Why are STIs on the rise? We do a bad job of teaching about sex.

Show Caption

It’s no secret among doctors and other health-care professionals that sexually transmitted infections are on the rise in the U.S. and other countries. As a urologist, I have certainly noticed an uptick in patients coming in with STIs. 

As I recently scrolled through Twitter, however, I came across a Paste BN news article referencing a study in the New England Journal of Medicine on the preventative use of an antibiotic (doxycycline) to reduce sexually transmitted infections. 

Basically, the idea from the study is that a person could lower the chance of becoming infected with gonorrhea, chlamydia or syphilis by taking doxycycline in the first 72 hours after risky sexual contact. 

At first glance, the headline seemed promising: An already available medicine that can be taken days after a sexual encounter to help prevent infection is obviously a good thing. We definitely want less STIs circulating in the general population. 

But as I read further, I realized that people – especially non-medical professionals – may take away the wrong message from the study. 

Education is better than antibiotics to prevent STIs

In a time of such easy, inexpensive and widespread digital information sharing, why aren’t governments focusing on teaching comprehensive sexual education focused on prevention of pregnancy and sexually transmitted infections? 

Why are infections increasing in the first place? And why have we shifted away from education and prevention to treatment-based policy as a first resort? Surely our values and priorities as a global society are misaligned. It’s time to recommit to education and prevention. 

Arnold Schwarzenegger: Environmentalists are behind the times. And need to catch up fast.

Reform is critical for public safety: Police shouldn't handle mental health calls

This study on the use of the antibiotic for treatment of STIs did not emerge in a vacuum. The Centers for Disease Control recently published a preliminary report on the increase in cases from 2020-2021 (2.5 million) of sexually transmitted infections, especially syphilis and congenital syphilis (passed in-utero). 

STIs, sometimes referred to as sexually transmitted diseases, are not only a public health problem in the United States. The World Health Organization estimates that “more than 1 million sexually transmitted infections are acquired every day worldwide, the majority of which are asymptomatic.” This, in turn, causes a series of disastrous consequences such as infertility, fetal and neonatal deaths, cervical cancer, risk of contracting HIV, as well as psychological and socio-economic consequences of suffering from one of these infections.

As a urologist, I find it worrying. The approach to reduce cases should not be merely prophylactic – the use of condoms should be emphasized, since with its use cases of syphilis, gonorrhea, chlamydia and HIV are easily preventable. The population should be educated about how STIs work and how they can protect themselves and others against them. This, of course, includes abstinence. But an abstinence-based approach turns a blind eye to the reality facing us. 

Sexual education campaigns are critical, and governments need to refocus on them by using digital tools like social media, where nearly everyone can be reached easily and in a cost-effective manner.

3 reasons why using antibiotics isn't best way to prevent STIs

The prophylactic use of an antibiotic and having it available without a prescription, in my view, can cause three major problems. 

∎ The first is encouraging unprotected sexual intercourse, giving the impression that with the use of this medication after the fact, the infection will automatically be cured – so there's no need to use protection during the sexual encounter. 

∎ The second scenario is that the indiscriminate use of the drug after risky sexual behavior could result in resistance (for the patient and the general population) to the antibiotic. 

∎ With such a drug widely available, and used in this manner, people may stop getting tested for STIs and may be less inclined to see their doctor about their sexual health.

It seems that we are in an ideal time to resume massive campaigns for the prevention of sexually transmitted diseases, since we have greater access to young people through platforms such as Instagram and TikTok. As a child of the 1990s, I remember that public service campaigns were broadcast on radio and TV, at a much higher cost than would be necessary today.

We must continue to research new ways to quickly prevent and cure STIs. Nevertheless, the search for cures should not come at the expense of prevention, vaccination, detection, monitoring and comprehensive sexual education.

Dr. Marcos Del Rosario Santiago is a urologist in the Mexican Navy (Armada de Mexico), a member of the American Urological Association and a freelance writer. Follow him on Twitter: @theurologist1