New data shows spikes in sexually transmitted diseases in Kansas and nationwide.
Syphilis rates more than doubled statewide over the past four years, according to state data. And local HIV cases are on track to surpass the county’s previous record-high, according to not-yet-finalized Sedgwick County data.
Nationally, chlamydia rates are some of the highest ever, according to new data released from the U.S. Centers for Disease Control and Prevention for 2014 STD cases.
Last year, 1.4 million cases of chlamydia were reported. That accounts for the highest “number of annual cases of any condition ever reported to the CDC,” according to the report.
The numbers also showed national spikes of gonorrhea and syphilis reports.
58Syphilis cases reported in Kansas in 2011
145Syphilis cases reported in Kansas in 2014
Public health funding
Some health experts have said the rise in STD rates across the country could stem from eroded public health funding. That’s because many STD tests and treatments are funded through public health dollars.
Gianfranco Pezzino, senior fellow and strategy team leader for the Kansas Health Institute, said public health dollars also go toward STD prevention and treatment in ways that are not direct clinical care.
One example, he said, is the Community Health Improvement Plan, which was cut from the Sedgwick County budget for next year. The plan is a compilation of data about the county’s overall health and identifies areas in need of improvement. Nonprofits and health organizations use the assessment to apply for grants and design health programs.
“There are specific things they (the county) are well positioned to do, but the other partners in the community may not be able to do,” he said in reference to the health assessment.
Pezzino said it’s often easier to measure the level of return on direct clinical care positions, such as a nurse with how many patients they treat. But with non-patient-contact positions in public health, he said it can sometimes be harder for policymakers to see the value and return on investment.
He said he hasn’t studied the specific effects of public funding cuts on STD rates, but said the research generally leans toward an increase in rates when funds are slashed.
“My best wish is that I’m wrong in my forecast,” he said. “But I have no evidence to say I’m wrong. All the evidence points in that direction, but I hope I’m wrong.”
My best wish is that I’m wrong in my forecast.
Gianfranco Pezzino, senior fellow and strategy team leader for the Kansas Health Institute
Pezzino said effective containment of STDs includes many pieces: proper screening, diagnosis, treatment and contact tracing.
The last component – contact tracing – refers to tracking down the source of a person’s STD and potential spread of the STD before the person received treatment.
“If you miss those, then you just treat one case, but you don’t stop the outbreak or diffusion of the disease,” Pezzino said.
The investigators, he said, receive specialized training to garner the trust of patients to give out the information.
“It’s not something the typical office assistant can pick up the phone and do,” he said.
In Kansas, the behavioral investigative specialists work with patients across the state. The investigators receive specialized training from the CDC and meet with patients in person.
The investigators typically only meet with patients who have syphilis or HIV and sometimes who have gonorrhea.
Jason Ybarra, tuberculosis control and STD program manager for the Sedgwick County Health Department, said the county has two investigators who cover a 52-county region.
Ybarra said investigators receive notification from laboratories when a person tests positive for syphilis, HIV or gonorrhea. He said investigators then contact the patient’s doctor who treated them and then contact the patient directly.
The investigator arranges to meet with patient in person to talk with them about how they got the infection, treatment for the disease, partners who might have exposed them and partners they might have exposed before treatment.
“As disease investigators, you have to build that rapport from the beginning and make sure they feel comfortable with you to give you that information,” he said.
He said the investigators are transparent and truthful with patients with the hope that patients will be truthful in return. He emphasized rapport building because the patients are not bound by law to divulge their partners if they have an STD.
As of the end of October, Ybarra said his 52-county region received 49 reports of syphilis. But he said that is an unofficial count because it had not yet been approved through the state, which tallies final statistics.
HIV on the rise
In 2009, the county reached a record high of newly reported HIV cases at 62 cases that year.
By the end of September 2015, the county had received approximately 46 new cases of HIV. Ybarra said the county has received about four to six cases each month this year. At that rate, the county could surpass the 2009 record.
At this rate, the county could surpass its 2009 high of new HIV cases.
Syphilis symptoms, treatment
Nationally, gay and bisexual men are most at risk for syphilis, according to the CDC report.
In Kansas, men were three times more likely to have syphilis than women. Syphilis was most common among people 20 to 29 years old, and African-Americans were more likely to have the disease than other groups.
Syphilis is most common among men, people 20 to 29 years old and who are African-American.
Ybarra said the disease investigators have seen an uptick in people who have anonymous sex, which complicates investigators’ ability to track the disease. He said people will find sex partners online or through an app and meet in person to have sex without ever knowing each other’s names, other than online names or chat user names.
Syphilis has a variety of symptoms and the symptoms can often change. But commonly, a painless sore will appear at the site of contact with the disease – usually a person’s genitalia, anus or mouth.
But the sores often go away on their own and then rashes appear on the person’s palms, bottom of their feet or torso during the second stage of the disease.
Syphilis is treated with a penicillin shot, but other oral treatments are available for people allergic to penicillin.
But the main takeaway, Ybarra said, is if you notice anything abnormal – visit a doctor.