Despite a drop in numbers by 2020, San Diego health experts expect sexually transmitted disease rates to continue to climb to historically high levels – and marginalized groups, such as people of color and members of LGBT communities, are hardest hit.
Bacterial sexually transmitted diseases have been on the rise for years. In the past two decades, San Diego County’s chlamydia rate has more than doubled. Gonorrhea has tripled. And the rate of syphilis in 2020 was more than 50 times what it was in 2000.
Social alienation measures implemented in the early part of the epidemic may have contributed to a decline in these rates by 2020, but the district official managing the STD public health strategy warns that the latest data probably do not indicate a decline.
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“I do not think it indicates the long-term trends we can expect,” said Dr. Winston Tilgman, district STD inspector. “
While the epidemic has disrupted society in ways that have reduced the spread of sexually transmitted diseases, experts said it has apparently also curbed the tests. Health care facilities have restricted outpatient services, and patients may have been reluctant to risk exposure to corona for STD testing.
With limited routine testing, asymptomatic venereal diseases may not have been detected, Tillegman said, and some of the infections were likely treated based on patients’ symptoms without a positive test.
Tilgman noted that STD rates have already started to rise again towards the end of 2020.
“We’re probably going to see trends similar to what we saw before COVID,” he said.
While many venereal diseases can be prevented and cured, the rates growing in the area pose a risk to public health. Infections that are not caught and treated early can have lifelong or fatal consequences. In addition, gonorrhea became more difficult to treat as it grew antibiotic resistant.
“There are problems that need to be addressed so they need to be taken seriously,” Tillegman said.
Infections transmitted through sexual contact do not affect the population to the same extent. Young people are at higher risk. Colored people usually have higher rates of STDs than white people. Men who have sex with transgender men and women are more likely to get infections.
Eric Walsh-Bohi, an assistant professor at the University of San Diego School of Public Health, said these groups are at higher risk because of social health factors.
“Social factors for health are the things in daily life that help keep you healthy or make you sick,” he explained. “Poverty and drug addiction, addictions, lack of access to health services, health insurance, as well as things like housing and housing.”
Social networks can play a huge role in sexual health, Walsh-Bohi added, so rates vary widely by geography as well. For example, South Bay has a much higher prevalence of chlamydia than the Eastern Province.
Walsh-Buhi also led a CDC-funded research project in South Bay that recruited young Latinos to conduct a community needs assessment. This group eventually launched a digital media campaign to raise awareness of sexual health issues in its community.
“Obviously these are cultural and geographical communities,” Walsh-Bohi said. “If the STD rate is high in this community, then every individual in this community is more likely to be infected with STDs.”
More money, less sexually transmitted diseases?
San Diego’s long-term growth in STD rates is following a national trend. New data released this week from the Centers for Disease Control and Prevention shows that while chlamydia dropped in 2020, rates of other sexually transmitted diseases like gonorrhea and syphilis continued to rise.
The explosion in cases across the U.S. occurred while funding for STD prevention was weakening, according to the National Coalition of STD Managers, and studies show that this type of funding is associated with lower infection rates.
In light of the rise in STD rates, Walsh-Bohi called for more public health funding.
“You’re not going to see things like syphilis walking or gonorrhea walking,” he said. “Another thing we need to fight is the stigma of even talking about it and making it a public health priority.”
The San Diego County has seen an influx of funding in recent years to fight sexually transmitted diseases. From 2016 to 2021, state funding distributed to the county increased from $ 508,000 to $ 1.1 million per year. And in 2016, the state enacted California’s Healthy Youth Act, which aims to provide children with “comprehensive sexual health education and HIV prevention education.”
But so far, it is unclear how these changes will affect STD rates in the region, Tillegman said.
Meanwhile, the treatment of these diseases – bacterial venereal diseases, as well as viral venereal diseases such as HIV, herpes and human papillomavirus – costs billions of dollars every year in the United States.
HIV rates continue among people of color
Unlike most other sexually transmitted diseases, the number of new HIV infections in San Diego County has been on the decline for many years.
“You get a drop and then it works out for a few years and then you get another drop,” said Samantha Tweeten, an HIV epidemiologist from San Diego County.
Twitter has attributed to the epidemic a sharp decline in new HIV cases by 2020.
“I just do not think people have been tested,” she said, adding that an initial count for 2021 indicates that the number of new cases has jumped to about 400, similar to data seen before the epidemic.
“The lower incidence – the number of new HIV infections – may be related to actual prevention strategies and perhaps more awareness,” said Dr. Gabriel Wagner, an infectious disease specialist at UC San Diego Health. posture.”
As with bacterial sexually transmitted diseases, certain populations are at higher risk – younger men, especially those who have sex with men, along with black and Hispanic men and transgender women.
In the past five years, the rate of new diagnoses of HIV among Hispanic people in San Diego County has more than doubled that of white people. The rate of blacks was 3.8 times higher.
Wagner stressed the importance of testing and prevention for the prevention of HIV infections. High-risk people can use pre-exposure prophylaxis, or PrEP, a drug taken daily to reduce the risk of contracting HIV. Condoms are also very effective in preventing the spread of the virus and other sexually transmitted diseases.
But gaps remain. As of 2019, only about a quarter of the people who needed PrEP would continue with it, according to data released by the U.S. Department of Health and Human Services. And data suggest that many people are not taking medications to suppress their viral load, which can prevent both the spread of the virus and complications from HIV infection.
“Unfortunately, the groups I mentioned earlier, like Latin men having sex with men, often do not have easy access to such testing and prevention services,” Wagner said. “It can also contribute to high gaps and rates of HIV and STIs.”
Studies show that stigma can cause people to delay treatment or avoid testing and prevention methods like PrEP.
Wagner recalled a Spanish-speaking patient who first saw in 2018 that after years of contracting HIV, they began to suffer complications.
“Several years ago, someone told him about the diagnosis, but he decided to take it out of his mind,” he said. Wagner believes that the stigma associated with HIV, coupled with the lack of culturally sensitive care, prevented the patient from addressing the problem when he or she first encountered it. “The situation went terribly wrong and he had to be hospitalized.”
Wagner, who identifies as Hispanic and speaks Spanish as a native speaker, said he was able to talk to the man and start treating his infection.
“Part of the reason he may not have connected to the healthcare system is because he could not find a Spanish speaker,” Wagner said. “He found one with me and now he has great control over his HIV infection and he is very successful.”