STDs rise sharply in SDSafe-sex practices likely in decline, epidemiologist says.
By: Chris Huber, The Daily Republic
Sexually transmitted diseases are on a sudden and startling rise in South Dakota.
From the start of the year through the end of July, new cases of chlamydia, gonorrhea, HIV/AIDS and syphilis are well above their five-year median averages, according to an infectious disease report released each month by the South Dakota Department of Health.
Physicians are required under state law to disclose diagnoses of some contagious diseases, including STDs, to the department.
So far this year, there have been 2,124 cases of chlamydia reported in the state, a 24 percent increase over the five-year median average. Gonorrhea is up 58 percent over the five-year median average with 316 cases reported.
Another and more alarming STD popping up in South Dakota is syphilis. Only nine cases have been reported so far this year, but because the disease is so rare, that equates to a 350 percent increase over the median average.
A distressing component of the data is South Dakota’s diversion from more positive national trends. A nationwide study released in 2010 by the U.S. Centers for Disease Control and Prevention found that cases of reported gonorrhea per 100,000 people dropped by 16 percent from 2006 to 2010. But in South Dakota, that number increased by 23 percent per 100,000 people.
Dr. Lon Kightlinger, South Dakota’s state epidemiologist, is concerned but said the explanation is simple: “People aren’t having safe sex.”
Gonorrhea, chlamydia and syphilis are all caused by a bacterium that can live in reproductive and urinary tracts of women and men. They are spread through sexual contact, and the disease can spread by fluid transmission even without male ejaculation.
Because they can lead to more serious complications, all diagnosed cases of gonorrhea and syphilis are investigated, and sexual partners of a person who is diagnosed with the diseases are contacted by the state and told to go in for treatment.
“This can go a long ways to helping stop these diseases from spreading,” Kightlinger said. “But it is still alarming to see how this disease can start with one person and spread like a web.”
Geographic, age distribution
The majority, 66 percent, of the new gonorrhea cases this year happened in the western one-third of the state. Those numbers prompted a visit from the CDC to American Indian reservations in the western half of the state to help curb the numbers.
“They were mainly here to educate and treat people with the disease,” Kightlinger said.
Sexually transmitted diseases aren’t exclusive to certain areas of the state, though.
In Davison County, for example, STDs also are up this year. Four cases of gonorrhea have been reported and 41 cases of chlamydia in just the first seven months of the year. In all of 2011, the county had four reported cases of gonorrhea and 62 cases of chlamydia. Between 2006 and 2011, only 13 cases of gonorrhea were reported in the county.
“The numbers for Mitchell aren’t shocking, but they are still increasing,” Kightlinger said. “This is something that affects the entire state.”
Though STDs strike in many areas of the state, they are mostly limited to younger people.
A 2010 study by the CDC found that even though young people ages 15 to 24 represent only 25 percent of the sexually experienced population, they acquire nearly half of all new STDs in the United States. Seventy-two percent of the new chlamydia cases in South Dakota so far this year have come from people in that age group. For gonorrhea, it’s 59 percent.
Kightlinger said an increase in STDs among the young isn’t because young people are becoming more sexually active. He determined that from a behavioral risk survey given to high school students across the state. Somewhere between 45 percent and 48 percent of high school students are sexually active, and that hasn’t changed in the past decade.
When asked if that means young people are being less safe when they have sex, Kightlinger said as an epidemiologist it’s hard for him to make that connection without having numbers to back it up.
“But as a journalist, I think it would be safe for you to make that assumption,” he said.
He thinks parents need to talk with their children about the dangers of these diseases.
“I think the perception is that these young people can just take a pill and everything will be better,” Kightlinger said. “While the antibiotics are great, that is not the best approach.”
Many symptoms of the diseases may seem minor and sometimes cause no symptoms at all, but leaving these diseases untreated can cause significant health risks in the future.
Untreated gonorrhea and chlamydia, for example, can steal a young woman’s chance of having her own children later in life. The CDC suggests that each year, untreated STDs cause at least 24,000 women in the United States to become infertile.
Studies also suggest that people with gonorrhea, chlamydia or syphilis are at increased risk for HIV.
While they account for the largest percentage of new cases of STDs in South Dakota, young people are not the only age group contracting the diseases. Twenty percent of new chlamydia and gonorrhea cases this year in the state came from people in the 25 to 39 age group, and 2 percent came from the 40- to 64-year-olds.
This year’s nine cases of syphilis have Kightlinger especially concerned.
“This is something we are worried about, because in the late 1990s to early 2000s, we didn’t have syphilis in South Dakota,” Kightlinger said.
Occasional cases would occur when someone contracted it from a different state, but Kightlinger said these new cases were contracted in South Dakota, specifically in the Sioux Falls area.
Every case of syphilis this year was contracted by a man. Men who have sex with other men are at a higher risk for contraction of the disease, and Kightlinger said that was the case with some of the people who contracted the disease this year in South Dakota, but not all of them.
Six of the cases have come from the age group 40 to 64, and the other three have come from the 25 to 39 age group.
Awareness, education key
Perhaps the biggest weapon against these diseases is knowledge.
“These things are largely preventable,” Kightlinger said. “If people know they are out there and know how dangerous they can be, they will be less likely to participate in the risky behavior that can cause them.”
Natalie Vandrongelen is a nurse at Mitchell Area Family Planning and is working to help diagnose and prevent STDs.
The clinic provides STD tests to anyone who would like one, and because the clinic is a state entity, most tests are provided at little to no cost. Billing is based on salary and family size on a sliding scale, so many patients pay nothing.
Bacterial testing for STDs such as gonorrhea and chlamydia can be done with a swabbing technique. The results are ready in about 15 minutes.
“Some people feel uncomfortable with a swab test, so we also offer a urine test which is sent to the state, and results are done in about a week,” Vandrongelen said.
The clinic routinely tests everyone 24 and younger at the clinic unless they say they don’t want the test.
As many as 80 percent of women with STDs can show no symptoms at all, and by offering more tests, Vandrongelen hopes to curb women’s chances of passing on the disease.
“We are starting to see more people come in to get tested just because they had a new partner, and that is very encouraging,” she said. Males are starting to be tested more often as well.
The clinic also works on preventing STDs. Condoms are free and readily available in several places throughout the clinic.
Vandrogelen makes several presentations to the high school throughout the year about the dangers of STDs and the options available for testing. She also works with Dakota Wesleyan University and Mitchell Technical Institute.
“We just want to make sure everyone gets tested and treated,” she said.