Health workers were the first to see it coming. They sensed it on the street corners where prostitutes loitered. Behavior was changing. Prostitutes were no longer bothering with motels. They were out on the curb hailing tricks, working hastily out of cars.
People coming into the sexually transmitted disease clinics could not remember their partners. More and more seemed to be out of work or using drugs. Despite warnings about AIDS, health workers sensed a desperate recklessness afoot--brought on by upsurges in cocaine, poverty and social decay.
"You know it's a matter of time until you see the statistics," recalled Sibyl Howard, a public health nurse with Los Angeles County. "When you're out in the field and you sense people's despair, you can say, 'Look, this is what's happening.' "
What Howard intuited during those years in the mid-1980s is now an alarming national fact. There is a "silent epidemic" of sexually transmitted diseases. They are spreading rapidly with no sign of a slowdown. And they are falling hardest on the young and the poor.
About 12 million Americans will develop sexually transmitted diseases this year. Eighty-five percent will be under age 30. As many as 100,000 women will become infertile as a result of infections. Thousands of babies will be born infected.
Organisms barely heard of 10 years ago appear to be rampant. More than 20 viruses and bacteria are now known to be spread by sex. Meanwhile, many inner-city neighborhoods have become permeated with syphilis, a disease long thought a thing of the past.
"It is increasingly apparent that the cities of North America are more and more resembling the cities of developing countries," Dr. King K. Holmes, a prominent researcher of sexually transmitted diseases, said in a talk at the international conference on AIDS earlier this year.
By contrast, cases of sexually transmitted disease in Orange County have been decreasing steadily, public health officials said. For instance, gonorrhea cases totaled 5,845 in 1986 but had dropped to 2,873 two years later, declining from a rate of 266.5 cases per 100,000 people in 1986 to a rate of 127.1 per 100,000 by 1988.
Because of the AIDS epidemic, "a fair number of people have changed their choices of sexual behavior, reducing the risk of getting AIDS, Hepatitis B, syphilis and gonorrhea," said county epidemiologist Thomas J. Prendergast.
"Where that has ceased to happen--in Los Angeles where the numbers are going back up--they're having a problem with 'crack houses,' with people trading sex for drugs. So far we haven't seen that phenomenon in Orange County," Prendergast said. "We have not seen a syphilis cluster around a crack house. . . . I'm not saying it couldn't happen."
Powering the grim statistics are a mix of forces, the most notorious of which is the spread of crack cocaine, the uncommonly addictive drug that has spawned a life style centered on swapping sex for drugs, inadvertently spreading disease.
Many inner-city heterosexuals have not learned the safe sex message of the AIDS era. In addition, urban and suburban teen-agers are having sex earlier and more often. Many use no protection, despite the spreading epidemic among their age group.
Meanwhile, resources for controlling sexually transmitted diseases, other than AIDS, have remained flat or declined. Many public clinics have had to cut their hours. New diseases have outsmarted old disease-control tactics. Research funding has barely grown.
The result has been a scourge of suffering borne disproportionately by women and children. Many of the diseases are linked to other conditions, including cervical cancer, and some carry with them the risk of birth defects and brain damage for babies born infected.
What's more, some sexually transmitted diseases now entail an added danger. They appear to increase one's risk of AIDS, either by causing sores through which the AIDS virus can be transmitted or, some researchers suspect, by accelerating the course of the fatal syndrome.
"The last thing we can allow to happen today is continued spread of those STDs which have been implicated as risk factors for sexual transmission of the (AIDS) virus," Holmes said. " . . . We must put control of these diseases back on the public health agenda."
A quarter of a century ago, there were for the most part just two well-known venereal diseases: syphilis and gonorrhea. Now, new diagnostic techniques have made it possible to identify and characterize more than 20 organisms spread through sex.
Among them are chlamydia trachomatis , a cause of a painful inflammation of the urethra; incurable viruses like herpes, hepatitis B and human papilloma; the bacterium that causes genital ulcers, once rare in the United States, and various fungi and protozoa.
The numbers, being accumulated by federal agencies and researchers, are stunning: