An Epidemic of STDs

Chlamydia cases are high, gonorrhea rates are rising, but syphilis could be eradicated.

THE UNITED STATES has the highest rate of curable sexually transmitted diseases in the developed world. Yet, despite hourly (or sometimes minute-by-minute) sexual references in the media, sexually transmitted diseases (other than HIV) are rarely discussed. Public knowledge of these diseases remains dangerously low.

Several STDs have reached epidemic proportions in our community. The most com-monly reported is chlamydia, whose prevalence has steadily climbed over the past five years. In 1998, Sacramento had 343.3 cases per 100,000 population, compared to the California rate of approximately 250 per 100,000. Most infections are diagnosed in young women between the ages of 15 and 25. The age group for men with the highest chlamydia rate is slightly older. In 1996, the Sacramento Public Health Laboratory began using a urine test to diagnose chlamydia and gonorrhea, which increased the number of women and men screened.

Very little education about STDs has occurred in the community but that will change this year. With the CSUS chlamydia screening program that will begin in September and a state grant to the State Department of Health Services for chlamydia awareness, we hope to educate our community regarding this treatable and preventable disease.

It is very worrisome to have such an epidemic in our midst. It indicates that young people are sexually active and are not protecting themselves adequately not just against chlamydia, but also against such deadly diseases as HIV.

The California State STD Control Branch is working on a comprehensive Chlamydia Action plan that includes an awareness campaign, and education of the public and of physicians. This may include changing the medical practice act to allow physicians to prescribe medication for chlamydia contacts without an examination. In the meantime, please continue your best efforts to see that the sexual contacts of any patient with chlamydia are also treated.

Gonorrhea is also rising in our community. Adolescents and young adults are disproportionately affected. Sacramento had an incidence in 1998 of 132.5 cases per 100,000 population, more than twice the state rate. Patients with Gonorrhea should be treated and sexual contacts traced and treated.

Syphilis, the scourge of the early 20th century, continues to decline. Our average annual incidence rate in the past five years has been 2.0 per 100,000. The Center for Disease Control has developed a plan to eliminate syphilis from the United States. Its eradication would decrease the likelihood of HIV transmission, and eliminate congenital syphilis and many spontaneous abortions and stillbirths. Success requires enhanced vigilance: all cases of syphilis must be reported promptly to the Health Department, we need a rapid public health response to outbreaks. Partner notification and treatment is a must with all new cases of syphilis.

There are other epidemics in our community: herpes genitalis and papillomavirus, both associated with increased rates of certain gynecological cancers. Neither is reportable, but I suspect they may be more prevalent than chlamydia.

How do we combat STD? In its landmark report The Hidden Epidemic, Confronting Sexually Transmitted Diseases the Institute of Medicine made several recommendations:

• Overcome barriers to healthy sexual behaviors. There must be open communication and information, especially to adolescents. We must educate the mass media and improve the skills of healthcare professionals.
  
  
• Develop strong leadership, strengthen investment and improve information systems for STD prevention.
  
  
• Design and implement essential STD-related services in innovative ways for adolescents and underserved populations.
  
  
• Ensure access to quality essential clinical services. The private sector must incorporate STD education, prevention and treatment into primary care. The health department must treat everyone for STD regardless of ability to pay.
  
  

All these recommendations are excellent, and we hope to implement as many as we can, with the help of all interested physicians. If you have any comments please call us at 875-5881. To obtain help with partner notification for a case of syphilis, gonorrhea or other STD, call 227-0445.

healthofficer@dhhs.co.sacramento.ca.us