, and soft to the touch. But they tingled
and itched, so shortly after finding them, she shut the
bedroom door of her off-campus apartment and called home
hoping for help. When her mother couldn't peg the cause
of the problem, Duffy dashed to the health clinic at her
East Coast college.
"After the doctor examined
me, she said, 'My God! You have genital warts!' in the
most offended voice possible," Duffy remembers. "She
didn't offer any advice. She didn't offer any information.
She responded with complete disgust. I was shocked as
I sat in her office, and I cried when I went home. Being
told you have an STD is bad enough. But my doctor offered
me no compassion or help whatsoever."
At the time, Duffy was
20 years old and had had less than a handful of sexual
partners. Now 31 and a graduate student at the University
of California, Berkeley, she has learned to live with
the threat of recurring genital warts and with the incurable
but treatable human papillomavirus (HPV) that causes
them. But, like the millions of women in this country
who have sexually transmitted infections-and the millions
more who are at risk for them--she's still waiting for
adequate and comprehensive care when it comes to her
According to the Kaiser
Family Foundation (KFF), a nonprofit organization that
tracks health care policy, 15.3 million STDs are contracted
annually in this country. The U.S. has the highest infection
rates of any industrialized nation. Every year, STDs
cost more than $8.4 billion in treatment. Experts say
we could slash this expense (and eliminate untold pain
and suffering) if we pledged to take one simple step:
provide effective screening and treatment during medical
"Many women don't know
what they're getting when they go in for a gynecological
exam," says Dr. Lisa Gilbert, director of the women's
health program for the American Social Health Association
(ASHA), a nonprofit organization devoted to STD education.
"They don't realize that a Pap smear detects changes
in cervical cells without testing for any specific diseases.
They don't realize that practically every STD requires
a separate diagnostic. Because they don't understand
the difference between a Pap smear, a pelvic check,
and an STD test, they walk away thinking they've had
all their STD tests when, in reality, they've had none."
for common STDs include cervical swabs for chlamydia
and trichomoniasis, follow-up testing of abnormal Paps
for HPV, and blood tests for herpes, HIV, and hepatitis
B. Patients don't realize they're not getting these
tests, and doctors aren't coming out and telling them.
Recent surveys show that this silence is widespread.
KFF found that 40 percent of women aren't asked about
their sexual histories on pre-exam questionnaires. And
according to the Commonwealth Fund, 84 percent of women
and 72 percent of teenage girls hadn't discussed STDs
with their doctors in the year preceding the survey.
Why do so many patients
fall through the cracks? Experts point to a lack of
public awareness. People fail to grasp the fact that
STDs are a real threat: transmitted through oral sex
as well as intercourse, lurking in the systems of the
mutually monogamous, and often asymptomatic or unnoticeable
(which is the case with chlamydia, herpes, and HIV).
People don't learn how to best protect themselves: condoms
and dental dams are the most effective methods, followed
by diaphragms, cervical caps, or spermicides. According
to a KFF study, 74 percent of men and 69 percent of
women who are of reproductive age seriously underestimate
the prevalence of STDs, guessing that one in ten Americans
will become infected during his or her life. Although
one in ten seems scary, the truth is even more alarming:
the real number is one in four. Says Tina Hoff, director
of public health information for KFF, "People seem to
believe that it just can't happen to them. There is
such denial that it's really astounding."