Since 2009, when a Japanese prostitute visited a clinic in Kyoto with a case of gonorrhea that proved resistant to ceftriaxone – the last remaining antibiotic effective against it – the World Health Organization has been terrified that we are on the cusp of another sexually transmitted epidemic.
“We’re on our last line of defense,” said Colorado Department of Public Health and Environment’s Dr. Mary Mattson, section chief for sexually transmitted disease and surveillance.
Mattson said that while most U.S. cases of drug-resistant gonorrhea have so far been clustered in Hawaii and California, (with none so far reported in Colorado) and concentrated among gay males, it could easily jump into the heterosexual population, as HIV did 30 years ago.
After chlamydia, gonorrhea is the second most common sexually transmitted disease in the country, with 100 million cases estimated worldwide. In Colorado, 75 percent of gonorrhea infections are in 15- to 29-year-olds, Mattson said. In fact, the frequency of gonorrhea among this population is twice the national average, causing public-health officials to raise newly urgent questions about the effectiveness of sex education in our public schools.
Durango School District 9-R uses the “Safer Choices” curriculum for its sex education, which is offered to middle school students and freshmen with parents’ consent. District spokeswoman Julie Popp said the curriculum is “highly renowned, and has actually been shown to change student behaviors.”
In studies, students who were taught Safer Choices – which states abstinence is safest and provides information about contraception – were more likely to use condoms in vaginal intercourse than those who did not receive Safer Choices instruction. It does not address the risks of disease transmission posed by unprotected oral and anal sex.
Nationwide, the percentage of teenagers who ever had vaginal intercourse has declined and condom use has increased, according to the U.S. Department of Health and Human Services.
Public-health officials said the problem with the Safer Choices approach is that it has had little effect on the rate of sexually transmitted infections, particularly among teenagers 15–19 and young adults ages 20-24, because such programs do not explain the high risk of disease transmission through unprotected oral and anal sex, which many see as a safe alternative to vaginal intercourse.
According to the Centers for Disease Control and Prevention, about half of teenagers have experienced oral sex, including 25 percent who have never had vaginal intercourse.
The result is that current adolescent sexual practice makes both girls and boys much more likely to contract drug-resistant gonorrhea, which is exponentially more contagious than HIV.
Students complained that Safer Choices was insufficiently frank about the risks and range of students’ modern sexual practices.
Hank Searfus, a junior at Durango High School, said Safer Choices wasn’t “very informative.”
“It’s not very in depth, and it isn’t adequate for the changing world we live in,” he said.
Another junior who declined to be identified said the curriculum “stayed away from controversial topics.”
Dr. Doug Kirby, senior research scientist at ETA Associates, which runs the Safer Choices program, said the program may have become dated because it does not address changing sexual behavior among youth, nor did its architects anticipate the emergence of a strain of gonorrhea resistant to antibiotics.
Both Ignacio School District and the Bayfield School District use teachers from Planned Parenthood to educate students with the consent of parents.
Bayfield High School’s health and science teacher, Dwight Windsor, said the curriculum was “pretty blunt, but you have to be. It’s not preachy or condescending, It doesn’t take a side on it. It talks about abstinence a lot, contraceptives.”
He said the curriculum directly addressed the risk of disease posed by unprotected oral and anal sex.
District 9-R spokeswoman Popp said instructors from Planned Parenthood used to deliver lectures to Durango students based on the Safer Choices curriculum, until four years ago, when the district decided its own personnel should teach students Safer Choices.
A winnable battle
The prospect of an incurable strain of gonorrhea is terrifying: Symptoms, when they occur, can be excruciating, and it causes both men and women to become much more susceptible to HIV. In some cases, gonorrhea enters the blood stream, infecting the joints, skin, heart valves and brain. It can cause infertility in men and woman and can be transmitted to a fetus in the womb.
The risk makes nuanced sexual education imperative, said Mattson. She called gonorrhea “one of our winnable battles.”
But winning would require that sex-education curricula across the state be updated to address the actual sexual behavior of young people, she said.
If drug-resistant gonorrhea spreads the way epidemiologists expect it to, programs like Safer Choices won’t be safe at all.