The Centers for Disease Control and Prevention (CDC) recently released its annual report on Sexually Transmitted Disease (STD) surveillance. According to the report, rates for gonorrhea and syphilis in the St. Louis region were above both the state and national rates. In addition, there has been an alarming rise in the number of congenital syphilis cases, which is a reminder to local health officials and clinicians to vigilantly adhere to all CDC screening recommendations. April 10-16 is STD Awareness Week, and the City and County health departments would like to use this opportunity to raise awareness about Sexually Transmitted Infections (STIs), reduce STI-related stigma, and ensure that residents have the tools to prevent, test for and treat STIs. STIs are a regional problem, and the City and County remain committed to a multi-pronged, coordinated approach to the issue.
What the data show
STI rates remained high in 2020. St. Louis County’s gonorrhea and syphilis rates increased by 13 percent from 2019 to 2020, and preliminary data from 2021 show that they continued to rise. Reported chlamydia rates decreased by 10 percent in 2020, but this is almost certainly the result of a COVID-related decrease in screening during the spring and summer of 2020, not a real decline in infections. In St. Louis City the rate of gonorrhea cases increased by 5 percent from 2019 to 2020. The incidence rate of syphilis in the city did not change significantly, but rate of chlamydia cases decreased by 15 percent in 2020. Once again, we believe that the latter is due to the result of decreased testing during the pandemic.
STIs affect sexually active people of all ages, but disproportionately affect people aged 15 to 29 years. In 2020, 3.5 percent of St. Louis County residents aged 20-24 years were diagnosed with chlamydia, and 1.7 percent were diagnosed with gonorrhea. In St. Louis City, 63% of chlamydia cases diagnosed in 2020 were among women, and the rates were the highest in women 15-24 years, with an incidence rate of 6,071 per 100,000 people.
It is particularly concerning that syphilis rates have also continued to rise, including a 176 percent increase in new syphilis cases among women in St. Louis County between 2016 and 2020. This has been accompanied by a heartbreaking resurgence of congenital syphilis. Congenital syphilis occurs when syphilis is passed on from a mother to their baby during pregnancy. It is a life-threatening illness that can lead to miscarriage, stillbirth, or early infant death, and babies born with congenital syphilis that survive, experience lifelong physical and neurologic problems. There were 4 cases of congenital syphilis in St. Louis County in 2020 (3.8 cases per 10,000 live births), and preliminary data show a steeper increase in 2021. In St. Louis City, there were 10 cases of congenital syphilis in 2020, which is double the 5 cases reported in 2019.
Every instance of congenital syphilis is preventable – screening and treatment of syphilis in pregnancy can prevent every single case. The City and the County encourage all pregnant persons to seek prenatal care, and all clinicians that treat pregnant persons to screen their patients for syphilis during the first trimester and at 28 weeks gestation of their pregnancy.
What are the City and County Health Departments doing
STIs continue to be a leading public health threat in the St Louis region. All STIs are preventable and treatable. As such, the City and the County health departments will work with local health systems to increase access and uptake of STI prevention, testing, and treatment and remove barriers to healthcare access, particularly among young people. Both health departments are heavily investing in STIs and HIV prevention, testing, and treatment efforts.
Unfortunately, the same health disparities that are observed in other diseases can be seen in STIs. In 2020, the chlamydia rate among Black St. Louis County residents (1,581.0 cases per 100,000) was 11.5 times the rate among white residents (136.7 cases per 100,000). The gonorrhea rate among Black residents (1,064.3 cases per 100,000) was 19.2 times the rate among white residents (55.4 cases per 100,000). The early syphilis rate among Black residents (74.5 cases per 100,000) was 14 times the rate among white residents (5.3 cases per 100,000). Both the City and the County are working hard to address these disparities and hiring and training more staff to support patients with syphilis, HIV, gonorrhea, and chlamydia throughout their diagnosis and treatment. The City and the County have also made investments to increase case investigations and partner follow-up in order to identify STI cases and link them to care quickly.
What should residents do
Sexual healthcare is healthcare. If you have not seen a doctor in some time, please make an appointment. This is especially true if you are having sex. We recognize that many in our community do not have access to regular primary care – the City and the County have a variety of confidential, free, and low-cost options available to you like the Health Stop at the City, the Sexual Health Clinic at the County, the SPOT, and local Federally Qualified Health Centers (FQHCs). In addition, if you are having sex or considering having sex, know that STIs are a risk and consider prevention methods such as condoms and Pre-Exposure Prophylaxis (PrEP) to prevent HIV.
Combatting the spread of STIs requires a regional response
We can prevent the spread of STIs, and health officials are reminding clinicians, schools, parents, and guardians to talk candidly to children and young adults about the risks associated with sexual activity and the steps they can take to protect themselves.
“We, as a region, must act swiftly to prevent and control the spread of STIs in St. Louis,” said Dr. Faisal Khan, acting director of the Saint Louis County Department of Public Health. “While we have lost ground during the on-going COVID-19 pandemic, now is the opportunity to regain it and continue to educate those most affected about safe sex practices.”
“We are committed to working with all of our regional and community partners to help bring down local STI rates,” said Dr. Mati Davis, director of health for the City of St. Louis Department of Health, “This has to include the continued coordination of regional prevention efforts, screenings, and treatment.”
The City and County health departments are taking advantage of the lessons learned, and the partnerships built during the COVID-19 pandemic response to take aggressive action to combat the spread of STIs. The Saint Louis County Sexual Health Clinic and the St. Louis City Health Stop, along with regional partners like the SPOT, Williams and Associates, and local FQHCs provide confidential testing and treatments for all STIs, often for free or at low cost to their clients. Both departments also work with local coalitions like the St. Louis STI Regional Response Coalition (STIRR) and Fast-Track Cities St. Louis to ensure a coordinated approach to sexual healthcare in the St Louis region.
Said Dr. Khan, “There are a lot of factors at work here and a regional response is required that addresses not only the disease, but also those factors that contribute to the problem such as the lack of health insurance, an inability to cover medical costs, or even the lack of transportation to needed services.”
Added Dr. Davis, “Addressing the problem of STIs will require innovative coalitions, programs, and activities such as the Community Approaches to Reducing STDs (CARS) project. The Supporting Positive Opportunities for Teens – known as The SPOT – is another existing example of a community-based model worth replicating to enhance education and screening opportunities throughout the region.”
The two departments have established strong public-private partnerships with community-based organizations, hospitals, health centers, and other agencies to identify additional programs and efforts that are effective at reducing STI rates.
For information about the Health Stop, visit the Health Stop website or call 314-657-1584.
For information about the Saint Louis County Sexual Health Clinic, visit the Sexual Health Clinic website or call 314-615-9736.
For information about The SPOT, please visit TheSPOT.wustl.edu.