Sexually transmitted diseases in the U.S. increased during the COVID-19 pandemic and area health departments have seen the same trend with certain types of disease.
The average rate of gonorrhea cases remained higher than the US. average in Butler, Clark, Warren counties, and in Montgomery County the rate was double that of the national average.
Montgomery County has a rate of 415.5 cases of gonorrhea per 100,000 individuals, according to 2019 and 2020 data in Public Health - Dayton and Montgomery County’s latest Community Health Assessment. The state average was 265 cases per 100,000 individuals, and the national average was 206.5 cases per 100,000 individuals.
“They definitely rose during the pandemic,” said Dan Suffoletto, Public Health’s public information manager.
The 2021 rate decreased to 306.6 cases per 100,000 individuals in Montgomery County, but the 2020 rate Montgomery County experienced was similar to other metropolitan areas. Rates included 563.5 in Cuyahoga County, 502.8 in Hamilton County, 440.1 in Lucas County, and 371.1 in Franklin County, according to Public Health.
The cases of gonorrhea increased over 2016 to 2020 in Montgomery County, but that number has been fluctuating back down. In 2016, there were 1,419 reported cases of gonorrhea and in 2020, there were 2,210 cases, according to the Ohio Department of Health. Warren County also confirmed a slow and steady increase of cases of gonorrhea over the past decade, even through the COVID-19 pandemic. The Butler County Health District did not respond to a request for comment.
Syphilis rates increasing
While chlamydia is the most commonly reported sexually transmitted infection, it has been decreasing in Montgomery County since 2016. Rates of syphilis have also been increasing both nationally and locally. In Montgomery County, the incidence rate of syphilis in 2017 was 17.7 per 100,000 individuals, which rose to 47.2 in 2021. In Clark County, the incidence rate of syphilis in 2018 was 26.8 per 100,000 individuals, which increased to 75 cases per 100,000 individuals in 2021.
“We see the trends are increasing, and they’ve increased every year,” said Mary Shaw, nurse practitioner with the Clark County Combined Health District, said about syphilis and HIV rates. Shaw said they have seen increases in those who use intravenous drugs, but syphilis can impact anyone of any age. The youngest patient she has had was 15 years old, and the oldest patient she had was 85 years old.
Part of the problem is individuals are not educated on the symptoms of syphilis, which are different than other STDs, such as unusual discharge or pain during urination. For syphilis, the first symptoms involves a painless sore on the genitals, rectum, or mouth, followed by a rash after the sore heals, according to the Mayo Clinic. There are no symptoms until the final stage of syphilis, which can result in damage to the brain, nerves, eyes, or heart. The final stage can also take place years after first contracting syphilis.
“They ignore them (the symptoms), and they continue to spread them unknowingly,” Shaw said.
Over 1.2 million Americans live with HIV, and some area counties are seeing slight increases. Nationally, new HIV infections declined 8% from 37,800 in 2015 to 34,800 in 2019, after a period of general stability, according to the U.S. Department of Health and Human Services. In 2020, 30,635 people received an HIV diagnosis in the U.S. and 6 dependent areas—a 17% decrease from the prior year, likely due to the impact of the COVID-19 pandemic on HIV prevention, testing, and care-related services.
Although Black people have more reported new diagnosis of HIV infection, white people have four times the rate of living with a diagnosed HIV infection, according to Public Health - Dayton & Montgomery County. Ohio and the U.S. have higher rates of new HIV infections than Montgomery County. In 2020, Montgomery County had an incidence rate of 6.6 new HIV infections per 100,000 individuals, compared to 7.7 in Ohio and 12.6 in the U.S.
Impact of COVID on STDs
Early during the COVID-19 pandemic, public health measures meant to help prevent the spread of COVID-19 may have impacted the surveillance of STDs in terms of reducing screenings, limiting resources, and social distancing measures.
“We did see a peek in 2020. We do kind of contribute that a little bit to COVID and the lack to access to care at the time,” said Shaw.
During lockdown measures, health care clinics either closed entirely or limited in-person visits to symptomatic patients only. Limiting screening measures maybe have led some STDs to go uncaught, as some STDs do not always have symptoms, the CDC said.
STD program resources also shifted to help control the spread of COVID-19, according to the CDC. Many jurisdictions redirected staff from routine STD surveillance and control efforts to COVID-19 activities. This could have limited case investigations, partner services, and case reporting. Social distancing factors may have also reduced the number of new sexual partners individuals had during the pandemic.
Minorities, low income individuals impacted more
Social determinants of health—which are defined as the conditions in the environments where people are born, live, learn, work, plan, worship, and age—affect a wide range of health and quality-of-life outcomes and risks. Those who are already experiencing disparities in health, or who also suffer insecure housing or food sources, are at greater risks of experiencing STDs, local health departments say.
“Unfortunately, through no fault of their own, minorities and poor individuals have historically had adverse health outcomes when comparted to wealthier non-minority groups,” Suffoletto said. “Disparities exist with racial and ethnic minorities having higher rates of STDs compared to whites. Certain social conditions such as poverty and low education levels make it difficult for individuals to remain sexually healthy.”
Individuals who have also experienced racism in the health care system, such as Black people and other minorities, has led to distrust in the system, Suffoletto said.
Officials: ‘Know your status’
Health officials recommend individuals get tested and know their STD status. All sexually active women younger than 25 years should be tested for gonorrhea and chlamydia every year, according to the CDC. Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STD should also be tested for gonorrhea and chlamydia every year. Additionally, sexually active gay, bisexual, and other men who have sex with men should be tested least once a year for syphilis, chlamydia, gonorrhea and HIV. Those who have multiple partners should be tested more frequently.
“There’s a stigma around these things,” said Nate Smith, communications coordinator for the Clark County Combined Health District. “Breaking down that stigma and making folks comfortable to come see us is definitely a priority.”
The Clark County Combined Health District offers a sexual health and wellness clinic to provide local residents with sex education, as well as has started a condom program where the department fills dispensers of free condoms at bars and other locations. They also try to get individuals connected with a primary care doctor is they don’t have one, in addition to getting individuals signed up for Medicaid if they don’t have health insurance.
“It should be a completely normal thing for people to come in and access condoms,” Shaw said. “I try to make it extremely comfortable for people to talk to me.”
Public Health - Dayton and Montgomery County is also similarly continuing outreach and education in affected zip codes, providing access to testing and care based on ability to pay, and helping eligible individuals sign up for Medicaid.
“Unfortunately STDs are going to be with us indefinitely,” Suffoletto said.
While STDs continue to around, individuals can help keep themselves healthy by by discussing their status with new sexual partners, getting tested before initiating sex, and practicing safer sex by using condoms.
“All of those things working together will help stop the spread,” Suffoletto said.
The national 2020 STD Surveillance Report found that at the end of 2020:
- Reported cases of gonorrhea and primary and secondary (P&S) syphilis were up 10% and 7%, respectively, compared to 2019.
- Syphilis among newborns (i.e., congenital syphilis) also increased, with reported cases up nearly 15% from 2019, and 235% from 2016. Early data indicate primary and secondary syphilis and congenital syphilis cases continued to increase in 2021 as well.
- Reported cases of chlamydia declined 13% from 2019.
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