Sexually transmitted diseases continue to be disproportionately affecting young people and minorities, both locally and nationally, and the need to turn the trend around is more evident than ever.
"We're seeing increases in the number of cases of chlamydia, gonorrhea and syphilis," said Harold Wiesenfeld, a physician in obstetrics and gynecology and director of the Allegheny County Health Department STD Program.
Some of the most recent figures for the county show approximately 6 percent more cases of chlamydia in 2012 compared to 2011 and 22 percent more cases of gonorrhea and syphilis in that period. Numbers of HIV and AIDS cases in 2012 have not been reported yet but have continued to go up in some population groups in recent years despite advances in treatment.
"Our concern is STDs are still too common in Allegheny County, as well as nationwide," Dr. Wiesenfeld said. "Our concern is STD rates in the African-American community are too high."
To make a difference, the county Health Department and the state Department of Health earlier this month held a conference of experts and representatives of health and human service agencies in Monroeville.
Although the stakeholders meeting was not the first, there's a renewed interest, Dr. Wiesenfeld said. Ideas shared by people from local agencies will help the Health Department plan new strategies and interventions to find and treat people with STDs in communities where rates are high.
"We want to reach people at risk, bring them to screening and reduce risk in these populations," he said.
It's not clear if the 2012 numbers for the county reflect more people with the diseases, Dr. Wiesenfeld pointed out.
"We don't know how many people are being screened for gonorrhea and syphilis in Allegheny County. Some of the increase may reflect better testing and more widespread screening of at-risk individuals," he said. With the STD treatment guidelines updated in 2010 by the U.S. Centers for Disease Control and Prevention, there are more screenings for STDs and more individuals being screened.
Some of the 2010 changes in the guidelines:
• In the case of chlamydia, an annual screening is recommended for all sexually active women 25 years old and under. An annual gonorrhea screening is advised for all sexually active women at risk of any age.
• A discussion of HIV screening is recommended for teenagers, and testing is encouraged for those who are sexually active and who use injected drugs.
• Although they might not have symptoms, young men who have sex with men and pregnant teenage girls should be evaluated for possible screening.
The U.S. Preventive Services Task Force is expected to soon release recommendations that endorse routine HIV screening of all adults and teenagers to enable early treatment of the disease and curb its spread. Despite what would be the testing of people at low risk of having HIV, people who otherwise would not be tested may find they have the virus. Treatment of HIV with antiretroviral drugs is a form of preventing additional cases. Two Perspective articles in the latest issue of The New England Journal of Medicine support the change for universal testing.
"The new HIV screening guidelines will hopefully reduce the stigma associated with being asked to undergo HIV screening," Dr. Wiesenfeld said. Efforts to counteract the stigma of STD testing are a priority of local health officials.
Although not life-threatening diseases, he said, undetected chlamydia and gonorrhea can lead to serious health issues in women, such as infertility, ectopic pregnancy and pelvic pain.
"Most cases of chlamydia and gonorrhea are asymptomatic in women [and sometimes men)]. Many of these infections can be passed along unknowingly. Seventy percent of women with chlamydia don't have symptoms."
Young women between ages 15 and 19 have the highest rates of testing positive for chlamydia and gonorrhea, Dr. Wiesenfeld said, and that potentially sets them at risk for complications later on. "They are in the group at highest risk."
"Every year for the past few years, the number of cases of chlamydia reported in Allegheny County have been steadily going up; it's the same nationwide," Dr. Wiesenfeld said. "We still don't know if it's because the message about screening is actually getting through." He said it could be more thorough screening, better diagnostic tests or it could be the actual number of cases of people infected with an STD.
In any case, the numbers are too high, he said. "We need to do better; we need to reduce the burden of STDs in our community."
For information about STDs from the U.S. Centers for Disease Control and Prevention: www.cdc.gov/std.
Jill Daly: firstname.lastname@example.org or 412-263-1596.