WASHINGTON, Nov. 19 (UPI) -- The Institute of Medicine called Tuesday
for a fundamental change in American attitudes toward sexuality as part
of a big effort to reduce sexually transmitted diseases.
        The United States has the highest rate of curable sexually
transmitted diseases (STDs) of any developed country, costing taxpayers
at least $10 billion a year, said a new report from the medical arm of
the National Research Council. The cost would be even higher if it
included incurable diseases like AIDS.
        ``One of the primary obstacles (to reducing the diseases) is this
country's reluctance to openly confront issues regarding sexuality and
STDs,'' said the report.
        Rates for some of the diseases are 50 to 100 times higher than those
in other industrialized nations, commented Dr. Helen Gayle, director for
the STD, HIV and TB center at Centers for Disease Control and
Prevention. She seconded the concerns described in the report and warned
that ``our future success depends on a willingness to talk directly
about conditions that were once only whispered about.''
        ``Sexually transmitted diseases were considered dirty diseases,''
said committee member Dr. Kathleen Toomey, state epidemiologist for
Georgia. ``Public attitudes haven't changed much.''
        Even her own mother asked her not tell the mother's classmates at a
school reunion that Dr. Toomey studied sexually transmitted diseases.
``If I can make my mother happy about I do, we'll have done a good job,''
she said.
        People may maintain that nice people like them don't get such
diseases, but ``the reality is sexually transmitted diseases are very 
widespread,'' Toomey said. One out of two or three Americans will catch
a sexually transmitted disease during his or her lifetime, she said.
Each year, doctors diagnose 12 million new cases.
        Studies in parts of Washington state and California, she said, have
found that one out of four female college students had a chlamydial
infection. Women often do not know they have the common infection, which
raises the risks of pelvic inflammatory disease and ectopic pregnancies.
        Out of the illnesses that must be reported to the Centers for Disease
Control and Prevention in Atlanta, five of the 10 most prevalent are
sexually transmitted, said the report.
        These diseases are ``quite prevalent among all sectors of society,''
Toomey said. She described an affluent community outside Atlanta that
has been jolted into awareness of the disease problem by an outbreak of
syphilis among 15- and 16-year-old girls.
        The United States' high rates of disease do not mean that Americans
are more promiscuous than other industrialized countries, Toomey said.
``That's simply not the case.''
        Instead she blames the high rates of U.S. disease on ``an incredible
dichotomy'' in American society that frowns on personal discussions of
sex and its consequences but allows ``a glorification of sex in the
        ``In our country, physicians are very uncomfortable with taking
sexual histories,'' she said. Her own med school education, ``the finest
in the country,'' did not mention chlamydial infections or techniques to
help patients discuss their sexual issues.
        To change the attitudes and reduce the disease rate, the committee
called for ``highly visible and strong leadership and support'' from
``both the public and private sectors.''
        The report calls for wider coverage from health plans for disease
screening. A number of plans reimburse for diagnostic tests only if
someone has symptoms, but ``in women, sexually transmitted diseases are
mostly asymptomatic until there are complications,'' Toomey said.
Letting the diseases wait until complications develop causes unnecessary
misery as well as leaving more time for people to spread the disease
        She praised a study by Group Health in Seattle that showed screening
participants for chlamydia paid for itself in reduced costs for care of
complications like pelvic inflammatory disease and ectopic pregnancies.
        This is not just an insurance issue or a government issue, said Dr.
David Satcher, director of the Centers for Disease Control and
Prevention. ``A number of players are going to have to step up to the