Sonoma County reports rise in STDs

Skyrocketing rates of sexually transmitted infections such as chlamydia, gonorrhea and syphilis have local public health officials and medical professionals sounding the alarm in Sonoma County, even as new HIV and AIDS infections appear to be on the decline.

The rate of chlamydia rose from just under 1,000 to 1,645 new cases between 2008 and 2014; new gonorrhea cases have gone from 70 to 220 during that period. And new early-stage syphilis cases, which numbered about 5 in 2008, shot up to 40 in 2012 and remained high at 30 in 2014.

“We’re in the middle of an epidemic when it comes to cases of chlamydia,” said James Stafford, a physician assistant at Vista Family Health Center who specializes in STD case management.

Stafford, who for many years worked at the county’s STD clinic before it closed in 2008, said the increase in cases of syphilis - a serious bacterial infection that can lead to a number of health complications such as stroke, deafness, visual problems and dementia - is particularly troubling.

“Now we’re seeing more than ever,” Stafford said. “I don’t remember a time in my career when we saw so many cases of syphilis.”

Though the county recently said reports of new local HIV and AIDS cases declined over the past five years, the rise in other sexually transmitted infections is worrisome because STDs can increase the risk of HIV transmission.

The local trend mirrors similar increases observed across the Bay Area, California and the rest of the country, according to local, state and national health officials. They say reasons for the spike in rates are varied and complex. Possible causes include an increase in risky sexual behavior, the rise of anonymous online dating, the substitution of condoms for a new HIV prevention treatment called PrEP and less condom use in general.

“It’s happening here, but we’re not unique. This is a trend that’s occurring across the state and actually across the nation,” said Karen Holbrook, Sonoma County’s deputy public health officer.

Holbrook said another possible contributing factor for the increase in STD rates is the implementation of more aggressive testing. Increased screening recommendations from the federal Centers for Disease Control and Prevention, or CDC, may be catching more infections, she said.

‘No single answer’

Eloisa Llata, a CDC epidemiologist, echoed that theory.

“There is no single answer to explain why STDs are increasing this year. These are complex diseases that can be impacted by a number of factors,” Llata said in an email.

Llata said that among sexually active men who have sex with men, the CDC recommends annual screening and testing for syphilis, chlamydia and gonorrhea, or more frequently if the patient’s doctor advises. But testing and screening also is more frequently being performed in other body areas, such as the throat and anus.

“That may be increasing detection of chlamydia and gonorrhea infections, specifically among men,” Llata said.

Llata said that for primary and secondary stages of syphilis, cases have been increasing among gay men since at least the beginning of the millennium. She said that in 2014, 91 percent of all cases of primary and secondary syphilis cases were men. Of these cases where the gender of the partner was known, 83 percent were men having sex with men, Llata said.

Though cases of primary and secondary syphilis increased among this group in 2014, increases were observed among women and heterosexual men as well, she said.

One factor could be men who have sex with other men and then later transmit STDs to heterosexual women, a phenomenon researchers have observed in studies looking at HIV transmission, Llata said.

“That could be contributing to increases in syphilis” as well, she said.

That finding is reflected in Sonoma County.

County follows trend

According to county analysis of local syphilis cases, nearly all cases of syphilis before 2010 were diagnosed among men, with the majority found in men who had sex with men. But between 2010 and 2014, nine women were diagnosed with syphilis, “indicating a shift in epidemiology to include the heterosexual population.”

Of the 117 syphilis cases diagnosed between 2011 and 2014, 92 percent were among males. Of the men, 72 percent were white and 41 percent were HIV positive.

Though on the rise locally, the STD rates in general are lower than state and national rates, said Dr. Gary Green, chief of infectious disease at Kaiser Permanente Medical Center in Santa Rosa. County data shows that an exception occurred in 2012, when local rates for syphilis - eight cases for every 100,000 people - matched that of the state.

Kaiser cases up

Green said STD rates among Kaiser patients also recently have increased. He said that not all of the increases may be attributed to more thorough testing and screening, since Kaiser has for years run a full spectrum of STD tests for patients. If a patient comes in for a gonorrhea test, medical staff will order tests for other STDs as well, he said.

Among other possible reasons for the recent spike in STD rates is the advent of online dating and a relatively new HIV prevention treatment called PrEP, Green said.

Online dating makes “sexual behaviors much more accessible and also more anonymous,” he said.

PrEP, which consists of a single pill called Truvada and is taken daily, is a combination of two anti- retroviral drugs used to treat HIV infection. In a patient with HIV, the drugs suppress the “viral load” to keep the infection from progressing to AIDS.

But in patients who are not HIV positive, PrEP works to block the transmission of HIV. Green said that some men who have sex with men appear to be relying on the drug as a substitute for condoms. Green said than none of Kaiser’s patients currently on a regimen of PrEP have become HIV positive and yet some are testing positive for STDs.

Stafford, the physician assistant at Vista Family Health Center, said the some people view PrEP as a “panacea,” dismissing the need to “still wear a condom.”

Dr. Heidi Bauer, chief of the STD control branch for the California Department of Public Health, said some populations are more affected that others. In a comparison of 2013 and 2014 rates, the state found that teenagers and young adults into their mid-20s are a particularly risky group, because they are less likely to be married or engaged in a steady relationship and usually have more than one partner.

Antibiotics used

Bauer said the three main STDs - chlamydia, gonorrhea and syphilis - can be treated with antibiotics. She said there’s no “magic bullet” approach to reducing rates. Public health officials are working on a number of fronts including public health education, screening and testing, she said.

All say testing is an important tool in controlling STDs. Testing more frequently reduces the time between a positive test and antibiotic treatment. That means a shorter window where others are possibly being infected.

“A lot of these infections don’t cause symptoms,” Bauer said, adding that STDs sometimes go undetected until a patient goes to a clinic or their doctor and gets tested.

“We really recommend widespread screening and testing based on risk,” she said.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @renofish.