Posted: 29 Sep 2020 08:15 AM PDT

Covid-19 is hogging the infectious disease spotlight for 2020. But that doesn't mean that other illnesses have disappeared. Many experts fear that in the absence of routine preventative healthcare visits, sexually transmitted infections, or STIs, have the potential to skyrocket.

That concern, however, has created a new kind of market: one for at-home STI testing collection kits.

"We noticed an explosion of STI at-home collection test kit sales starting in March," says Christina Song, a spokesperson for Everlywell. Along with companies like Fig, LetsGetChecked, and Nurx, Everlywell sells kits for collecting blood or urine that can be shipped back to a lab to get analyzed. "To be quite candid, we didn't get why," says Song. In theory, people should have been staying home during the pandemic—which would mean they'd be having less sex, or fewer sexual partners.

In practice, though, that's not likely the case. "Some people are less sexually active than usual right now, others are reporting no changes in behavior, and some are actually more active than they were before and are pursuing new partners," Justin Lehmiller, a social psychologist at the Kinsey Institute at Indiana University, told Vox.

It all comes down to how concerned people are about contracting Covid-19. "For those with low levels of concern, we're likely to see them going about their intimate lives as usual, with some perhaps even becoming more sexually active for a while in order to make up for lost time," Lehmiller told Vox.

All the while, though, the pandemic decreased capacity for clinics to handle new STI cases. A report from the National Coalition of STD Directors conducted in March found that (pdf) 60% of sexual health clinics in the US had to limit their capacity for STI screenings. A similar survey conducted in June found that nearly 80% of the workforce devoted to sexual health in this group had been reallocated to emergency Covid-19 response. This includes contact tracers, who in normal times would spend their days alerting the partners of people who test positive for HIV or other STIs.

It's not surprising that companies like Everlywell saw an uptick in demand for at-home testing. In fact, the US Centers for Disease Control and Prevention (CDC) currently recommend them for people who want to get screened for STIs, but can't due to limited capacity, or don't want to make the trip to the doctor's office for fear of contracting Covid-19.

These kits all work in roughly the same way. Once you've collected your samples, you ship them back to the same kind of lab that would analyze tests ordered by a primary care provider or a clinic. Prices and timelines may vary by test; most kits offer screenings for chlamydia, gonorrhea, hepatitis C, herpes, HIV, syphilis, and trichomoniasis. An independent physician is included in the cost—around $200—who can advise you on what you need to do based on your results.

That's steep, but some companies will take insurance for these claims; others don't, but they can be reimbursed by a health savings account. And Everlywell now offers a subscription plan called Current for people who would benefit from monthly screenings for just $14.99 per month (although this kit doesn't include herpes testing, which has a notoriously high false positive rate).

These at-home collection kits may be a much-needed defense against the spread of STIs, even after the pandemic ends. STIs have been on the rise in the US for the past few years. A report from the US Centers for Disease Control and Prevention (CDC) showed that in 2018, there were 1.7 million cases of chlamydia—the most ever recorded. Gonorrhea cases, at 580,000, hit a two-decade high.

According to the CDC, these increases are partly related to increased drug use and decreased condom use. But lack of testing—whether because of low funding for local testing agencies or the stigma of walking into a testing clinic—is also part of the problem. "Earlier in the AIDS pandemic, we set up HIV counseling and testing centers, and people would be seen embarrassed or ashamed testing in that space," says Charlene Brown, a physician and medical advisor to Everlywell.

Although some of that stigma has gone away—especially as more people get tested through their primary care physician's office—at-home testing eliminates it entirely. "You're engaging with a provider that you may not know remotely," says Brown, which could ultimately be useful for other conditions, too.

While at-home testing offers convenience to those who can't access a clinic right now, it still won't reach everyone. For some people, free testing is the only way to make it accessible; the few hundred dollars out of pocket is still a barrier to care.

But it's at the very least another option for people to take care of their sexual health. "While getting tested for STIs at a doctors office or clinic is still available, there's still going to be people who don't want to engage the system that way," Brown says. By creating new options that reach more people, she says, more infections can get diagnosed and treated.

Cleveland County drops in state health rankings - Shelby Star

Posted: 29 Sep 2020 07:03 AM PDT

Cleveland County is once again trailing behind the state in an annual health ranking report.

In the 2020 County Health Rankings & Roadmaps Report, the county scored 82nd out of 100 counties in the state in terms of overall health outcomes. Last year the county placed at 80th.

The report, produced by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, collects data in several categories, including health behaviors, clinical care, length of life, social and economic factors and more.

Drop in adult smoking

The county's premature deaths increased by three points although it is not clear what caused the uptick.

Some numbers and behaviors have remained steady such as physical inactivity and excessive drinking.

There has been some good news. Adult smoking decreased along with alcohol impaired driving deaths and teen births.

"We did better in other categories," said DeShay Oliver, Cleveland County Public Health Center deputy director. "We're happy to see smoking down."

Obesity, drinking and STDs

Over the years, the health department has targeted teen births by creating a teen pregnancy prevention coalition and teaching reproductive health safety to all 8th-grade students.

The department has also done work in tobacco prevention and making treatment more available. Potential policy changes could also create tobacco-free campuses in the near future at government buildings around the county.

Contributing to the poor health rankings are increases in adult obesity, excessive drinking and certain sexually transmitted infections.

Oliver said the Eat Smart, Move More coalition was created to target obesity and find ways to encourage physical activity and nutrition.

She said there are barriers to healthy food options that contribute to obesity, such as lack of access to fresh foods and the tendency for those foods to be more expensive. In a county with a median household income that is $10,000 less than the state, many families can't afford healthier meals.

Education can also have an impact.

"We've found younger families don't know how to cook," said Ann Short, community health services director.

How the data is used

When the ranking began in 2010, Cleveland County was in the upper 70s, but the county has been ranked in the 80s consistently since 2012.

Some of the data is limited.

Although sexually transmitted infections increased from 524.4 for every 100,000 people last year to 581.5 this year, Oliver and Short said the rankings only account for chlamydia cases. Overall, they said, the county has had a slight decrease in other STDs.

Short said over the past decade, the health rankings have been collected in 3,000 counties and over the years, categories have been added, subtracted or redefined.

She said some of the information from the health rankings is used to create the county's health assessment, a comprehensive document highlighting key health issues in the county.

The department also uses it as a comparison tool with peer counties and to help create realistic objectives.

"It helps round out the information," Short said.

COVID-19 could have an impact

Next year, the department expects to see an impact on rankings as a result of COVID-19.

Oliver said she expects next year's numbers to be affected by the pandemic, something that will be reflected across the nation.

She said they feel it will have a negative impact on areas such as overdoses, mental health, obesity and even teen births and STDs.

"It could potentially impact social and economic areas," Oliver said.

Rebecca Sitzes can be reached at 704-669-3339 or rsitzes@shelbystar.com

Chlamydia and gonorrhea have increased among younger women, study finds - Greater Milwaukee Today

Posted: 29 Sep 2020 05:42 AM PDT

Rates of chlamydia and gonorrhea are increasing among women ages 18 to 30 in the United States, a recent study by Quest Diagnostics suggests.

The study, recently published in the American Journal of Preventive Medicine, analyzed more than 17 million laboratory samples taken between 2010 and 2017 from females ages 12 to 30. Researchers found that while there was a decline in cases of chlamydia and gonorrhea among adolescents ages 12 to 17, women of ages 25 to 30 experienced a 50% increase in positive test results. Women 18 to 24 had a 21% increase in positive test results over the period of the study.

The U.S. Centers for Disease Control and Prevention (CDC) recommends annual screenings for sexually transmitted diseases (STDs) among sexually active women under 25, said Harvey Kaufman, director of Quest's Health Trends Research Program. For women 25 and older, the CDC recommends screenings only for those with specific risk factors, such as reporting that their sex partner may have a concurrent sex partner. Kaufman, a co-author of the study, said the findings suggest that sexual and contraceptive practices have changed since 2002, when the CDC guidelines were first published.

Kaufman pointed out that the CDC guidelines were largely influenced by a 1998 study published in the New England Journal of Medicine that found that the overall rate of chlamydia among female Army recruits was 9.2%. As a result, the authors of the study recommended a screening program for female recruits 25 and under.

"Military recruits tend to be a younger, convenient sample," Kaufman said. "We think that's the basis for this CDC guideline. It's not based on what we think is best for women's health care. That's why we hope that this report provides insights to public health, and that those who remake guidelines consider this study."

Annual STD screenings can lead to the identification of early infections, said Sarah Wood, a pediatrician in adolescent medicine at Children's Hospital of Philadelphia.

"We know that when we screen, we can treat, and we can have a better long-term outcome," she said.

Wood said both negative and positive test results can lead to important conversations about safer sex practices, the opportunity for patients to get screened for HIV, and more awareness about general reproductive health.

"When we think about STIs, we're never thinking about just the one individual," she said. "We're thinking about their partner and their partner's partners. When we catch early infections, we may identify young men who need to come in and get treated as well."

Unfortunately, COVID-19 shutdowns have interrupted testing at community sexual health centers, making it particularly difficult for health-care providers to catch early infections this year. The availability of test kits has dwindled as well — the CDC released a letter this month outlining how individuals who need STI testing should be prioritized.

"That's going to be a real challenge to expanding screening programs," Wood said. "Even maintaining the level of screening that we're doing right now is difficult."

Sharan Abdul-Rahman, a gynecologist with a practice in Center City, said that clinicians currently screen for risk of STDs by asking patients questions about their sexual behavior. Risk factors can range from having new or multiple partners to not using condoms on a consistent basis. If STDs go untreated, consequences such as infertility, chronic pelvic pain and increased risk of ectopic pregnancies can emerge.

"Clearly the question is … are we doing an adequate job in detecting chlamydia and gonorrhea based on the criteria we currently use?" Abdul-Rahman said. "If we're asking the right questions, we shouldn't be missing that many women. If we're not asking questions at all, then we need to move to something more universal."

Wood, at CHOP, said the increase of chlamydia and gonorrhea in women did not surprise her. She pointed out that CDC data have shown annual increases in chlamydia, gonorrhea, and syphilis in the last five years.

"We know that these infections are happening mostly in teenagers," Wood said. "But when we think about providing health services to this group of women in their late teens or early 20s, we have to realize that's a really vulnerable population, because they're transitioning from pediatrics to adult health care. It drives home that we shouldn't forget about that population, which has unique health-care needs."

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