Talk to your doctor: CDC report shows STD cases at an all-time high - The Macomb Daily

Posted: 18 Nov 2019 12:00 AM PST

There's a reason people prefer to use the acronym.

No one wants to talk about STDs.

Even with their doctors.

One physician believes changing this factor alone would help turn the tide on cases of sexually transmitted diseases in the United States, which, according to an October report by the Center for Disease Control and Prevention, are at an all-time high.

"We really need to talk about what's going on," said Dr. Robert McClowry, a Beaumont family medicine physician in St. Clair Shores who is encouraging his colleagues and other physicians to make STDs a topic of discussion now rather than later.

"We've known about it for the past couple of years and it just continues to rise," McClowry said.

Worrisome report

The CDC Sexually Transmitted Disease Surveillance Report on STDs in the United States shows, for the fifth consecutive year, cases of the most common STDs including chlamydia, gonorrhea and syphilis are still on the rise:

• Cases of gonorrhea increased 5% to more than 580,000 cases, the highest number since 1991.

• Chlamydia increased 3% to more than 1.7 million cases, which is the most ever reported to the CDC.

• Syphilis cases reached more than 115,000 in 2018. While the number of primary and secondary syphilis cases, the most infectious stages of syphilis increased by 14% to more than 35,000 cases, the highest number reported since 1991.

• Congenital syphilis is the term used when syphilis is passed between a mother and her unborn child. This condition known as congenital syphilis is among the most alarming, as it increases the risk of stillbirth, miscarriage, newborn death and lifelong medical issues. In 2018, there were 1,300 cases of syphilis in newborns, an increase of 40%. As a result, newborn deaths related to congenital syphilis rose from 77 to 94, an increase of 22%.

"This goes beyond data and surveillance, beyond numbers and calculations," said Dr. Gail Bolan, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention in her letter to public health service officials. "We lost 94 lives before they even began to an entirely preventable infection."

Data from the Macomb County Health Department shows a similar surge locally:

• Chlamydia cases rose from 2,736 in 2015 to 3,586

• Gonorrhea cases in 2018 more than doubled, from 522 in 2015 to 1,093

• Syphilis cases went from 108 in 2015 to 145 in 2018. In 2018, there were also 3 cases of congenital syphilis.

As of Nov. 1, 2019, STD cases in Macomb County appear lower but health officials said all the data is not in and once compiled is likely to be similar to last year.

Stopping STDs

Antibiotics can cure syphilis, gonorrhea and chlamydia with timely detection and treatment, however, many people who have an STD don't know it. If left untreated STDs have serious complications, such as pelvic inflammatory disease, infertility, getting other STDs, and increasing risk for HIV.

"I wish people would talk to their doctors," McClowry said.

A strong, doctor/patient relationship can make all the difference in addressing key factors in the epidemic such as stigma and lack of awareness.

"You should be able to talk to your doctor about anything. If you can't, you need a new doctor," said McClowry, who also believes sexually transmitted disease prevention should be a standard part of everyone's primary medical care.

"My patients often tell me I'm the first person who's talked to them about risk and prevention," McClowry said. "We as medical professionals should be doing a better job of getting the information out to the community."

That includes adolescents, seniors and everyone in between.

"No one thinks twice about educating about the spread of influenza or strep throat," McClowry said. "Chlamydia is easier to prevent than the flu, in my opinion. But it isn't happening. The way in which our society views sex prevents patients and docs from talking to each other about this very important topic."

Macomb County Health Department Director Bill Ridella concurs.

"Urgent action is needed by all stakeholders to address the increases in STDs," Ridella said.

Screening is a standard part of medical care and since anyone who is sexually active can get an STD why wouldn't that care include screening for STDs said Ridella.

The increased cases has also led the Macomb County STD/HIV program, which provides STD and HIV testing, counseling and treatment at its offices in Warren and Mount Clemens, to hire an additional public health nurse to increase its capacity to serve more patients needing testing, education and treatment.

The program also expanded its outreach in the community by partnering with community-based organizations, schools, and drug treatment centers to promote its services and provide educational presentations. Niki Mach, who is the manager for the county's communicable disease program, said all that a school has to do is ask and a health care professional will be provided for a presentation.

Mach said another new program aimed at decreasing the number of sexually active teens getting STDs, features a flyer (schools can post) with tear-off coupons that can be turned in at the front desk for free condoms, no questions asked.

Among the services that have helped to reach people is the clinic's Expedited Partner Therapy (EPT), which is a practice of treating the sex partners of patients diagnosed with chlamydia or gonorrhea by providing medications to the patient to take to his/her partner without having the partner be examined by a healthcare provider.

"This often reduces further transmission/re-infection for patients that qualify," Ridella said.

Sex-plained

STDs are not spread by handshakes, hugs, toilet seats, towels, dishes or telephone receivers. They are diseases that are passed from one person to another through sexual contact.

Among the facts to know: A person can get an STD by having vaginal, anal or oral sex with someone who has an STD. Some STDs may spread to a baby during pregnancy, childbirth, or breastfeeding. STDs such as herpes can be transmitted by kissing, if herpes blisters are in the mouth or around the lips. Hepatitis B, syphilis, and HIV, the AIDS virus, can be spread by sharing needles or other objects contaminated by blood, as well as through sexual contact.

"One of the most common misconceptions among physicians and patients is that STD's produce symptoms," McClowry said. "It's very common for STDs to be asymptomatic."

Thus, the reason routine screening is so important, especially for groups who are at a higher risk such as the Lesbian, Gay, Bisexual and Transgender (LGBTQ) community.

"This population requires increased and specific screening," McClowry said. "For example: gonorrhea and chlamydia screening really should be happening at sites of contact in certain populations.'Did someone screen your throat?' I always ask. In certain populations, over 50% of infections occur in extra-genital locations."

Here are a few ideas on how to combat the rising cases:

• Increase funding for state and local health clinics that help prevent spread of the diseases.

• Promote a normalization of care. That means screening teens, without their parents in the room, as well as individuals who have been married for 50 years or more.

• Primary care doctors should offer: HIV screening and treatment; pre-exposure prophylaxis (PrEP), which is access to HIV-prevention medication that at-risk individuals can take daily to prevent infection.

• Make Expedited Partner Therapy more accessible.

• Among Bolan's urgent to-do list is to intensify efforts to find women with syphilis and swiftly connect them to care and immediate treatment. As doing so keeps them healthy and, for those who become pregnant, it keeps their babies healthy, too.

"This is something we can fix," McClowry said.

As Bolan pointed out in her letter for the CDC, there was a time when gonorrhea rates were at historic lows, and syphilis was close to elimination.

"I think it all comes down to eliminating the stigma so people feel empowered to have an open discussion with their physician, to address where they are with regards to this happening to them," McClowry said.

For more information on STDs visit cdc.gov/std/

Rise in STD cases prompts U.Va. community to take action - University of Virginia The Cavalier Daily

Posted: 13 Nov 2019 12:00 AM PST

Recently, despite the availability of antibiotics that effectively cure them, cases of STDs like chlamydia, gonorrhea and syphilis continue to rapidly spread across America. Virginia has not remained immune from this national trend, as the Thomas Jefferson Health District that encompasses Charlottesville witnessed a significant inflation of cases.

According to the Centers for Disease Control and Prevention, chlamydia, gonorrhea and syphilis infections rose in the United States by 19, 63 and 71 percent since 2014, respectively. Based on a report the CDC released in early October of 2019, gonorrhea grew by 5 percent and chlamydia by 3 percent from 2017 to 2018. Moreover, at least 2 million people suffered from one of the three illnesses, the most ever recorded by the CDC.

Relatively common STDs such as chlamydia, gonorrhea and syphilis wreak havoc on men and women's reproductive symptoms, causing swelling, sores, rashes, internal damage and bleeding. Transmission occurs via sexual contact with an infected individual or from a pregnant woman to her unborn child.

Jamie Leonard, director of the office of health promotion in the Department of Student Health, listed several precautionary steps to prevent STDs, such as limiting the number of partners and using protection when engaging in sexual contact. When starting a relationship, Leonard recommended regular STD screenings and sharing one's STD status with any significant others.

"Talking with a partner about expectations around condom usage, mutual monogamy and/or STI status ensures that everyone is on the same page, making informed decisions, and protecting themselves and their partner(s)," Leonard said.

Young adults and homosexual males traditionally represent the most at-risk populations, the CDC claimed. However, as Clare Ruday, MSN, senior public health nurse and PrEP program manager for the Thomas Jefferson Health District noted, STDs affect a wide range of people.

"Basically, anyone who has sex is at risk because you might be monogamous, but your partner isn't," Ruday said. "I think people forget about it or think STIs are just an issue for young people, but we want everybody to get tested."

All three diseases are curable, but without treatment, serious complications can arise. Chlamydia can cause a fertilized egg to develop outside of the uterus, while severe syphilis can negatively impact the brain and heart. Infection also increases the probability of contracting HIV.

The Thomas Jefferson Health District, which spans Charlottesville and five counties in central Virginia, noticed local trends that mirrored those reported by the CDC. Ruday stated that over the past five years, syphilis cases surged by 77 percent, with gonorrhea following at 33 percent and chlamydia at 29 percent. Approximately 57,000 Virginia residents received STD diagnoses in 2018, whereas only 55,000 did the previous year.

"[The diseases are] happening here," Ruday said. "People don't think it's here but it's here … nobody really wants to talk about it or think about it. My job is to put it in front of people."

The CDC attributed national patterns to factors that impede people's ability to obtain effective STD care, prevention education and resources. Reasons include poverty, substance abuse and recent fund reductions for local and state programs that combat STDs. Furthermore, a general decrease in condom use has left individuals more vulnerable to STD transmission.

In fact, the Thomas Jefferson Health District offers free condoms to the Charlottesville community and students as one of the first lines of defense against STDs. The medical center also conducts free walk-in clinics on Tuesday mornings and Thursday afternoons that address sexual health, and on the first and third Wednesday evenings of each month, they host free "test and go" clinics. The event provides community members with the opportunity to quickly have blood and specimen collected and screened for chlamydia, gonorrhea, syphilis, HIV and Hepatitis B and C. Staff even attempt to make the experience enjoyable, showing a movie and supplying attendees with snacks as they wait.

The Elson Student Health Center engages in similar forms of intervention and aid focused specifically on students. Clinicians examine patients for indicators of STIs and advise them on steps moving forward, regardless of a person's test results. Currently, it costs $30 to be tested for gonorrhea and chlamydia at the Elson Student Health Center, and Student Council is planning to offer 70 free STI tests in an event at the center towards the end of the fall semester. Dr. Meredith Hayden, associate executive director of the Department of Student Health, promoted these resources.

"Student Health is a great resource for students," Hayden said. "Clinicians are skilled in screening, treating and preventing infections."

In addition, the Department of Student Health places a particular emphasis on education via the healthy sexuality issue of The Stall Seat Journal, as well as Peer Health Educators. Both serve to inform and counsel the public about safe practices when choosing to be sexually active.

"PHEs provide one-on-one patient education to students about a variety of college health issues," Leonard said. "They provide outreach education to groups, i.e. residence halls, fraternities/sororities and student groups, etc., on college health issues, including sexual health."

Whether seeking advice and treatment from the Thomas Jefferson Health District or Student Health, students and community members can attend STD screenings, clinics and consultations with trained medical professionals and health advisors. However, as Ruday emphasized, along with routine screenings, one of the keys to remaining healthy is as simple as communicating with potential and current partners.

"[You can get yourself tested] regularly so at least you know your status and can share that with your partner, or you can at least know you are covered," Ruday said. "It shows [your partners] that you value your health and expect them to respect it as well."

For more information about resources for STD prevention and treatment:

Thomas Jefferson Health District clinic: http://www.vdh.virginia.gov/thomas-jefferson/sexual-health-services/

434-972-6269

Elson Student Health Center:

https://www.studenthealth.virginia.edu/medical-services

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