Problem drinking puts people, especially women, most at risk for sexually transmitted diseases, according to a new study by researchers at the University of California, Davis, and in Berkeley. The study found that problem drinkers are most vulnerable not because of a tendency to engage in high-risk sexual practices, but because they may be less aware of health ailments, slower to seek medical attention for them and thus endure a longer duration of sexually transmitted infection. The results of the study, funded by the National Institute on Alcohol Abuse and Alcoholism, appear in the current issue of the journal Social Science and Medicine. Unlike previous studies that have examined narrowly defined groups considered most at risk for sexually transmitted diseases (STDs), the new study identified the behavioral traits associated with STDs in a randomly selected population of households. Conducted by Karen Ericksen, a professor of psychology at UC Davis, and Karen F. Trocki, a research scientist with the Alcohol Research Group in Berkeley, Calif., the study is the first to report such a strong link between problem drinking and STDs, according to Ericksen. Although the people often associated with STDs are those who use illegal drugs, go to bars frequently and otherwise occupy the margins of society, Ericksen said, "These aren't those folks. They're average citizens of every stripe." The researchers identified "problem drinking" as alcoholism or alcohol dependence as it has been defined by scientific research. They distinguished it from such specific drinking habits as going to bars, getting drunk and drinking heavily, irrespective of alcoholism. Experts in the field estimate the number of alcoholics in the United States is between 10 and 15 percent of the population. Although the role of high-risk sexual activities in the transmission of STDs is well established, surveys indicate that the number of people who engage in these high-risk behaviors is relatively small. Health care professionals and others have argued that within this population, alcohol and drug use leads to irresponsible sexual behavior. The survey by Ericksen and Trocki allowed for the examination of alcohol's role in the transmission of STDs among the general population. The sample consisted of 968 randomly selected adults in a San Francisco Bay Area county. Respondents were asked to report on whether they ever had an STD (syphilis, gonorrhea, herpes, genital warts, etc.); their sexual behaviors, including the age at which they first had intercourse, their number of partners within the last month, year and five years; and their current sexual partnerships. They also were asked a wide variety of questions about drinking habits, drug use and symptoms of alcoholism. Overall, the dominant behavioral factors linked with STDs are large numbers of sex partners and problem drinking. People with five or more sex partners in the last five years are nearly five times more likely to report having had STDs than those with fewer partners. Drinking problems have nearly as strong a correlation, with problem drinkers being four and a half times more likely to report STDs than others. Among women, the researchers found that drinking problems are the trait that puts them most at risk for STDs, with problem drinkers being more than seven and a half times more likely to report the diseases than women without drinking problems. Having intercourse for the first time at an early age also was a strong predictor. Women who were younger than 16 when they first had sexual intercourse are almost three times more likely to report STDs than women whose first sexual experience was at a later age. The authors note evidence that early sexual experience makes women more physically vulnerable to later infection due to the effects of intercourse on a physically and immunologically immature genital tract. The study did not reveal a similar pattern for men. Neither multiple sex partners nor problem drinking put men at the same high risk for STDs as women. Currently nonmonogamous men and illicit drug users are more than twice as likely to report STDs. Current problem drinkers are three times more likely to report STDs, but men who have ever had a drinking problem are five times more likely to report STDs than others. Ericksen and Trocki also report the major predictors of multiple sex partners among men and women. Among women, those who frequently go to bars and heavy drinkers are three times more likely to have had a history of multiple partners. Among men, going to bars and feeling disinhibited when drinking are the factors most likely to contribute to multiple partners. These results indicate that some drinking habits increase the likelihood of STDs indirectly by increasing the frequency of high-risk sex. However, the researchers did not find problem drinking to be a risk factor for multiple partners for either sex, even though it is an important risk factor for STDs. Because it does not appear as if the sexual behavior patterns of women problem drinkers are what put them at risk for STDs, Ericksen and Trocki say it is possible that problem drinkers may remain infected for longer periods than others, increasing their chances of infecting a sex partner during that time. The researchers also say the high rates of STDs may be due to problem drinkers being less prompt about seeking medical help for health problems, less vigilant about the condition of their bodies, and, through psychological denial, less likely to acknowledge symptoms of disease until they are severe. Ericksen and Trocki say their findings raise public policy implications. If women problem drinkers are at increased risk for STDs, then policy makers should begin to focus on this group through media campaigns and other means to increase awareness of their need for diagnosis and treatment. Also, if it is the duration of infectiousness as well as sex behavior that distinguishes problem drinkers, then policy makers should direct their efforts to dispensing treatment instead of modifying behavior. Diagnosis and treatment could take place at institutions likely to come in contact with problem drinkers inadvertently, such as county jails, emergency rooms and places of employment.