Federal guidelines don't recommend STD testing for straight men. Check It is screening them anyway. - NOLA.com

Posted: 13 Feb 2020 12:00 AM PST

As rates of sexually transmitted diseases (STDs) continue to skyrocket in the United States, with Louisiana ranking high among them, one group is notably absent from federal recommendations for yearly testing — straight men.

The Centers for Disease Control and Prevention (CDC), the country's leading public health institute, suggests annual STD screening only for sexually active women, pregnant women, gay and bisexual men, and people who use needles.

CDC officials say there's little evidence to prove that screening men regularly contributes to a decline in overall case rates — partially because young men are less likely to seek preventative health care services in the first place — and that limited public health resources are best spent on women and gay and bisexual men, who are disproportionately affected by STDs.

Check It, a New Orleans program and study funded by a National Institutes of Health (NIH) grant, aims to test and treat a group outside those populations targeted by the CDC — straight black men ages 15 to 24 — for chlamydia and gonorrhea. Louisiana ranks in the top five highest case rates in the nation for both infections.

"What the [CDC is] doing right now is not working," said Patricia Kissinger, the principal investigator of Check It, run by Tulane University's Department of Epidemiology. "The rates are increasing."

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Chlamydia and gonorrhea are both common bacterial infections that easily can be cured with a one-time dose of medication, but what makes them dangerous is that most people who have them don't show symptoms. For people who do not get screened regularly, these STDs may go undiagnosed and untreated.

When untreated, both infections can cause pelvic inflammatory disease in women and infertility issues in men and women. Pregnant women may experience inflammation of the neck of the womb and the fallopian tubes, which can increase the chances of miscarriages and pregnancy complications.

For men, chlamydia can cause swelling of the testicles and an inflamed urethra, while gonorrhea can cause a painful condition in the tubes attached to the testicles. Both increase a person's likelihood of contracting HIV.

The Check It team goes to nonclinical spaces around New Orleans — like local barber shops, universities and eateries — and asks young black men to enroll in the study, offering them incentives like a free haircut or a gift card. Once they enroll, they'll answer a 15 minute long survey and provide a sample of their urine, which is then tested for chlamydia and gonorrhea.

If they test positive, the program provides participants with that free medication that can either be picked up at one of six partnering Walgreens pharmacies or received via mail. The grant also pays for medicine for participants' sexual partners.

The program started about three and a half years ago and has a year and a half left of grant funding.

Check It Nola — Members of Check It stand with the Complete Barber Shop team at a screening event.
PHOTO BY KRISTIE POWELL, COURTESY OF CHECK IT

So far, Check It has screened more than 1,800 men for chlamydia and gonorrhea, with about 10% testing positive for one of the two infections, Kissinger said. Around 200 men in the program together have named 346 sexual partners — half of which were also treated through Check It.

"Most of them had no symptoms, so they had no idea," Kissinger said of the men treated through the program.

Rates of chlamydia, gonorrhea and syphilis have increased dramatically over the last several years. Nationally, there were more than 1.7 million cases of chlamydia reported in 2018, a record high according to the CDC. The same year, there were more than 580,000 gonorrhea cases reported, the most since 1991.

That means from 2014 to 2018, the U.S. saw a 63% increase in gonorrhea cases and a 19% increase in chlamydia cases, the CDC report said. In the same period, primary and secondary syphilis cases saw a 71% increase, while syphilis in newborns saw a 185% increase.

In 2018, Louisiana had the second highest chlamydia rate in the nation and the fifth highest gonorrhea case rate. The chlamydia ranking was the same as in 2017, but the state went down two spots in its gonorrhea ranking, from third highest to fifth highest. That's because while Louisiana's gonorrhea and chlamydia case rates increased, they did not increase as much as other states' rates did.

According to the CDC, cuts to STD prevention services at state and local levels, decreased condom usage and lack of access to STD prevention and treatment services are causing the substantial uptick in STD rates nationally.

Kissinger said she hopes that the data Check It researchers collect will help convince the CDC to consider adding men to their testing recommendations for chlamydia and men who have sex with women to their recommendations for gonorrhea.

"You can't just screen women," Kissinger said. "You have to screen the whole sexual network and treat the whole sexual network that are infected in order to get rid of infection."

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