Here's what public health officials are saying about Sacramento County's persistently high rates of sexually transmitted disease: "From bad to worse," "alarmingly shocking," "unacceptable."
Sacramento had the third-highest rate of gonorrhea cases among the state's 58 counties in 2012.
It had the fourth highest-rate of chlamydia and syphilis cases.
New cases of STDs have jumped since 2008, when budget cuts began fraying the health safety net. Officials say the lack of resources means they can't track the sources of STD infection as well as they used to, which hurts prevention efforts. Another factor in the increase may be the proliferation of smartphones, which enable young people to more easily meet up and have sex.
"This STD crisis has been going on for a number of years. There are many theories but there's no single theory that explains the rise," said Dr. Miriam Shipp, who was hired earlier this year to be the county's STD controller.
State data show that from 2008 to 2011, chlamydia rates increased by 27 percent in Sacramento County. In that same period, gonorrhea rates rose by 8 percent. And from 2010 to 2011, syphilis rates soared by 128 percent.
Then, from 2011 to 2012, gonorrhea rates went up another 20 percent. Last year also saw a bump of 16 percent in syphilis rates. Only chlamydia dipped a bit, still remaining at an alarming level, officials said.
Sexually transmitted diseases are hitting Sacramento's youth population the hardest. The majority of those infected are ages 15 to 29, a demographic most likely to use smartphones to hook up with partners.
The instant connectivity smartphones provide is believed to be a contributing factor in the spread of STDs among young people, experts said.
Dr. Olivia Kasirye, the Sacramento County public health officer, wants to see more STD screening among young people and is spearheading a new charge to halt the steady rise of cases. She is backing a strategic planning process that brings together stakeholders from throughout the county.
"The youth is a huge priority for us," Kasirye said.
The crisis is not exclusive to Sacramento County. It mirrors statewide, nationwide and even international trends, Shipp said.
Regionally, the surrounding counties of El Dorado, Placer and Yolo saw increases in the same three diseases in 2012, but their totals remained significantly lower than in Sacramento County.
Amy Moy is vice president of public affairs for the California Family Health Council, a nonprofit organization trying to increase the quality of STD health care statewide.
"How do we curb this?" said Moy. "And how do we buck this alarmingly shocking trend of the majority of new cases being among young people."
Moy and others noted that the explosion of cases coincides with severe cuts in funding for county health care services, including clinics that once provided treatment and screening. "County clinics were closed several years ago, and that might be at play here," she said.
In Sacramento County, budget cuts slashed the number of county health communicable disease investigators from 10 to 1.5, Shipp said.
Investigators trace reported cases of STDs. Now, with such a limited staff, the only cases being followed are those of pregnant women with chlamydia who have not been treated.
"Chlamydia is a huge problem and at this point, there is not much being done to trace the cases," Shipp said.
The confluence of factors behind the spread of STDs also includes the need for more screening, education, treatment and follow-up with sexual partners of people with confirmed cases.
Soon the public health department will launch a prevention campaign in which women under 25 can request a free STD test kit. The test will be mailed discreetly to a residence, and results can be checked on the Internet.
The county already distributes condoms for free through the mail. They can be accessed at teensource.org.
So far, such efforts haven't reversed the troublesome trend of infection. About 10,000 cases of STDs were reported in Sacramento County last year.
Dr. Cassius Lockett, the county's chief epidemiologist, said those struck by the diseases generally are from lower socioeconomic backgrounds, are not consistent condom users and may live in disadvantaged neighborhoods.
African Americans are four times more likely to have chlamydia than their white counterparts, Lockett said. And young black women are the demographic most often infected by STDs.
State officials are able to track the prevalence of STDs by ZIP code, ethnicity, age and gender. In Sacramento County, those figures show, the areas reporting the most cases are in south Sacramento, Oak Park, Florin and Del Paso Heights.
Lockett said he mapped out locations of clinics that screen for and treat STDs. Most were clustered downtown, where there were fewer cases.
Some of the most commonly reported STD infections in Sacramento County are chlamydia, syphilis and gonorrhea. Chlamydia, the most pervasive of these, is caused by bacteria. It can infect both men and women and do serious, permanent damage to a woman's reproductive organs.
A study by the Centers for Disease Control and Prevention reported in 2012 that about one in 15 sexually active females aged 14 to 19 years has chlamydia.
The CDC also revealed that up to 75 percent of sexually active women may not get screened annually for chlamydia and gonorrhea unless symptoms are present.
This lack of screening is a problem because about 70 percent of women experience no symptoms and an even greater proportion of the male population is asymptomatic.
Gonorrhea is also bacterial. If left unchecked, it can cause pelvic inflammatory disease in women and affect the fertility of both men and women.
Syphilis is a disease more common among men who have sex with men. It wasn't long ago that public health authorities believed that this most serious of the three common sexually transmitted diseases was on the verge of eradication. But infection rates have jumped in the past few years.
Planned Parenthood in Sacramento trying to combat the high infection rates runs an education program in schools to teach kids about the dangers of having unsafe sex. The organization's health educators say they will go to any classroom that welcomes them, and have taught safe sex practices at Sacramento City Unified School District.
Raquel Simental, spokeswoman for Planned Parenthood, said much more needs to be done to reach sexually active teens and young people.
Noting that there's no state or federally funded STD prevention program in Sacramento, Simental said county cutbacks and slimmer grant opportunities have made battling high STD rates more difficult.
"Now, since there's less funding, I think it begs the question, 'Is there a correlation' between the spread of disease and the lack of resources?" Simental said.