Swipe right to regular STD screening: The Center for Human Development expects cases of chlamydia, gonorrhea and syphilis in Union County, Oregon state and the U.S. to rise for the sixth consecutive year in 2019.
In its February 2018 Communicable Disease Summary newsletter, the Oregon Health Authority attributed this rise in cases of sexually transmitted diseases to four specific drivers: increased sexual activity without condoms due to reduced risk of HIV; reduced local public health infrastructure leading to lack of STD education; use of methamphetamines and other drugs that increase sexual drive and decrease inhibition; and the abundance of mobile apps facilitating “hookups” with anonymous sexual partners.
The newsletter also noted while part of this increase is due to the rising number of people getting screened regularly because of some destigmatization, “most of the observed increase represents a true increase in incidence.”
Elizabeth Sieders, communicable disease nurse at the CHD, agrees.
“It could be thought the increase (in reported STDs) is caused by the increase in testing, but the way the numbers have risen, it doesn’t look to be true,” she said. “It looks like it’s caused by the increase of social media apps where you can find partners anonymously. It’s more of a behavior we’re seeing change culturally.”
A popular argument against the dating apps theory, however, is the people who are on Tinder, Grindr and other apps would be looking for anonymous partners anyway, even without using social media as a tool to find them. Although dating apps may lead to more sexual encounters, increasing the likelihood of contracting an STD, the other factors listed by the OHA also seem to contribute, so it’s difficult to pin the increase down to one particular cause.
At the Centers for Disease Control and Prevention’s annual STD Prevention Conference in August 2018, David C. Harvey, executive director of the National Coalition of STD Directors, cited the reasons he believes the STD epidemic is occurring.
“The first is an extreme lack of awareness and education about STDs and sexual health. The second reason is doctors are not screening and testing for STDs and patients don’t know that they need to ask for that screening and treatment,” he said. “The third reason is that we’ve had a tremendous cutback in federal and state funding over 20 years.”
These three catalysts are tied together. Because federal and state funding has seen a 40-percent decrease in purchasing power since 2003, STD education and awareness programs have deteriorated, leading health care providers to screen less and leaving patients unaware of the importance of regular screening practices, according to Harvey.
In August 2018, the CDC published a report outlining what it termed an STD “crisis” with data from 2017: “Nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in the United States in 2017. This surpassed the previous record set in 2016 by more than 200,000 cases.”
CHD’s Sieders said chlamydia cases are by far the most common in Union County, but the presence of gonorrhea and syphilis is also growing.
“Chlamydia (is) increasing, but it’s always been here,” said Sieders. “Syphilis has gone from ‘zero to sixty’ real fast.”
Although data provided by the CDC and the Oregon Health Authority both list zero cases of syphilis in Union and Wallowa counties in 2016, the most recent year available, the state of Oregon is experiencing an overall increase in reported syphilis cases. Multnomah County had the highest rate of syphilis in the state in 2016 with 20.9 cases per 100,000 people.
Sieders said the most concerning aspect of syphilis is the detection in pregnant women, as the disease is more dangerous to a fetus than either chlamydia or gonorrhea.
“Our priority when looking at all STD cases are pregnant women, especially with syphilis because it can be transmitted to the baby during pregnancy and the outcomes can be very poor,” she said. “Syphilis is the one that can cause the most damage to the baby during pregnancy. It can cause multiple birth defects with brain development, bone development and vision.”
Out of 916 cases of congenital syphilis in the U.S. reported in 2017, 64 of them resulted in a stillborn child, according to the OHA.
While the number of national syphilis cases seems fairly small, there was a 44 percent increase from 2016 to 2017.
Cases of chlamydia, which is much more common at the county, state and nationwide levels, are also increasing. Because people with chlamydia rarely show symptoms, they are less likely to get tested and more likely to unknowingly spread the disease to their partners.
More than 1.7 million cases of chlamydia were diagnosed in the U.S. in 2017, with 45 percent among 15- to 24-year-old women, according to the CDC. Data from the OHA shows Oregon state held 17,618 of those chlamydia cases in 2016 — including 115 in Union County and 13 in Wallowa County, an increase from the previous year in both counties.
The OHA also notes an increasing trend in reported gonorrhea cases. In 2016 there were 4,367 at the state level and 11 in Union County, a substantial increase from 2013, when there were 1,729 cases in the state and only one in Union County. No cases of gonorrhea were reported in Wallowa County in either 2013 or 2016. Nationally, reported gonorrhea cases have increased by 67 percent in just five years, according to the CDC.
Gail Bolan, director of the CDC’s Division for STD Prevention, spoke on the reasoning behind the increase in gonorrhea specifically at the same conference as Harvey in 2018.
“Over the years, gonorrhea has become resistant to nearly every class of antibiotic we’ve used to treat it,” she said. “Our nation urgently needs additional treatment options for gonorrhea.”
Following Bolan at the conference, Harvey noted the U.S. “continues to have the highest STD rates in the industrialized world.”
“We are in the midst of an absolute STD public health crisis in this country. It’s a crisis that has been in the making for years,” he said.
In order to fight this “public health crisis,” CHD relies on educating the health care providers and community members of Union County on the importance of regular screening habits and safe-sex practices. Joelene Peasley, family nurse practitioner at CHD, educates La Grande High School students on STD prevention at one of CHD’s two school-based health centers in Union County (the other is in the Union School District). These school-based centers also provide discreet STD screening services to students.
Peasley said while it is important to treat individual cases, the focus needs to be on each person’s partners in order to halt the spread of disease.
“We can treat the initial case, but the other part of it is getting those partners notified and treated,” she said. “That, out of anything, will help control these cases and bring our numbers down.”
In addition to its outreach programs, Sieders said CHD also provides the latest STD information to health care providers in order to cast a wider net in the area.
“Ultimately, the doctors, physicians and nurse practitioners in our community are seeing a vast majority of these patients,” she said. “We’re not providing direct clinical services all the time, so we try to give them as much education and tools as possible to stay in the know about these diseases as the trends and information change.”
To truly quell this epidemic of STDs plaguing the nation, state and county, Peasley urges people to use protection, while Sieders recommends looking at STD treatment in a new light.
“We’ve got to change the stigma,” Sieders said. “We live in a conservative area, but we don’t really have conservative behaviors in our community. We’ve got to change this culture of ‘we don’t talk about it; we don’t do it.’ (STD screening) should be as normal as going to the dentist.”