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St. Louis' rise in STDs may be due to better reporting

This article first appeared in the St. Louis Beacon, Nov. 17, 2011 - The city's top health official said Thursday that part of last year's rise in STD rates in St. Louis may have been due to better reporting -- the result of expanded outreach programs to test and treat more people.

The 2010 data showed that St. Louis ranked second in chlamydia, third in gonorrhea and 20th in syphilis among the 65 cities and counties in the report from the Centers of Disease Control. All information is based on data that local governments submit to the CDC. That means information from some cities and counties may be more accurate than others, depending on how aggressively local governments screen and test their at-risk populations.

Pamela Walker, director of the Health Department, was reacting to data showing a 46 percent jump in syphilis, a 31 percent rise in gonorrhea and a 3 percent increase in chlamydia in St. Louis. Most of the cases involve black men and women between 15 and 24. The numbers were part of data released this afternoon by the CDC, which said the higher numbers for chlamydia in particular were probably due to increased screening and expanded testing.

Walker said, "We had big declines in both gonorrhea and chlamydia in 2009, so we've basically erased the gains we made in 2009." She added that she didn't expect much change in the data for 2011.

"As far as the trends, over the last 10 years, we're 40 percent down for gonorrhea and 4 percent down in chlamydia, and we're about level for syphilis from the high years. Even though it (the syphilis increase) was only 18 cases, it still represents a 46 percent increase."

Though disappointed by the data, Walker said the numbers underscored the impact of the city's measures to deal with STDs. She mentioned the findings of the CDC Infertility Prevention Project in which chlamydia tests were done for every woman between the ages of 15 and 30 who visited a health clinic in another city. One of every three of the women tested positive for the disease, Walker said.

"We know that if we look for (an STD) in that population, we're going to find it," Walker said. "I expect our chlamydia rates to go up over the years and they should go up if we are doing our job and (health) providers are doing their job in finding and treating it. We want to find it because it needs to be treated. If it isn't treated, women are at a high risk of not being able to conceive and have a family later."

Although health officials cite many initiatives to show they are now doing more to address the STD problem, some north side alderman have argued that those efforts are falling short. Earlier this week, Alderman Charles Troupe, D-1st Ward,  criticized the city's effort on STD following Walker's appearance at a Health Committee hearing that focused in part on efforts to locate a facility on the north side to handle stray dogs. Troupe, a committee member, accused the city of being more concerned about dogs than the STD crisis. He and some other aldermen have argued that the city's high rankings on STDs -- which are more prevalent on the north side -- are proof that not enough is being done to address the issue.

Walker says one unusual feature of the city's fight against chlamydia is testing men as well as women. Most cities only test women. In addition, she says the city's STD picture will improve over time as a result of Missouri's new Expedited Partners Therapy law for those being treated.

"That's one of the positive things that will help. Providers can now ask (patients) how many partners (they) have. If they say two, the providers can give that person antibiotics to give to the partners. We're talking about any STD. If there is a delay (in getting information about partners), those partners are still out there spreading (the STD). So we're going to close that gap as fast as we can."

She says rising STD numbers mean "you have increased testing (in the at-risk population) or you have not found all of the contacts. The latter issue explains why she thinks the Expedited Partners Therapy program is important.

In addition, she adds that dual testing is probably helping the city uncover and treat more of certain STD cases. When people seek an STD test, the city now urges both public and private health providers to test them for all common STDs. That's especially useful for chlamydia, she says, because the carrier tends to have few, if any, symptoms.

"For syphilis, we know it's in the HIV positive population right now. So we're really doing a lot of outreach for dual testing. When we test for HIV, we also test for syphilis. A lot of places don't do that either."

But that's only part of the explanation for the increase in the syphilis rate, she says.

"The other part is that we may not be finding all the contacts. A lot of people in St. Louis go to public clinics or private providers who may not be as skilled in partner identification as the city health department staff. So we're asking the providers to report those positive cases directly to us as soon as they can so we can contact the person and make sure all their contacts are identified and make sure that they get treatment."

Outreach and expanded testing continue to be major tools for getting a handle on STDs in St. Louis, she says. The city now performs testing of inmates at the Juvenile Justice Center and through a mobile unit

"We go to weekend football games, talk to parents, talk to coaches and interact with young adults in those settings so they get to know us and trust us," Walker says.

"STDs are completely preventable, and it's important to raise awareness among young people so they feel loved, safe and have hope for the future. We just need to make them aware that they are at risk and don't have to be."

In 2010, according to the CDC, St. Louis had 4,564 reported cases of chlamydia, giving the city the second highest rate of reported cases in the nation. The CDC said it found an average of 4,398 reported cases of chlamydia in St. Louis between 2006-2010, with a peak of 4,703 cases in 2006.

The city had 1,702 reported cases of gonorrhea in 2010, the third highest rate of reported cases nationally. The CDC reported an average of 2,034 cases of gonorrhea in St. Louis from 2006 to 2010.

The CDC found 56 cases of syphilis in 2010, with the city ranking 20th highest in the nation that year. The CDC said it had counted an average of 49 syphilis cases in St. Louis between 2006 and 2010.

City public heath officials say they are concerned about the increasing rise in syphilis among men having sex with men and among women with HIV.

"We must remain vigilant in our fight against STDs," Walker said in a statement. "We still have too many STDs, and our data show that STDs are especially prevalent in our young African-American adults. In cases where the individual's race is known, African Americans between the ages 15-24 comprised over 90 percent of chlamydia and gonorrhea cases."

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.

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