A record number of California residents were diagnosed with sexually transmitted diseases in 2017. Recently released data from the California Department of Public Health show a 45 percent increase in cases of gonorrhea, syphilis and chlamydia in the state compared with rates five years prior.
STD rates have continued to rise in Sacramento County, as well as both state and nationwide over the last several years. Data released by the department shows increasing rates of STDs since 2013.
“Currently, what we’re seeing is increases across the board,” said Heidi Bauer, the chief of the STD control branch within the California Department of Public Health.
Health officials are looking at decreased condom use, an increase in sexual partners from social media and dating apps and accessibility of care as possible reasons for the increases.
Data show rates climbing higher in Sacramento County than other areas. Out of all 58 California counties, Sacramento County had the sixth-highest rate of chlamydia, the eighth-highest rate of gonorrhea and the 10th-highest rate of primary and secondary syphilis.
There are cures for all three diseases. If left untreated, however, long-term health problems can occur.
“What’s most concerning is the congenital syphilis,” Bauer said, referring to an increase in cases in which syphilis is passed from mother to child in the womb.
W. Suzanne Eidson-Ton, a professor in the Department of Family and Community Medicine and an OB/GYN at UC Davis Health, said it can be devastating for the fetus if syphilis is passed from mother to child during pregnancy. Syphilis testing is a routine part of prenatal care and the disease can be found and treated easily, but issues occur when women do not have access to prenatal care, she said.
In California in 2017, there were 30 stillbirths related to congenital syphilis. In 2012 to 2016, the CDPH reported an over 500 percent increase in cases of congenital syphilis. California has the second leading rate of congenital syphilis in the nation, with a rate of 41 per 100,000 live births, as reported by the Centers for Disease Control and Prevention.
Locally, the rate of congenital syphilis cases from 2013 tripled in 2017, with six cases in Sacramento County.
“Probably more than half of women with congenital syphilis come into care late,” Bauer said, adding that there are providers who have never seen a case of congenital syphilis before.
CDPH officials have a few theories as to why rates are rising across the board. One of the primary theories is related to a decrease in condom usage.
“People aren’t using protection as much anymore,” Eidson-Ton said. “You really can prevent most STDs by using a barrier method.”
During the HIV AIDS crisis, people were more worried about getting infections and there was an increased effort and motivation to use protection. Since HIV rates have dropped off, condom usage has decreased, Eidson-Ton explained.
“I do think that effort has waned over the years,” she said.
In addition to decreased use of protection, officials are looking at the rising use of social media and an increase in casual hook-ups. As people’s social networks have expanded, so have their amount of sexual partners.
Health officials are also looking at cuts to health programs which provide treatment and testing as a potential reason for increasing rates.
“There’s definitely been cuts to public health funding generally which have affected things like public testing sites,” Eidson-Ton said.
According to Bauer, although there haven’t been recent cuts to public health funding in the state to centers that provide services like testing and treatment, state funding has remained level in recent years while cases have continued to increase during this time.
“Having level funding to protect increases becomes challenging,” Bauer said.
A spokesperson from the governor's office was unable to verify that funding has remained level, but was able to note that the "2018 Budget Act includes a total of $14.2 million" for "STD-related activities." Additionally, STD testing and treatment are covered by the Family Planning Access, Care, and Treatment program. The 2018 budget plans to allocate $322.3 million to the program.
On June 27, Gov. Jerry Brown approved Senate Bill 840, which includes a one-time allocation of $2 million for improved access to STD prevention. These funds will improve upon existing services.
"Counties shall be targeted and prioritized based on population and incidence of sexually transmitted diseases," the bill text states. "Funds shall be allocated to targeted counties in a manner that balances the need to spread funding to as many counties as possible and the need to provide meaningful services to each funded county."
During the 2008 recession, some STD clinics were forced to close. But, Bauer explained, since then, some of the services that were lost have since returned. She said there needs to be a multiyear effort in order to rebuild the public health infrastructure, and one-time funding doesn’t allow for that.
“It’s a scramble (...) to use the funds in the most effective way,” Bauer said.
With one-time funding, counties are forced to allocate to the issue they deem is most pressing. In Sacramento County, the priority is syphilis, said Olivia Kasirye, the public health officer for Sacramento County. But with additional funds, the county could be doing more.
Kasirye explained that public health officials look to treat not only the infected individual, but also attempt to investigate, evaluate and test the infected individual’s partners in order to curb the spread of the disease. With additional funds, more investigations to determine where new cases are coming from could be done.
Currently, Sacramento County Public Health allocates funding for HIV and STI prevention education, screening and testing to several different agencies. The county provides testing supplies for Golden Rule Services, Harm Reduction Services, the Gender Health Center and the Sacramento LGBT Center, but does not provide funding for staff at any of these agencies, a spokesperson from the county explained.
Improved access to tests and treatment does lead to improved health if, Eidson-Ton said, the services are acceptable to the community. In order to achieve acceptability, services must be culturally appropriate — in certain cases, this means care that is multilingual. Spaces providing services must also be welcoming and located in a place that’s easily accessible.
And there is always room to improve access to treatment and testing in the community, Kasirye said.
“Being able to have more regularly available sites for testing is important,” she emphasized.
But in order to secure more testing sites, Kasirye said there would need to be an increase in outpatient clinics that take walk-ins.
Education as a means to prevent the spread of STDs was emphasized by several health officials. Kasirye said she feels there is a need to reevaluate the education that is being given — specifically, how it’s being given and whether it’s still relevant.
Next school year, a new pilot program is scheduled to begin, resulting from a collaboration between the county and the Los Rios Community College District. Current plans are for a part-time clinician to provide STD testing and educational materials to students at Cosumnes River College and Sacramento City College. The clinician will be funded through discretionary funds from County Supervisor Patrick Kennedy.
Rates of chlamydia and gonorrhea among people ages 15-24 were the highest rates since the reporting of these cases first began, in 1990, according to the state health department’s 2017 data. Fifty-four percent of chlamydia cases and 33 percent of gonorrhea cases were among those under the age of 25.
Over the years, the vulnerable populations at risk have changed. Now, females age 15-29 are the at-risk population for chlamydia, males age 20-30 are the at-risk group for gonorrhea, according to Kasirye.
But because of health disparities, vulnerability within age groups is not equal. For instance, the CDPH reported that chlamydia and gonorrhea rates were close to five times higher among African Americans than whites, based on 2017 data.
“These higher rates are not caused by ethnicity or heritage, but by social conditions that are more likely to affect minority groups,” the Center for Disease Control reports. “Factors such as poverty, large gaps between the rich and the poor, fewer jobs, and low education levels can make it more difficult for people to stay sexually healthy. People who cannot afford basic needs may have trouble accessing quality sexual health services.”
In general, Eidson-Ton explained, these inequalities are consistent with many other health disparities seen in the African American community. These disparities are related and have to do with access to good health care.
“In general, the rising STI rates are a symptom of a larger issue,” Eidson-Ton said. “It’s symptomatic of people not having enough access to health care in general in California and also nationwide.”
Officials recommend individuals who are sexually active get tested at least once a year. Testing is necessary for everyone, not just those who are exhibiting concerning symptoms. Bauer explained that a high proportion of those infected with STDs have no symptoms, so routine testing is necessary to treat conditions as soon as possible.