[Noozhawk’s note: First in a series on sexually transmitted diseases in Santa Barbara County. Click here for a series index. Coming June 22: Syphilis Makes an Alarming Comeback in Santa Barbara County.]
Public health officials are calling the increase of sexually transmitted diseases staggering, as the number of gonorrhea and chlamydia cases increase by the hundreds each year in Santa Barbara County.
Reported cases of gonorrhea almost tripled between 2013 and 2015, while chlamydia increased 22.6 percent and cases of syphilis — which was nearly eradicated in the 1990s — more than doubled in the same three years.
Theories for the increase include the rise of social media — apps like Grindr and Tinder make it easy to connect with new sexual partners — and the loss of fear of HIV infection, said Dr. Lynn Fitzgibbons, an infectious disease physician who works at the county Public Health Department and with the Santa Barbara Cottage Hospital residency program.
“We worry that social media is kind of the virtual bathhouse,” she told Noozhawk.
“It’s kind of a high-risk meeting place in 2016 that people can easily and anonymously connect with many partners, and if they have a STD, they are very easily transmitting that STD to many, many partners.”
Sexual behavior may also be affected by a loss of fear of HIV infection, Fitzgibbons said.
“In the early 1990s and early 2000s, groups of sexually active young adults had HIV on their minds,” she said. “As treatment methods improved dramatically in the last 20 years, the concern is that people are practicing less safe sexual practices.”
STDs are being diagnosed in teenagers and 70-year-olds; it’s not just one demographic, Fitzgibbons said.
The lack of comprehensive screening for STDs could be contributing to the increase in STDs, said Paige Batson, director of the Public Health Department’s disease control and prevention.
“There needs to be more emphasis on comprehensive screening, and that I see as a barrier because the current recommendations are that STDs predominantly affect the 15-24-year-old age group, gay, bisexual and other men who have sex with men,” she said. “But there are other risky behaviors.”
|Year||Chlamydia Cases||Gonorrhea Cases||Syphilis Cases||New HIV Cases||New AIDS Cases|
|First quarter 2016||576||77||5||7||2|
Having multiple partners, using intravenous drugs and having sex without using a condom correctly are all risk factors, but factors can also be environmental, such as being involved in the sex industry, or cultural, where some people don’t believe in screening or talking about the risk of STDs.
There are social barriers as well — people with substance abuse issues may not be inclined to follow up with testing, and therefore can spread the disease without knowing it, Batson said.
“I think it’s important for people to know to be as sexually healthy as possible using condoms, minimizing the number of partners, and avoiding things that impair your decision-making like heavy alcohol use and meth abuse,” Fitzgibbons said.
High-risk individuals should be tested for STDs on an annual basis, and health-care providers need to be properly assessing those risk factors, Batson said.
“People may be afraid of the results, but they need to get the test,” she added.
“Talk, test, treat” was this year’s STD Awareness Month motto, and Batson said that is the basis of the Public Health Department’s approach.
She said there are social, economic and knowledge barriers to STD testing, and the county has seen — over and over again with cases — that high-risk individuals are not receiving comprehensive screening.
“Despite everyone’s knowledge and Public Health emphasis on sexual health and testing, there’s not enough screening going on,” Batson said. “There are increasing, staggering numbers of bacterial sexual diseases. Tests have to be coupled with HIV, it has to be universal.”
Access to care can also be an issue. More people have insurance with the Patient Protection and Affordable Care Act, but she said that getting an appointment to see a doctor and getting the required treatment is still a barrier.
“There’s access and then there’s access,” Batson said. “Yes, I should have access, yes I have insurance, but it’s not always readily available. Doctors are more impacted nowadays.”
Chlamydia, gonorrhea and syphilis are all treatable, with one-time treatment is they are caught early.
Short-term regimens are best to make sure people finish the treatment, Batson noted.
“Any untreated gonorrhea and syphilis, we track them down,” she said.
The county launched an STD Summit last year for the medical community to identify gaps in prevention, testing and treatment.
“In order for us to make a dent or decrease the prevalence of STDs, the Public Health Department can’t do it alone,” Batson said. “Educating the medical community and making sure they’re following recommendations is key.”
Santa Barbara Neighborhood Clinics was part of the county’s task force on this issue, and Dr. Charles Fenzi, the CEO and chief medical officer, said physicians typically screen for chlamydia, gonorrhea, syphilis and HIV.
“We do this all the time,” he said. “We screen and treat.”
Chlamydia and gonorrhea are tested with urine, and syphilis and HIV are usually tested with blood. HIV can also be tested with a swab since it’s an RNA test, Fenzi explained.
“If there’s a real concern they have a risk for Hepatitis C, mostly that they’re using needles for something other than health care, then a Hep C panel will be done as well,” he said.
They are not point-of-care tests, meaning patients usually come back to get tested the following day, he noted.
The risk of syphilis and HIV is less than the more common gonorrhea and chlamydia, but if there are risk factors, like multiple sex partners, Fenzi said he would advise patients to get tested for all four STDs.
“If I don’t detect a big risk factor in my questions then I leave it up to the patient,” he said. “I pose it this way, ‘Typically there are four common STDs we can test for, would you like to have all four?’ And a lot of times when they discover it’s a blood test, they’ll elect to do a urine test.”
The fear of needles will lead some patients to opt out of the tests that require taking blood from the arm, he said.
If patients are in for a routine visit with bloodwork — checking for conditions like diabetes — and they are sexually active, physicians may offer the screening then, Fenzi noted.
“Following that, I will have the condom lecture with them,” he said. “The oldest patient I had to do it to was 92. On his little sheet of paper it said STD screening and I thought it was a mistake.
“He said no, it wasn’t a mistake, he got a girlfriend and wanted to make sure he was safe for her.
“Many of us carry guidelines in our phones in case we forget what we’re doing,” Fenzi added.
In Santa Barbara County, the population of new HIV cases includes people who are younger and sicker — people who have been ill for a significant amount of time, under the care of a physician and are not usually diagnosed until they’re in the hospital, Batson said.
“It makes us wonder why HIV wasn’t on the differential diagnosis,” she added. “Why do they have to be in the hospital before we realize they have HIV?”
“It’s all walks of life. We can’t assume it’s only the men who have sex with men who have HIV or syphilis or gonorrhea. The primary-care providers, everyone should be thinking and following those screening guidelines.”
HIV testing used to involve counseling and consent forms, but the Centers for Disease Control and Prevention quickly realized that was a barrier to people getting tested, Batson said.
The recommendations changed around 2006, she said, and now the standard is to offer universal testing and people can opt out of HIV testing.
Some health-care practitioners are still operating the old way, even though they don’t have to, Batson said.
“It’s hard to comprehend how somebody who has gonorrhea or syphilis does not get a HIV test or vice versa,” she said.
She said assessing risk factors is key in these situations.
“It’s very much akin to someone with tuberculosis, you see it in all the communicable diseases,” Batson said. “When someone has been coughing for weeks, losing weight, has night sweats, for months they’re seeing a doctor and hear bronchitis, asthma, and you name it — and then you find out they have risk factors for TB, were recently exposed, living in the Philippines or Mexico recently, and somehow TB was not on their differential diagnosis.”
As a stark contrast to the rates of other STDs, the rate of newly diagnosed HIV cases has been stable over the past four years in Santa Barbara County. But more than half the people diagnosed in the first half of 2015 had AIDS at the time of diagnosis, according to Public Health data.
Of nine new HIV cases reported in January through June, five individuals had AIDS at the time of diagnosis.
The majority of cases reported in the county since 1981 have been in men on the South Coast. The most common transmission modes reported are men who have sex with men/bisexual men and intravenous drug users.
Eleven percent of the 210 people living with HIV in Santa Barbara County are in their 20s, 25 percent are in their 30s, 24 percent are in their 50s and 13 percent are over 60, according to the 2015 data from the Public Health Department.
In addition to the county’s education, prevention and case management services, the nonprofit Pacific Pride Foundation offers free and anonymous HIV testing, free mental health services, HIV prevention and education, and youth services.
Funding cuts led to the organization’s elimination of its food pantry and case management programs, and the transfer of clients to the Public Health Department.
Both Pacific Pride Foundation offices — 126 E. Haley Street, Suite A-11, in Santa Barbara, and 819 W. Church St. in Santa Maria — offer free testing and syringe exchange.
How to Prevent STDs
Using condoms correctly, minimizing the number of partners, and avoiding substances that impair decision-making are three ways to be as sexually healthy as possible, Fitzgibbons said.
This year’s STD Awareness Month theme was “Talk, Test, Treat” and the CDC recommends sexually active people talk openly and honestly with their partners and health-care providers about sex and STDs.
Condoms are the only birth control that reduces the risk of both pregnancy and STDs, but they cannot always protect against some STDs such as herpes, syphilis or human papillomavirus (HPV) that causes genital warts and cervical cancer, according to the CDC.
When to Get Tested for STDs
Sexually transmitted diseases don’t always cause symptoms, but the CDC recommends frequent testing for sexually active adults.
Screening recommendations from the CDC include:
» All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.
» Annual chlamydia screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
» Annual gonorrhea screening for all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
» Syphilis, HIV, chlamydia and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women starting early in pregnancy, with repeat testing as needed, to protect the health of mothers and their infants.
» Screening at least once a year for syphilis, chlamydia and gonorrhea for all sexually active gay, bisexual and other men who have sex with men (MSM). MSM who have multiple or anonymous partners should be screened more frequently for STDs (i.e., at 3-to-6 month intervals).
» Anyone who has unsafe sex or shares injection drug equipment should get tested for HIV at least once a year. Sexually active gay and bisexual men may benefit from more frequent testing (e.g., every 3 to 6 months).