USDHHS, 2000). This is what most significantly separates the United States from industrialized countries that have low rates of sexually transmitted infection. (USDHHS, 2000). Even in the most intimate relationships, talking openly and comfortably about sex and sexuality is difficult for many Americans. A recent survey indicated that approximately one-fourth of married women and one-fifth of married men had no knowledge about their partner’s sexual history (EDK Associates, 1995; USDHHS, 2000). The secrecy surrounding sexuality hampers sexuality education programs for adolescents, and it discourages open discussion between parents and their children and between sex partners regarding sexually transmitted diseases. It also impedes balanced messages from mass media, health care professionals’ education and counseling activities, and community activism (IOM, 1997; USDHHS, 2000).

Sexually Transmitted Infections and Cancer

Several sexually transmitted viral infections are known or strongly suspected to cause cancer. The most important of these are the sexually transmitted types of human papilloma virus. At least 90% of the approximately 16,000 cases of cervical cancer diagnosed each year are estimated to be attributable to infection with the human papilloma virus (Morrison et al., 1997).

A strong link between hepatitis B and hepatitis C viruses and hepatocellular carcinoma (liver cancer) became evident during the 1980s. Hepatitis B infection occurs more frequently among persons who have multiple sex partners and who also have a history of sexually transmitted infection. An estimated 53,000 cases of hepatitis B virus (out of a total of 200,000– 300,000 cases) were sexually transmitted in the United States in 1994 (IOM, 1997).

Disproportionate Affliction of Sexually Transmitted Infections

Although people in all communities—including all racial, cultural, economic, and religious groups—and sexual networks are at risk for sexually transmitted infections, some are disproportionately affected by these diseases and their associated complications. For instance, not only do sexually transmitted diseases occur more frequently in women than in men, but women also suffer more serious complications (USDHHS, 2000), including pelvic inflammatory disease, ectopic pregnancy, infertility, and



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