TMC PULSE

12 t m c » p u l s e | o c t o b e r 2 0 1 8 STDs Hit Record High in U.S., Mirroring Upward Trend in Houston Area Testing and treatment urged to stop surge S exually transmitted diseases (STDs) in the United States hit a record high in 2017, mark- ing a "steep, sustained increase" over the last four years and a discouraging trend after decades of decline. Texas and Houston have seen a similar spike in STDs, according to Texas STD data and the observations of Houston experts. The Centers for Disease Control and Prevention (CDC) released preliminary 2017 figures showing a combined 2.3 million diagnosed cases of chlamydia, gonorrhea and syphilis. That number surpasses 2016 by more than 200,000 and represents a nearly 10 percent increase over one year. "It's an important moment to message that testing is available for everyone and you need to be aware of your sexual health and that you need to be tested," said Paige Padgett Wermuth, Ph.D., M.P.H., assistant professor of management, policy and community health at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health. The 2017 surge marked the fourth straight year of increases. Nationwide, chlamydia remained the most common condition reported to the CDC last year, with 1.7 million cases diagnosed. Nearly half— 45 percent—occured among girls and young women ages 15 to 24. Syphilis diagnoses nearly doubled over the four-year period, with more than half of cases among men who identify as gay, bisex- ual or sexually active with other men. Gonorrhea cases jumped 67 percent from 2013 to 2017. Officials expressed concern about gonorrhea grow- ing resistant to treatment, with only one highly effective antibiotic remaining now in the U.S. Federal funding cutbacks blamed for "crisis" The preliminary 2017 STD figures were released during the 2018 STD Prevention Conference in Washington, D.C., where hundreds of sexual health experts convened in August. During a media teleconference, experts called the rising trend a "crisis" and an "epidemic," while lamenting the uptick following decades of decreasing STD cases. David Harvey, executive director of the National Coalition of STD Directors, said during the call that funding cutbacks have crippled local STD public health programs from adequately addressing awareness, education, screening, testing and treatment. "Federal STD funding has seen a 40 percent decrease in purchasing power since 2003," Harvey said. "That means that state and local health departments—most of which depend primarily on federal funding to support their STD programs— are working with budgets that are effectively what they were 15 years ago." Local numbers mirror national uptick Harris County is a historical hot spot for the trio of infections outlined in the national analysis. Gonorrhea, chlamydia and syphilis diagnoses rose sharply from 2013 to 2017 in Harris County, according to Houston Health Department data. Gonorrhea showed the steepest increase, from 6,482 diagnoses in 2013 to 8,827 in 2017— a 36 percent increase. Chlamydia cases increased 17 percent and primary and secondary syphilis by 6 percent over the same period. "That is disconcerting to us because it tells us that people are acquiring the disease and if they don't get treated, they can spread it to other people," said Michael R. Thomas, M.P.H., a CDC public health advisor who has been embedded with the Houston Health Department's Bureau of HIV/STD and Viral Hepatitis Prevention for more than two decades. "To be able to combat that, we are going to need the resources … and that's why you are seeing the uptick in syphilis, gonorrhea and chlamydia." Thomas also attributes some of the challenges with surveillance, partner identification and treat- ment to the ubiquity of social media applications. "A lot of the increase that's going on now, par- ticularly syphilis—but also other STDs—is because of social media," he said. "People are now meeting partners on social websites. You have websites B y C i n d y G e o r g e 1,401,906 1,708,569 2013 2017 2013 2017 333,004 555,608 Most common condition reported to CDC; 45% of 2017 cases among women and girls ages 15 to 24 Increased 67% overall and nearly doubled among men; only one highly effective antibiotic used in the U.S. Men who have sex with men were almost 70% of cases CHLAMYDIA GONORRHEA PRIMARY & SECONDARY SYPHILIS STD TREND IN THE UNITED STATES Source: Centers for Disease Control and Prevention 1,401,906 1,708,569 2013 2017 2013 2017 2013 2017 333,004 555,608 17,375 30,644 1,401,906 1,708,569 2013 2017 2013 2017 2013 2017 333,004 555,608 17,375 30,644 Primary care providers and anyone, really, who is caring for a patient, should be screening for hepatitis, HIV and sexually transmitted infections. It's not that hard to do. — THOMAS GIORDANO, M.D., M.P.H. Medical director of Harris Health System's Thomas Street Health Center

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