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May 8, 2019

Sexual infections on rise in Worcester, beyond

Photo | Courtesy Angelique Bouthot from Planned Parenthood offers educational programs on the prevention and detection of sexually transmitted infections.
Photo | Courtesy "Reach people before they start having sex and educate them on the fact that all it takes is one unprotected encounter," says Dr. Michael Burns, the chief of emergency medicine at Saint Vincent Hospital.

With easier testing methods via advanced science and the ability to communicate to the masses with the advent of things like social media, one would think sexually transmitted infections would be on the decrease.

But one would be wrong.

Statistics indicate the exact opposite is true in the U.S., especially in Massachusetts, even more so in urban centers like Worcester. Rates of STIs like gonorrhea, chlamydia and syphilis are not even holding steady, but increasing. 

From 2013 to 2017, the federal Centers for Disease Control & Prevention reported a 22-percent hike in cases of chlamydia in the U.S.; 67 percent more cases of gonorrhea and a whopping 76-percent rise in reported instances of syphilis.

In Massachusetts, the picture is even more grim.

From 2012 to 2017, the CDC reports chlamydia up 47 percent; reported cases of gonorrhea up 200 percent; and syphilis up nearly 120 percent over 2012.

Perfect storm

Funding cuts mean fewer prevention-education resources for vulnerable populations such as those ages 15-24, the uninsured or underinsured, and less access to affordable care, said Dr. George Abraham, chief of medicine at Saint Vincent Hospital in Worcester. Board-certified in internal medicine and infectious disease, he is a professor of medicine at UMass Medical School in Worcester.

Reasons for the steady rise in STI numbers are multifaceted, Abraham said, but involve a lack of funding when it comes to prevention.

“This is all a good motivator [to fix it] before it is a staggering problem. We don’t want to be No. 1 in STIs,” he said.

Where in the past people were urged to have frank conversations about sexual history with potential partners, as a society we’ve gone past that point now, Abraham said. He urges regular STI testing.

“There is no such thing as being too careful,” he said, with many infections not producing any symptoms, their host unaware. “You never know the status of a person by looking at them. You can’t tell if they’re harboring infection.”

Dating apps often serving as vehicles for casual-sex hookups are likely negative contributors to the overall problem as well, said Abraham. Those engaged in risky behaviors like opioid use can be more likely to have multiple sex partners and STIs.

Rising rates

Chlamydia and gonorrhea are the No. 1 and No. 2 most common STIs in the nation, according to the CDC. The Massachusetts Department of Public Health says chlamydia is the most-frequently reported infectious disease in the Bay State overall.

In many ways, chlamydia and gonorrhea are similar.

Someone can have these conditions and not have any symptoms; vulnerable populations are men who have sex with men, teens, pregnant women and older women with multiple partners; and damage from the infections – such as infertility and scar tissue – can’t be reversed. Both conditions are curable (though there are new, more-challenging antibiotic-resistant strains of gonorrhea). Both conditions can be passed from mother to infant during childbirth.

Gonorrhea hit a historic low in 2009, according to the CDC, but rose more than 75 percent since then. The federal agency reports two-thirds of recent chlamydia cases were in the 15-to-24-year-old age group. 

Massachusetts had 1,474 cases of syphilis in 2017, according to CDC data. Though on the rise, it’s not reported as often as gonorrhea and chlamydia are. Treated with penicillin, syphilis develops in stages, beginning with a painless sore. Left unchecked, it could result in damage to the brain, nerves, eyes or heart.

Cycle of scripts

Saint Vincent Chief of Emergency Medicine Dr. Michael Burns pointed out better testing or more reporting of these infections are not the reason for the higher numbers. There is no spike, but rather, a gradual, steady increase.

Burns is on the frontline of diagnosing and treating gonorrhea, chlamydia and syphilis. He said he is writing prescriptions all the time for chlamydia and gonorrhea, or folks infected with both, in the Worcester ER.

“We’re asked to do more for less,” Burns said of healthcare in general, with dwindling clinic allocations and less access to primary health care.

The hospital has a dedicated follow-up nurse for patients who test positive and don’t come back for a prescription or whose phone numbers are no longer in service – with partnerships at area shelters and social service programs to track them. Burns calls it a tremendous amount of work, with certified letters, phone calls to primary care physicians, and other attempts. It’s a concentrated effort to help control the spread, but one he said Saint V’s does well.

Syphilis test results takes longer, said Burns, requiring a blood test.

From an educational standpoint, Burns said, basic information – such as the fact most STIs are asymptomatic; people can transmit them without knowing it, even years later; and oral or implantable contraceptives don’t prevent against infection – are just not widely enough understood.

“Get to them as early as middle school,” he suggests. “Reach people before they start having sex and educate them on the fact that all it takes is one unprotected encounter. The pill doesn’t protect you from STIs, and you need to be tested,” and start additionally using barrier methods like condoms.

Burns is an advocate for regular testing for the sexually active, testing which has come a long way.

“It’s easy now,” he said. “We test the urine for chlamydia and gonorrhea.”

An understanding of the magnitude of the local STI problem is not as strong as it could be for primary care providers, Burns said. But the national nonprofit Planned Parenthood, with a sexual-health focus, is a trusted resource for the hospital.

Education edge

Worcester has significantly higher STI rates than neighboring areas, according to Planned Parenthood.

In Worcester since the early 1980s, Planned Parenthood’s education efforts have been developed and based upon what the community lets us know they need, said Angelique Bouthot, community outreach specialist.

Her position is one of them: She was made full time over a year ago. The staff expanded to include a full-time bilingual team member for parent education.

Planned Parenthood has STI treatment and testing at its Worcester, Fitchburg and Marlborough locations, free or at a reduced cost, if a patient is uninsured or low income.

The reason STIs are no longer referred to as STDs, or sexually transmitted diseases, said Bouthot, is it wasn’t totally accurate.

“Diseases usually have symptoms,” she said, making STI a better term to help dispel the myth a person would know it if they had an STI without being tested.

Planned Parenthood operates training programs for schools, parents and professionals on how to educate on sexual health. The nonprofit dedicates resources to translation services to communicate to patients in all languages.

This kind of education is needed, Abraham said.

He suggested even combining education on barrier methods like condoms as part of an annual physical, along with things like firearm safety and seatbelt use.

“We want parents to proactively talk to their children about sexual health, starting early, with building blocks,” such as personal boundaries, said Bouthot. The result is parents who are “reliable and askable … parents who have grown in their knowledge and comfort level.”

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