and their complications. Women are particularly vulnerable to STDs because they are more biologically susceptible to certain sexually transmitted infections than men and are more likely to have asymptomatic infections that commonly result in delayed diagnosis and treatment. Active infection with STDs during pregnancy may result in a range of serious health problems among infected infants, including severe central nervous system damage and death. Adolescents are at greatest risk of STDs because they frequently have unprotected sexual intercourse, are biologically more susceptible to infection, and are likely to have social problems that significantly increase their risk.

STDs are difficult public health problems because of the "hidden" nature of these diseases. The sociocultural taboos related to sexuality are a barrier to STD prevention efforts on a number of levels. Effective STD prevention efforts also are hampered by biological characteristics of STDs, societal problems, unbalanced mass media messages, lack of awareness, fragmentation of STD-related services, inadequate training of health care professionals, inadequate health insurance coverage and access to services, and insufficient investment in STD prevention.

Although the barriers to STD prevention are formidable, STDs can be prevented by intervening at multiple points with behavioral, biomedical, and structural interventions on both individual and community levels. These and other effective interventions, however, are not being fully implemented or utilized. Because STDs are complex diseases that are associated with a variety of social issues and involve a wide spectrum of stakeholders in the community, a collaborative, multifaceted approach to STD prevention is essential.

Conclusions and Recommendations

The committee concludes that an effective national system for STD prevention currently does not exist and, as a result, STDs are a severe health burden in the United States. Many components of the system need to be redesigned and improved through innovative approaches and closer collaborations. In addition, programs that address important gaps in the current fragmented system of services have not yet been designed and implemented. The committee's recommendations are outlined below and presented in complete detail in Chapter 6.

In formulating a strategy to prevent STDs, the committee developed the following vision statement to guide its deliberations.

An effective system of services and information that supports individuals, families, and communities in preventing STDs, including HIV infection, and ensures comprehensive, high-quality STD-related health services for all persons.

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