Young People Carry Disproportionate Burden Of Sexually Transmitted Infections

The Health Protection Agency has reported a 6% increase in the total number of new sexually transmitted infections (STIs) diagnosed in 2007 compared to 2006.
To coincide with the launch of the Agency’s fifth Annual Report and Accounts, figures are released today showing that across all age groups almost 400,000 (397,990) new STIs were diagnosed in UK genitourinary medicine (GUM) clinics in 2007 – an increase from 375,843 in 2006.
The greatest burden continues to fall among young people (aged 16 to 24 years), who are disproportionately affected by STIs.
While just one in eight of the population are aged 16 to 24 years old, this age group accounts for around half of all newly diagnosed STIs in the UK – 65% of all chlamydia (79,557 of 121,986), 55% of all genital warts (49,250 of 89,838) and 50% of gonorrhoea (9,410 of 18,710) infections diagnosed in GUM clinics last year.
The Health Protection Agency, in its latest publication on sexually transmitted infections and young people, is advising that:
* All sexually active young people are screened for chlamydia annually and every time they change their sexual partner. Chlamydia, which can have no symptoms, remains the most common sexually transmitted infection.
* All gay men should take an HIV test annually and each time they believe themselves to have been at risk of infection.
* People can reduce their risk of catching an STI by having fewer sexual partners and avoiding overlapping sexual relationships.
* Everybody should use a condom with a new sexual partner and continue to do so until they have both been screened.
Professor Peter Borriello, Director of the Agency’s Centre for Infections, said:
“The number of people being tested for STIs has risen considerably over the past five years, giving us a better insight into the sexual health of the nation. More than one million sexual health screens were carried out in 2007 – a 10% increase on the previous year and one of the reasons why we have seen an increase in the number of diagnoses
“This increase in testing, together with the decrease we have seen in waiting times for GUM services, ensuring prompt treatment of infections, will help to reduce risk of transmission and the development of complications. If sustained this could have a significant impact on the control of sexually transmitted infections.
“However, we cannot rely on prompt diagnosis and treatment alone – a shift in behaviour is the only way that we will bring down this continued increase in infections.
“Substantial numbers of young people remain undiagnosed, untreated and unaware of the risk they pose both to their own health and that of their sexual partner.
“It is crucial that young people continue to be exposed to messages about safe sex, including condom wearing, and the importance of getting checked out at their nearest GUM clinic if they have had unprotected sex with a new partner.”
New HIV diagnoses in young people remain relatively low compared to older age groups (702 new diagnoses in 2007) although this is still almost three times the number recorded in 1998 (258 diagnoses).
Among young gay men, there has been a substantial increase in the number diagnosed with a STI over the past decade, with more than a doubling of HIV diagnoses between 1998 (128) and 2007 (281) and almost a tripling of gonorrhoea diagnoses (339 to 1001).
The National Chlamydia Screening Programme in England, which offers sexually active young people screening for chlamydia and undertakes sexual health activities mainly in the community setting, performed 270,729 screens in 2007 (January to December), a 93% increase on the 140,157 screens performed in 2006. 9.5% of young women and 8.4% of young men tested positive for chlamydia. This resulted in 24,236 chlamydia diagnoses in under 25 year olds.
Justin McCracken, Chief Executive of the Health Protection Agency, said:
“Monitoring of STIs and other infectious diseases forms only one part of the Agency’s work in safeguarding the UK’s public health. Our fifth annual report illustrates the many other areas in which the Agency has made significant progress in protecting people’s health over the last year.
“The Health Protection Agency brings together an exceptionally wide range of skills and experience across the entire public health protection spectrum.
“Firmly embedded at the heart of health protection locally, regionally, nationally and internationally, the Agency is in a unique position to champion public health and help to protect people from radiation, chemical and infectious diseases hazards.
“We are committed to building on the achievements of the first five years of the Agency’s development to create an expert body that is widely recognised as authoritative and effective at protecting the health of the public through helping reduce the burden of infectious disease, including sexually transmitted infections.”

New Drug Udenafil for Erectile Dysfunction in US Trials

A potential addition to the treatment options for erectile dysfunction (ED) is entering Phase III trials in the United States. Udenafil, a new long-acting drug under development for ED, will be evaluated in 80 sites throughout the country.
Erectile dysfunction, an inability to achieve or sustain an erection suitable for sexual intercourse, affects approximately 18 million men in the United States. Current drug treatment options for this condition now include a category of drugs called phosphodiesterase type 5 (PDE-5) inhibitors. These drugs are Cialis® (tadalafil), Levitra® (vardenafil), and Viagra® (sildenafil). Udenafil is also a PDE-5 inhibitor.
Dong-A PharmTech Co. Ltd, announced that its US partner, Warner Chilcott plc, has started two Phase III trials for the new PDE-5 drug. The randomized, double-blind, placebo-controlled trials will enroll approximately 1,120 subjects who have erectile dysfunction. Dong-A PharmTech hopes to complete these Phase III trials as well as other trials in the European Union and other major markets within two years. The pharmaceutical company also plans to initiate Phase 2b clinical trials that will evaluate the safety and efficacy of udenafil for treatment of benign prostatic hyperplasia and pulmonary arterial hypertension.
According to a clinical practice guideline issued by the American College of Physicians in an October 19, 2009 news release regarding treatment of ED, clinicians are urged to use PDE-5 drugs for men with erectile dysfunction unless they are taking nitrates.
A comparison among the different PDE-5 drugs, according to the ACP news release, indicates that “the evidence is insufficient to compare the effectiveness or adverse effects of different PDE-5 inhibitors for the treatment of ED because there were only a few head-to-head trials,” noted guideline lead author Dr. Amir Qaseem, who is also senior medical associate with the ACP.
Udenafil was approved for treatment of erectile dysfunction in Korea in November 2005 under the trade name Zydena®. The drug was also approved for marketing in Russia in July 2008. If udenafil is approved in the United States, it will compete with Cialis, Levitra, and Viagra for treatment of erectile dysfunction. According to an analysis by the American College of Physicians of 130 studies that evaluated PDE-5 inhibitors alone or in combination, treatment with the currently available drugs resulted in statistically significant and clinically relevant improvements in sexual and erectile function in men with ED, regardless of the cause (e.g., depression, diabetes, prostate cancer).