According to surveillance data from the Centers for Disease Control and Prevention (CDC), the U.S. experienced steep, sustained increases in STDs between 2013 and 2017. In Connecticut, reported cases of syphilis rose 51 percent during the four-year period, while gonorrhea jumped 25 percent and chlamydia rose 27 percent. According to the CDC’s ranking of all 50 states, Connecticut was 27th for reports of chlamydia, 4oth for gonorrhea, and 45th for syphilis.
iStock
STDs are on the rise both in Connecticut and nationally.
Health officials acknowledge that the rise in reported STDs cases is partially due to better testing and tracking. “There’s much better sensitivity and specificity to tests,” said Carol Steinke, retired public health nurse supervisor for Hartford. Lynn Sosa, deputy state epidemiologist for the Connecticut Department of Public Health, also points to an uptick in electronic lab reporting, which is more reliable than manually recording data. But these factors don’t fully explain the recent persistent jump in STD numbers.
So, many communities are expanding their outreach efforts to get to the source: those at a high risk of contracting an STD.
In the spring, Waterbury Health Department’s mobile outreach van will hit the streets of the city Monday through Friday, going to hot spots like parks, soup kitchens and shelters, where people who might not willingly go to a health clinic can step aboard the van. With four medical exam rooms for primary care, the van also offers on-site testing for STDs. In this nonjudgmental setting, a cup of coffee and some free condoms might be accepted.
Employees of Hartford’s health department show up at local college events to inform students about STDs and where they can go for testing and other resources. They also routinely stop in at four local barbershops to fill condom dispensers they’ve placed.
Bridgeport’s health and social services department recently completed its Get Tested campaign, heavily promoting STD clinic hours to the public. New Haven’s health department works in concert with public school nurses to make sure they’re conveying important messages about educating students about STDs; more broadly, the health department also advocates for consistent, modern sexual health education curriculum in schools.
Experts suggest that a complex combination of factors continues to impede prevention efforts, including the public’s attitudes—some new and others stubbornly old; recent behavior changes; and budget cuts. Together, they help explain how dogged efforts to halt the increase in reported cases of STDs fall short.
Flat funding and budget cuts have had a negative impact on statewide efforts to provide STD treatment and tracking. “Our federal funds have been stagnant for many years, so we do need more resources to combat the increase we are seeing,” Sosa said.
One city’s plans to enhance STD data-tracking have been put on hold due to state budget cuts. Maritza Bond, director of health and social services for Bridgeport, said plans to hire a part-time epidemiologist to identify and better target age groups affected by increases in STDs were put on hold because of state budget constraints. Instead, Bond said, she’s exploring how to work with her counterparts in other cities to share resources regionally.
Health practitioners who work to prevent the spread of STDs may encounter evolving attitudes that make their jobs more difficult. A casual attitude about contracting HIV and other serious sexually transmitted diseases is one. “Now HIV is not a death sentence,” Sosa said. “People can live full and healthy lives with HIV. It makes people think differently.”
There’s also a widespread misconception about the relative safety of oral sex, Sosa and other health officials have learned through patient interviews. “I think people do think it’s safer,” said Sosa, who points out that STDs can be contracted orally.
It’s this and other misconceptions that health officials are up against as they work to educate the public, whether in clinics or in the community. At the Hartford STD Clinic, they provide outreach services relevant to STDs and HIV. “We do testing right there,” said Steinke, who retired in January as nurse supervisor of the clinic.
Also at Hartford’s STD clinic, clinicians make it easy for STD-positive patients to halt the spread of infection through a practice called expedited partner treatment. “We’ll give patient information and medication on site so they can pass it on to their partner,” Steinke explained.
But in some cases, patients may be unwilling to share that information with their partners. Others may not know who they are or where to find them, a problem that some experts blame on the rise in anonymous sex partners, made easier by mobile apps like Grindr.
“It’s important for people to understand that we’re not trying to be intrusive,” said Ava Nepaul, a regional supervisor with the public health department’s STD/HIV Partner Notification staff. “We are contacting them to make sure they get their health checked out.” Nepaul emphasizes that the partner notification program follows a prescribed training protocol that’s backed by the CDC and maintains confidentiality of infected individuals and their partners.
“Clearly, the message we’re giving now is not working,” Sosa said.
]]>Though experts note that some of the increase is due to better screening, they are concerned about an actual rise in cases and attribute that to more casual sex through hookup apps and an increase in unprotected sex.
Nationwide, more than 2 million cases of chlamydia, gonorrhea and syphilis were reported in 2016, the highest number ever, with chlamydia making up the majority of cases.
iStock Photo.
Connecticut had one of the lowest rates of STDs in the country, but in large cities the rates remain high.
The annual Sexually Transmitted Disease Surveillance Report, released in late September, found that a total of 1,598,354 cases of chlamydia were reported in 2016, a 4.7 percent increase over 2015. Gonorrhea cases increased by 18.5 percent to 468,514, and syphilis increased 17.6 percent to 27,814 cases.
In Connecticut, 14,028 cases of chlamydia were reported, 759 more than in 2015, a 5.7 percent rise. There were 2,745 cases of gonorrhea, 653 more than in 2015, a 31 percent increase, according to the state Department of Public Health (DPH). The number of syphilis cases reported was 111, up 12 percent from the previous year.
“We need to start focusing our education efforts among younger populations so they can be aware of the risk factors,” says Martiza Bond, Bridgeport’s director of Health & Social Services. The city plans to hire a part-time epidemiologist to identify age groups that are experiencing an increase in STDs so they can be better targeted.
Connecticut has one of the lowest rates of STDs in the country, ranking 42nd of the 50 states for the number of chlamydia cases per 100,000, and 41st for gonorrhea and syphilis cases. But in the state’s largest cities, the rates remain high.
Hartford, Bridgeport and New Haven had the highest rates of STDs. Hartford had 1,689 cases of chlamydia and 415 cases of gonorrhea. Bridgeport had 1,254 and 314, respectively. New Haven had 1,125 and 260.
Chlamydia is almost twice as common among women as among men, and most common among adolescent and young adult women. Gonorrhea, which was once more common among women, is now much more common among men, mostly among men having sex with men. Syphilis is about eight times more common among men than women, and is mostly found in men having sex with men.
Experts say that some of the increase seen in 2016 can be attributed to better screening and diagnostic testing that has been rolled out in the past year or so.
“Beginning in July 2016, we started conducting oral and rectal swabs for chlamydia and gonorrhea, whereas prior to this, we only tested urine in men,” says Joshua Rozovsky of the Hartford Gay & Lesbian Health Collective. “We now swab 100 percent of patients who walk in the door,” he says. In the past, testing of urine samples and swabs of the genitals in women may have missed infections.
Connecticut Department of Public Health’s (DPH) laboratory, which serves STD clinics, school-based health centers, colleges and some community health centers, also moved to oral and rectal swabbing last November.
Experts point to a rise in casual and unsafe sex and a lack of knowledge among young people about unprotected sex as reasons for the increase in STDs.
“It’s partly because of the increase in the use of apps for hookups,” Rozovsky says. “And because most people do not see oral sex as sex, it’s seen as a casual low-risk type of activity.” Adding to the problem is message fatigue among the gay community. “It’s a group that’s been hearing the same message for a long time,” says Dr. Lynn Sosa, TB/STD control programs coordinator at DPH.
At the Hartford Gay & Lesbian Health Collective, they are seeing STDs not only in gay men, but also in heterosexual men and women. “We’re treating men, women, people in their 90s, all age ranges,” Rozovsky says. “Nobody is immune and STDs have become essentially endemic with the sexually-active populations,” he says.
In women, untreated chlamydia and gonorrhea can cause pelvic inflammatory disease and infertility. Syphilis, which was nearly wiped out in the 1990s, has been on the rise since 2001 and is beginning to show up in women across the country. In Connecticut, it is still mainly seen in the male gay community.
“We are really at a little bit of a crossroads with syphilis,” Sosa says. “The real concern is if we start seeing syphilis among women, then we’re going to start seeing more babies with syphilis,” she says. In the United States in 2016, 628 babies were born with syphilis, compared with 334 in 2012. There were no cases of syphilis in infants in Connecticut last year, the health department reports. Babies born with syphilis can suffer physical and mental developmental disabilities. These complications can be prevented if women are tested and treated early in their pregnancy.
The Centers for Disease Control and Prevention (CDC) is calling for state and local programs to do more to reduce the incidence of STDs. But health departments are challenged with getting an effective message out. “We need to do more research on how we can engage this group better,” Sosa says.
“It’s important to continue informing and advising the public of the potential infections that could be acquired from unprotected sex and the effective and appropriate forms of contraception that can prevent infection, like male and female condoms or dental dams,” says Brian Weeks, an epidemiologist at the New Haven Health Department.
]]>
Nationally, the number of cases involving all three common sexually transmitted diseases increased for the first time since 2006, the CDC reports.
The 2014 Sexually Transmitted Disease Surveillance Report, which was released in November, shows that, nationally, the number of reported cases of syphilis increased 15 percent over the number reported in 2013. The number of gonorrhea cases rose 5 percent last year, and reported chlamydia cases increased by 3 percent.
Statistics for the state show a slightly different picture. Connecticut last year reported 13,382 cases of chlamydia and 169 cases of syphilis, 607 more chlamydia cases and 36 more syphilis cases than in 2013. Gonorrhea cases fell from 2,860 in 2013 to 2,333 last year.
“For all three diseases, Connecticut’s rates are below the national average,” says Dr. Lynn Sosa, deputy state epidemiologist with the Department of Public Health.
According to the CDC, Connecticut last year ranked 40th of the 50 states in the number of reported chlamydia cases per 100,000 residents. The state ranked 37th in gonorrhea cases and 37th in primary and secondary syphilis cases.
Sosa says there are many reasons for the big increase of chlamydia cases last year, including advances in tests to diagnose chlamydia and more efforts to increase screening of persons at risk.
Sexually active women younger than 25 years old are encouraged to have annual screenings, she says.
iStock Photo
Syphilis cases in CT increased last year.
As in other regions of the country, there is a wide disparity in Connecticut in the rate of sexually transmitted diseases among races and ethnicities.
The rates of reported cases of chlamydia and gonorrhea are five times higher for Hispanic residents than for white residents in Connecticut, Sosa says. For African American residents, the rate of reported chlamydia cases is nearly 17 times higher than the rate for whites and 24 times higher for gonorrhea.
Nationally, the CDC reports, the gonorrhea rate among Hispanics last year was 73.3 cases per 100,000 population; nearly double the rate among whites. The rate of chlamydia and primary and secondary syphilis among Hispanics was also double the rate among whites.
Hartford and New Haven last year reported the most chlamydia and gonorrhea cases in the state. There were 1,666 chlamydia and 398 gonorrhea cases in Hartford and 1,400 chlamydia and 250 gonorrhea cases in New Haven.
In both cities last year, the numbers of chlamydia and primary and secondary syphilis cases increased over the 2013 numbers, while the number of gonorrhea cases decreased. The increase of chlamydia cases in Hartford was small — seven more than in 2013.
Hartford reported the most primary and secondary syphilis cases last year — 13. New Haven, Bridgeport and Waterbury tied for the second-highest total — each reporting 11.
In Connecticut’s most populous city, Bridgeport, the city’s communicable disease clinic has seen a slight increase in syphilis cases but a stable number overall of sexually transmitted diseases, according to Kristin duBay Horton, the director of health at the Bridgeport Health Department.
Horton said that the number of patient visits to the clinic has decreased, likely as a result of the Affordable Care Act, which has provided people with health insurance and created more health care options.
To reduce the likelihood of contracting a sexually transmitted disease, Connecticut residents should use condoms and have safer sex practices, including limiting the number of partners and having partners tested, Horton says.
There’s been an increase in the number of people using PrEP (pre-exposure prophylaxis) — a pill to prevent HIV infection — and these people “are less likely to use condoms and follow other preventative measures,” she says.
Dr. Jonathan Mermin, the director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, says sexually transmitted diseases particularly affect young women and men, but the agency’s new data suggest “an increasing burden among gay and bisexual men.”
Primary and secondary syphilis among men who have sex with men has been increasing since at least 2000, the CDC says. More than half of men who have sex with men and were diagnosed with syphilis last year were also HIV-positive, the agency says. Infection with syphilis can cause sores on the genitals, which make it easier to transmit and acquire HIV.
Syphilis is currently the only STD for which information on the gender of the sex partner is reported. The CDC reports that a growing body of evidence indicates that men having sex with men are experiencing similar increases in gonorrhea and chlamydia infections, underscoring the need to further understand what is contributing to the increase.
The CDC recommends screening at least once a year for syphilis, chlamydia and gonorrhea for all sexually active men who have sex with men.
The agency says the most reliable way to avoid sexually transmitted diseases is abstinence. Another effective strategy for reducing the risk is mutual monogamy, which, according to the CDC, “means that you agree to be sexually active with only one person, who has agreed to be sexually active only with you.” The CDC also recommends vaccinations to prevent hepatitis B and HPV (human papillomavirus). Vaccines for males and females can protect against some of the most common types of HPV, which are spread by sexual contact. The CDC recommends three vaccination shots before becoming sexually active.
]]>