Steady rise in California's STD rates frustrates public health officials

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160489 full

Use condoms and get tested for sexually transmitted diseases. That's the plea from state health officials, who report that rates of chlamydia, gonorrhea and syphilis increased for the third year in a row.

"We should not be seeing steady increases in curable infections," says Dr. Jeffrey Klausner, a UCLA professor of medicine and public health. "These are readily detected by routine tests and they are easily cured by antibiotics."

The California Department of Public Health says more than 250,000 cases of STDs were reported in 2016, a 40 percent increase compared with five years ago. Young people, African-Americans and gay and bisexual men had the highest infection rates.

Los Angeles County experienced sharper increases in gonorrhea and congenital syphilis cases than the state as a whole, according to the county Public Health Department.

State health officials say they're particularly concerned about a 43 percent increase in cases of congenital syphilis compared with 2015. The state recorded 207 cases of congenital syphilis last year, the highest number of cases since 1996.

"Countries like Cuba and Thailand have eliminated mother-child transmission [of syphilis], so to see an increase in the United States is frightening," Klausner says.

Congenital syphilis can lead to stillbirth or permanent, lifelong disabilities. It occurs when a mother with syphilis passes the infection to her baby during pregnancy.

All women should be tested for syphilis during their first prenatal visit, according to the Centers for Disease Control and Prevention. The state report says cases of congenital syphilis are frequently associated with a lack of access to prenatal care, poverty and substance abuse.

In response to the increase in congenital syphilis cases, the L.A. County Department of Public Health will be dispatching public health nurses to provide case management to any women diagnosed with syphilis, according to Mario Perez, director of the department's Division of HIV and STD Programs.

The state also reported a 19 percent increase in gonorrhea cases compared with 2015.

The bacteria that causes gonorrhea has developed resistance to nearly all of the antibiotics used to treat it; the CDC says it's down to one last effective class of antibiotics for gonorrhea.

Klausner is concerned that more cases of the infection will lead to more antibiotic resistance.

"One of our approaches to combatting untreatable gonorrhea is to control gonorrhea, and we're obviously not effectively controlling gonorrhea," he says.

Rates of gonorrhea among men increased 22 percent in 2016 compared with 2015, according to the state report. Men who have sex with men accounted for 63 percent of the state's male cases.

Chlamydia remains the most common reportable disease in California; it's at its highest level since mandated reporting began in 1990.

The highest rates of chlamydia are among young women. The infection can cause serious, permanent damage to a woman's reproductive system, making it difficult or impossible for her to get pregnant later on, according to the CDC.

Perez, with L.A. County, say there are several factors contributing to the steady increase in STDs. He says there's evidence that condom use is decreasing; one reason is because more young women are using long-acting reversible contraception, like IUDs.

"They are protecting themselves against pregnancy, but not protecting themselves against STDs," Perez says. "Condoms continue to play an important role in disease transmission."

And many people aren't being appropriately tested and treated for STDs, even when they visit the doctor, he adds.

"Most of these STDs are asymptomatic and unless we're routinely screening the groups that are most at-risk, a lot of disease is going to go undiagnosed and untreated," Perez says.

Perez says there's dwindling funding for STD prevention programs.

In a statement, the L.A. County public health department says it will be "aligning resources and programming to address the disproportionate impact of STDs in communities of color, and among young people, transgender persons and men who have sex with men."

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