Rising Rate of STD Infection in California Troubles Public Health Officials

Robert Levin, M.D., of the Ventura County Health Care Agency.
Ventura County made an extensive effort to bring down the rates of the most common STDs beginning in 2012. The public health officer of the county’s Health Care Agency, Robert Levin, M.D. (pictured) tasked 20 health care workers with following up on every reported case of chlamydia, gonorrhea, syphilis and HIV. Photo: Kit Stolz.

The rates of the most common sexually transmitted diseases – chlamydia and gonorrhea – have risen over the last five years in California, particularly among men and in the case of gonorrhea, and even in counties that have made a concerted effort to reduce the number of infections.

In 2010, the rate of incidence in California for gonorrhea stood at about 70 cases per 100,000 men. By the end of 2015 that rate soared to almost 200 cases per 100,000, up almost fifty percent in the last two years alone.

Although the rate in women has also climbed, from about 50 cases per 100,000 women in 2010, it’s a much slower rise, and at the end of 2015 stood at 70 per 100,000.

In the case of chlamydia, the most commonly reported infectious disease in the country, rates of infection have been rising more gradually in California. The rate of incidence rose from about 400 cases per 100,000 people in the state in 2010, to about 450 per 100,000 through 2015.

Public health officials are uncertain about what has caused the increases. Potential causes include changed behaviors because of newer mobile phone apps and changes in drug use, according to Heidi Bauer, the public health official who oversees efforts to slow the rate of sexually transmitted disease in California. “One question we have is whether more people are using mobile phone apps such as Tinder and Grindr to find multiple partners and if this is changing behavior,” she said. “We also are looking at correlations with meth use.”

Matthew Hogben, from the Division of STD Prevention at the Centers for Disease Control, said that gonorrhea had been falling around the country “for quite a long time,” by nearly 75 percent from 1975 to 1997, according to CDC, but has resumed its climb nationwide. Rates of the disease are rising fastest in the nation in the West, by over 22 percent during 2013-2014. In California the rate of incidence per 100,000 people in 2014 stood at 118.5 percent, above the national rate of 110 percent.

Bauer said that in 2014, California recorded almost 45,000 cases of gonorrhea and 54,000 in the state in 2015, with an especially sharp increase among men.

California did not meet the Healthy People 2020 National Objective for gonorrhea, and even regions of the state that had previously had success at lowering the rate of STDs in recent years recorded big increases in the incidence of gonorrhea.

In the Central Coast region, Ventura County – located between Los Angeles and Santa Barbara — made an extensive effort to bring down the rates of the most common STDs beginning in 2012. The public health officer of the county’s Health Care Agency, Robert Levin, tasked 20 health care workers with following up on every reported case of chlamydia, gonorrhea, syphilis and HIV. In the case of the less serious and more communicable diseases chlamydia or gonorrhea, the agency gave either care or medication to be passed on to the partners of those infected, an established treatment authorized by the CDC called “expedited partner therapy,” first approved in California in 2001.

Beginning in 2013, the Ventura County Health Care Agency posted warnings in known hot spots for casual sex about the risks of gonorrhea transmission, gave away condoms, and this year opened a walk-in STD clinic at its headquarters in Oxnard.

For two years the effort appeared to be succeeding, as the number of cases of gonorrhea in the county fell slightly, and the number of cases of chlamydia fell substantially, from over 2,500 cases total in 2012, to fewer than 2,200 in 2014.

But in 2015 the incidence rate for gonorrhea in the county soared, from 43 to 64 cases per 100,000 people, while in contrast the rate of chlamydia in the county continued to decline. The rate of syphilis in the county in recent years also tripled in the most recent statistics – but the increase occurred only among men.

Ventura County’s Planned Parenthood gave out 14,000 testing kits for STDs, including HIV, according to spokesperson Julie Mickleberry, and had a record number of men come in for STD testing in 2015.

Levin, the public health director in Ventura County, said in recent years his department has reached out to sexually active young people in a “narrowcasting” campaign with posted warnings, free condoms and trainings of community college nurses. Now he’s concerned that their efforts may be outstripped by the new mobile app technology.

At Oxnard College, located in Ventura County, Deanna McFadden, the coordinator of student health care services, said that one trend she has noticed among her students in recent years is disinterest in condoms.

“Condom use seems to be falling off,” she said. “I do talk to students about that but they just don’t seem to have the level of alarm they once did.”

She also expressed concern about hook-up sites like Grindr and Tinder, for both men and women.

“Just from talking to students, I think a lot of men who have sex with men seem to be using hook-up sites and a lot of time for them going without a condom seems to be part of the deal,” she said. “I think for heterosexual people too the hook-up mentality is really alarming,” she said, given the reduction in condom usage she’s noted.

At Ventura College, Mary Jones, also the coordinator of health services, suspects that the new medication known as PrEP, for Pre-Exposure Prophylaxis, along with the existing cocktails of medicines that are used to control HIV infections, may have convinced young people that AIDS/HIV is no longer a threat.

“When HIV first came out, we were all over the students with warnings and testing and follow-up but as time has gone by and people have seen the longevity of people with HIV, I think the usage rate of condoms has declined,” she said.

At the same time, Jones said that she thought young people today were much more concerned about their sexual health and fertility than they were in the past. She said students now come in to get a clean bill of sexual health routinely.

“I think we are going to turn the tide,” she said. “Kids are much more savvy today, and they’re concerned about their health. They’re Googling, and they’re asking questions, and I see a lot more awareness about these issues than in the past.”

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