[Congressional Record Volume 144, Number 124 (Thursday, September 17, 1998)]
[House]
[Pages H8022-H8025]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           SEXUALLY TRANSMITTED DISEASE: EPIDEMIC IN THE U.S.

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentleman from Oklahoma (Mr. Coburn) is recognized 
for 60 minutes as the designee of the majority leader.
  Mr. COBURN. Mr. Speaker, tonight I am going to be talking about a 
subject that is rarely talked about from this chamber, and one of the 
reasons I am doing so is because the Federal agencies that have been 
charged with this duty have failed in their duty.
  In the time that I take to talk about these issues, what will happen 
is in the next hour, 1,300 people in this country will contract a 
sexually transmitted disease. Mr. Speaker, 500 of those people will 
never be cured of that disease. In the next hour, 30,000 Americans will 
be exposed to a sexually transmitted disease, and in the next 24 hours, 
30,000 Americans will actually contract a sexually transmitted disease, 
of which 12,000 will be entirely incurable.
  What we have today in our country is an epidemic of sexually 
transmitted diseases that is covered up, that is not talked about, that 
nobody wants to know the information about. This knowledge is valuable. 
It is powerful for us as parents, as a Nation, to see the consequences 
of the sexual revolution of my generation of the 1970s.
  So we are going to be talking about sexual health today. We are going 
to be exploring the past, we are going to be talking about preserving 
the future, and we are going to talk about how we do that. How we do 
that with our children, how we do that in terms of our relationships.
  Today, as I mentioned, 32,000 people are going to become infected. 
Mr. Speaker, 370,000 Americans have died of AIDS since this epidemic 
started, and 2,700 teenagers between the ages of 15 and 19 will become 
pregnant in the next 24 hours. That is 1 girl every 31 seconds.
  The most common sexually transmitted disease, human papillomavirus, 
causes almost every bit of cervical cancer in this country. Women die 
routinely from this disease. Is it treatable? Yes. Will one ever lose 
the virus that causes this disease? No.
  It is important for us to recognize that there has been a historical 
trend and growth in this epidemic. In 1960, syphilis and gonorrhea were 
the only major sexually transmitted diseases that were counted and 
recognized as contributing to this malady. In 1976 I was in medical 
school, and our professors laughed at the Swedes when they said 
chlamydia was a sexually transmitted disease.
  What we know today is it is the number 1 sexually transmitted disease 
that is caused by a bacteria. In 1981 AIDS was identified and HIV was 
identified. In 1982, genital herpes became more common. One of 5 
Americans between 15 and 74 years of age in our country today is 
carrying genital herpes. Genital herpes is incurable. It is not 
preventable if one in fact is exposed to the virus.
  In 1992, what we saw statistically was pelvic inflammatory disease. 
One million women in the United States experienced an infection in 
their abdomen and reproductive organs secondary to sexually transmitted 
disease, and over 200,000 teenagers are now annually diagnosed with 
this disease.
  Pelvic inflammatory disease. What is it? It is when these organisms 
invade and not only infect and harbor the reproductive tract, but cause 
damage and grow and are irreversible in terms of their damage. We can 
cure and treat pelvic inflammatory disease, but the scar tissue that is 
left there leads to infertility and pelvic pain which is the number 1 
reason, the number 1 reason, pelvic pain is the number 1 reason why we 
have hysterectomies in this country.
  In 1997, 8 new sexually transmitted pathogens have been identified 
since 1980, including HIV. Actually that is 9, because hepatitis C now 
infects 4 million Americans, 4 million Americans. There are 4 times as 
many people infected with hepatitis C as there are infected with HIV in 
our land. Twenty-one percent of those cases are transmitted sexually. 
The outcome from hepatisis C is one either gets a liver transplant or 
one dies, one or the other. That is the long-term consequences of 
hepatitis C.

                              {time}  2130

  There are now 25 significant sexually transmitted diseases. There 
will be 12 million Americans that get a new sexually transmitted 
disease this year.
  Some people may say as they hear me talk about this that this is the 
opinion of one physician. That is not true. My colleagues will see on 
all of these charts and everything that I have referenced either the 
Institute of Medicine, the National Institute of Health, the CDC, the 
American Medical Association, the Journal of the American Medical 
Association. These are not opinions. Those are absolute facts of where 
we stand with an epidemic today.
  Two-thirds of all the sexually transmitted disease infections occur 
in people under 25. So if there is 12 million a year and we think of 
our population of being 260 million of which only 45 million to 50 
million are under 25, what does that tell us? That we have a large 
percentage of people under 25 that are carrying a sexually transmitted 
disease.
  Eighty-seven percent of all reportable communicable diseases in the 
U.S. are caused by chlamydia, gonorrhea, HIV, syphilis and hepatitis B.
  The largest sexually transmitted disease, human papillomavirus has 
not even been asked to be reported by the

[[Page H8023]]

Center for Disease Control, the virus that is incurable, that causes 
cervical cancer, causes cancer of the reproductive organs of men as 
well is not a reportable disease.
  Genital herpes. What has happened? What we have seen is these 
diseases are infecting a lot more people today than they ever have in 
the past. From 1976 to 1994, 30 percent more Americans across ethnic 
groups are infected with herpes today than were just 15 years ago. 
There has been a 500 percent increase in the number of white teenagers 
infected in the past 15 years.
  When we break it out and look at it by categories, by race, by 
socioeconomic background, what we see is this is going across all 
trends, all classes, all socioeconomic backgrounds, and all races in 
our society.
  What is important for us to learn as a Nation is to dispel a lot of 
the safe sex messages that are out there. It is not safe to have 
indiscriminate sex in this country regardless of what message others 
might say. I hope that my colleagues will see as we go through this 
tonight why that is so.
  This chart is extremely important. Sexually transmitted diseases are 
broken down into those that are viral, a virus like a common cold 
virus, that type of organism, or a bacteria, or something somewhat in 
between, which chlamydia happens to be.
  On viral sexually transmitted diseases, there is no cure. We cannot 
eliminate it from the body. We have no ability to kill the virus. We 
can treat the virus. We can slow down the virus, but we cannot kill the 
virus. Condoms are somewhat effective. They are more so effective for 
some; and those will be HIV, hepatitis B and hepatitis C. But on herpes 
what we know now is essentially condoms are not effective.
  On human papillomavirus, the number one virally sexually transmitted 
disease today, we know that condoms are hardly effective at all. But 
that message is not out there. There are good studies that show that.
  We also know with human papillomavirus that, if you are infected with 
it and you are pregnant, the amniotic fluid around the baby has the 
virus in it. We also can culture many times this same virus in a 
newborn child born to a mother who has this virus. So not only is this 
a sexually transmitted disease, it is a disease that is transferred 
from mother to child.
  If my colleagues look over on the other side, and they look at 
chlamydia and gonorrhea, what they see is we can fix it. We have got 
great antibiotics. We can solve that infection. But the damage that 
those organisms do to the reproductive track we cannot solve without 
eliminating those reproductive organs.
  Condoms are fairly effective in chlamydia and gonorrhea, but they are 
not 100 percent effective. Once you get infected, then it will require 
treatment, and there will be consequences of that infection. There are 
others that we will not go into.
  One other point that I would like to make is how are they contracted. 
If my colleagues look at this first group, body fluid contact. The 
other is direct contact. You have to have direct contact with these to 
become infected. Yet, at the same time, we talked about the 
ineffectiveness of condoms even though you have to have direct body 
contact. That is because this virus is not just in the reproductive 
organs, and so, therefore, it can be transmitted regardless of condom 
or not.
  Chlamydia. Eighty-five percent of women who are infected with 
chlamydia have no symptoms whatsoever. And 40 percent of men who have 
this bacterial sexually transmitted disease are asymptomatic. Chlamydia 
is the most common nonviral sexually transmitted disease in the United 
States with an estimated 4 million new infections a year. It is one, 
along with gonorrhea, of the number one causes of infertility in the 
United States for which we spend millions of dollars trying to achieve 
pregnancy for many women, not all, but many women who have silently 
been infected with a sexually transmitted disease, never to their 
knowledge, and have become incapable of conceiving a child because of 
that sexually transmitted disease.
  The other thing that is important about chlamydia as well as 
gonorrhea is that it is the major cause of pelvic inflammatory disease, 
pelvic pain, ectopic pregnancy, and infertility.
  Gonorrhea. We have all heard of this disease. It causes a significant 
difficulty for men. It may result in strictures and other problems with 
urination. Females, it could cause pelvic inflammatory disease. It can 
cause an inflammatory arthritis that has long-term consequences, and 
most physicians have seen it. It also causes pelvic pain and other 
problems. Teens 15 to 19 are most often infected with gonorrhea, higher 
than any other group.
  Human papillomavirus. At least 2.5 million Americans each year are 
newly infected with this virus. This virus is incurable. Once you 
contract this virus, you will have it the rest of your life. Does 
everybody who gets this virus get cervical cancer? No. But of the 
people who had cervical cancer, over 90 percent of them had it caused 
by this virus. It causes genital warts. It also causes the cancer, as 
mentioned.
  Herpes. We mentioned this earlier. One in five Americans is now 
positive for what we would call genital herpes in our Nation. It is not 
curable. It is treatable. We spend a significant amount of money each 
year treating genital herpes. What we now know that we did not know 10 
years ago is you can be infected and never be symptomatic until the 
first episode. You can carry the virus for 10 years and never have a 
difficulty with this virus.
  This virus is a significant cause for morbidity in pregnancy in that 
women are subjected to cesarian section if, in fact, they have an 
active lesion associated with this virus at the time they go into 
labor. This is a much higher risk if this is their first episode of 
herpes. It is fairly low. But most women do not want to take the chance 
of delivering a child when they have an active infection because of the 
high mortality and morbidity associated with this disease.

  Almost everybody in America knows about HIV and AIDS. We know that 
there are somewhere around 900,000 Americans living with HIV. We know 
that HIV almost always results in AIDS, the end stage of the infection 
of that virus. We know that AIDS is a fatal disease. We know that we 
made major strides of slowing down the progression of infection of the 
virus to the full-blown disease.
  What we do know is HIV is preventable. It is an absolutely 
preventable disease. We now spend, Federal money, $7 billion a year on 
either HIV research, treatment facilities, and drugs to help those 
people who have that.
  The Congress of the United States in terms of mandated spending at 
the CDC spends about $650 million just on HIV. But every other disease 
that I have listed here we spend less than $150 million. That is why 
Americans do not know about these diseases. We need to know about these 
diseases.
  Hepatitis B. We are now immunizing our children at birth and at very 
young ages against hepatitis B. We do not have an immunization right 
now against hepatitis C. Hepatitis B we know is passed from mother to 
baby and can be. We are very careful. We test all pregnant women for 
hepatitis B. We do not test all pregnant women for hepatitis C, and yet 
we know there are 4 million out there. Five thousand Americans each 
year die from hepatitis B.
  Hepatitis C. We have talked about this. Four times as many Americans 
are infected with hepatitis C as HIV. It has the same prognosis. You 
will either have to have a liver transplant or you will ultimately die 
of liver failure or carcinoma of the liver.
  Twenty percent, somewhat over 20 percent of the people who contract 
this virus contract it from a sexual relationship. Ten thousand 
Americans die each year of associated cirrhosis or liver cancer with 
this. So this is a long-term, chronic, fatal disease of which 800,000 
of the 4 million people who have it in our country today contracted it 
because they did not know it was a sexually transmitted disease.
  What do the studies tell us? There has been a wonderful NIH study 
recently that the gentleman from California (Mr. Waxman) asked for in 
1993, and it tells us a ton about what parents can do with their 
children and sexual activity.
  Here are some things that we know. We know at the age of first sexual 
activity by a young girl, if she is less than 16 years old, her number 
of lifetime partners being one partner is 11.3 percent. The number of 
young girls that will have more than five partners is 58 percent.

[[Page H8024]]

  As we progress, what we see is what we would expect to see is, as we 
mature, we make better decisions. What we see is that these numbers 
completely reverse if in fact we tell our children to wait. If in fact 
we tell our children that monogamy and abstinence is protective of 
their health, not just their emotional health but of their health.
  What about teenagers and sexually transmitted diseases? A sexually 
active 15 year old has a one in eight chance of getting pelvic 
inflammatory disease. That is not getting them infected just with one 
of these organisms. That is requiring antibiotics to treat a painful, 
sick, infected, and oftentimes hospitalized adolescent female. Whereas, 
if the same young person is 9 years older, the risk decreases by 
tenfold for a lot of reasons.
  One from every four people newly infected with HIV is under the age 
of 22 in our Nation today. Under the age of 22. What do we think their 
life expectancy and what do we think their life is going to be like? 
Approximately 20 percent of sexually active teens acquire a new 
sexually transmitted disease every year. In other words, one out of 
five sexually active teenagers are getting a new infection at least 
every year.
  We spend hundreds of millions of dollars with family planning 
clinics, with clinics to help our children make these choices, and they 
are failing. We would not see this statistic if they were successful. 
They are failing.
  The top reason for hospitalization of teenage girls is that they are 
pregnant and they are delivering. That is a national tragedy for us. 
Oftentimes it is a national tragedy for the children. One million 
females under 20 experience a pregnancy each year. One-third of those 
end in an abortion. Regardless of your position on abortion, nobody who 
has undergone an abortion thinks it is a great thing.

                              {time}  2145

  It is never a great experience. So we have to be dedicated to 
preventing pregnancies with our teenagers.
  Seventy-two to 76 percent of births to teens are to unmarried teens 
and that goes all the way up to 19-year-olds.
  What happens to our teenaged daughters who get pregnant? Seventy 
percent of them drop out of school. What happens to the fathers of 
these children? They never attain, a large portion of them never attain 
the education, living standard, or earning power of somebody who was 
not a father of a child as an adolescent.
  The teenaged sons of adolescent mothers are 2.7 times more likely to 
spend time in prison than the sons of mothers who delay childbearing 
age until their early twenties. We know as we get older, we make better 
decisions. Why is our government enabling our children to make poor 
decisions? Why are we allowing this epidemic to continue?
  The teenaged daughters of adolescent mothers are 50 percent more 
likely to have a child out of wedlock than children of nonadolescent 
mothers.
  What about older fathers? What we know is with adolescent pregnancy 
is most of the time the father is over 21 years of age. When was the 
last time we heard of a district attorney prosecuting for statutory 
rape of an underage female in any city in this land? Where are our 
district attorneys? It is against the law, but we do not see it 
prosecuted. Seventy-one percent of all births among teenaged girls are 
fathered by men older than 20. The mean age was 22.8 for fathers and 
16.4 for teen mothers, 6.4 years average age difference.
  What about condoms and pregnancy prevention? There are some great 
studies and these are just two. There are ranges in these studies, but 
it is important to know that published peer review scientific data says 
something different than what the government says about condom 
effectiveness. What it says, of 100 couples using condoms, how many 
will get pregnant in the first year? Here is a study from 1992 
published in ``Family Planning Perspectives'': 16 percent. One in five, 
one in six. Hatcher, ``Contraceptive Technology'' this year, 14 
percent.
  They are really effective in stopping pregnancy for our children when 
14 to 17 percent of them are going to get pregnant in the first year, 
when that is how we teach them to protect themselves.
  How about condoms and human papilloma virus and infertility? The data 
on the use of barrier methods of contraception to prevent the spread of 
human papilloma virus is controversial, but it does not support a 
condom as an effective way to prevent the number one virally 
transmitted sexually transmitted disease that causes cervical cancer. 
And I would say that most Americans do not know that, and most 
teenagers do not know that, and most doctors do not know that.
  Infertility. Spermicide, used alone, had no significant effect on 
risk for tubal infertility, whereas condom use alone decreased the 
risk, but to a significant extent. Even with the things that they are 
teaching our children, they are still just as likely to have 
infertility as a consequence of their activity.
  What about condoms and HIV and AIDS? There is no question that a 
condom markedly reduces the risk of the transmission of HIV, but it is 
one of the lower risks in terms of numbers in terms of sexually 
transmitted disease. But does it reduce it 100 percent? No. Does it 
reduce it to 90 percent? Some studies say yes. Some studies say only 60 
percent.
  The question is, if it is a fatal disease, why would we want anything 
other than 100 percent effectiveness? These studies were conducted with 
married couples who one partner had HIV and the other did not, and they 
were trained specifically how to use effectively what we are teaching 
our kids to use, yet a significant percentage contracted HIV using 
these methods perfectly.
  What about other sexually transmitted disease? Condoms must be used 
consistently and correctly to have any chance. They work best against, 
protecting against HIV and gonorrhea. They are much less effective for 
herpes, trichomonas, and chlamydia. Condoms are little or no protection 
against bacterial vaginosis and human papilloma virus.
  Our teenagers say, ``We cannot get pregnant because we will take the 
pill.'' What do the specific studies say about teenagers taking the 
pill? What it says is all women under typical use, the number that are 
not taking the pills correctly, 7.3 percent; unmarried teens, between 6 
and 13 percent; unmarried women between 20 and 29, 5.9 to 15 percent. 
That is the number of women who get pregnant during the first year 
using oral contraceptives.
  Mr. Speaker, it is not hard to figure out. Adolescent females often 
have trouble remembering to brush their teeth, let alone remembering to 
take a pill at the same time each evening.
  Some people say, ``Dr. Coburn, you're a prude. Abstinence is not 
realistic.'' Abstinence is the only thing we have to offer our children 
that is safe, the only thing that we have to offer our children that 
will stop this epidemic, this epidemic that has taken the lives of 
thousands of our fellow citizens and is causing tremendous costs in 
terms of operative expense, causing cancer.
  What is happening? What we saw, and actually released today by the 
CDC, is that we are seeing a marked shift now that we are talking about 
abstinence. Our teenagers are listening. 1988: Men, young men 15 to 19, 
40 percent were abstinent, were pure. 1995: 45 percent. Today, over 50 
percent, as released today by the CDC, of our young men between 15 and 
19 are virgins.
  What about young women? Forty-five percent, now 50, now 52 percent. 
So we are starting to make some headway, but we cannot deny the fact 
that we have an epidemic of proportions that we have never seen that 
will complicate the lives, if not take the lives, of our young people.
  What are the top risk factors? This study that I referred to, what we 
know about sexual activity in our youngsters is the number one risk 
factor is alcohol use. Number two is a steady boyfriend or girlfriend. 
That makes sense. Number three, no parental monitoring. If the parents 
are not involved in the activity of their children, they are much more 
likely to be sexually active. And fourth and most important, if a 
parent is accepting of adolescent sexual activity, is condoning it, it 
will happen. If they are not, it will not. It is the number one factor.
  What are the behavioral risks associated with virginity and 
nonvirginity? What we know is if they are abstinent,

[[Page H8025]]

they have all these other risk factors that are markedly reduced. In 
regard to alcohol, 20 percent of the kids who are not sexually active 
use alcohol. Of the kids that are sexually active, almost 65 percent 
do. And these are males. We can go down the line. Dropping out of 
school, threefold increase. Use of other drugs, 4\1/2\ to 5 times 
increase if they are sexually active. They are five times more likely 
to use an illicit drug than if they are not sexually active.
  What is the number one connection here? It is how well are they 
connected to their parents or parent, and we know that. We see similar 
patterns just with this on females. We see the same pattern if our 
youngsters are abstinent, that the risk factors for other risks that 
will markedly impact their life goes way down. So it is an indicator of 
what they are going to be exposed to and what other risks are going to 
be put on them in their life.
  What we saw from this adolescent study from 1993 is that when the 
relationship was good with mom, and mom was opposed to premarital sex, 
and when discussions of birth control, of how to not get pregnant, are 
decreased, not increased, they were 12 times more likely to have a 
youngster that would not be sexually active than ones whose parents 
talked about, ``Here is how you protect yourself and it is okay to be 
sexually active.''
  So what we have done is set a trap for our kids. If we are accepting 
of a behavior that puts them at risk and we talk about how to minimally 
protect them, what we are doing is dooming them to failure and to a 
sexually transmitted disease.
  So what are the other factors that we found? Parent connectedness, 
parent disapproval of sexual activity, parent disapproval of sexual 
adolescent contraceptive use.
  School is real important. The school connectedness is related to 
parent connectedness, attending a parochial school or school with high 
average daily attendance.
  What are the individual factors? We have seen through programs like 
``True Love Waits'' and ``Best Friends,'' that a commitment to remain 
sexually pure works wonderfully. Our children respond to it. High grade 
point average. A religion. Jewish, Muslim, Protestant, Catholic. The 
fact that the faith is impacting their life.
  So, what is the answer? We have 12 million new sexually transmitted 
diseases a year. We have a million people with AIDS, with HIV. We have 
had nearly a half million die from it. We have 4 million people that 
are going to die from hepatitis C or they are going to get a liver 
transplant. What is the answer? What is the answer for our children?
  Mr. Speaker, it is time for a new sexual revolution. It is time for 
the revolution of the 1960s and the 1970s to die. Why? Because it is 
morally wrong. But there are consequences to morally wrong behavior. 
And the morally wrong behavior is that we have an epidemic that is out 
of control in our Nation.
  Abstinence until entering into a committed, lifelong, mutually 
faithful, monogamous relationship. That is called marriage. Marriage is 
a wonderful institution. It does us well as a society. We should do 
everything we can to support that institution, because that oftentimes 
protects us.
  Abstinence until marriage and faithfulness in marriage that is 
supported by our society. That is supported. That is condoned by our 
society. Where our society stands up and says, Stay together. Do not 
violate the principle.
  Who benefits from character-based abstinence education? The answer is 
all of us. It is them and it is us. It is our Nation. It is our budget. 
It is the life, health, and well-being of our children.
  Mr. Speaker, I say: America, wake up. Twelve million new infections 
every year and none of them have to be. Let us ask for the truth. Let 
us ask the CDC to do its job. Let us make sure we teach our children 
what the risk factors are. Let us make sure we talk about that there 
are consequences to sexual activity outside of marriage, and many of 
them are very, very grave.
  Mr. Speaker, I yield back the balance of my time.

                          ____________________