The rates of sexually transmitted diseases such as chlamydia, gonorrhea and syphilis have been skyrocketing in Sonoma County since 2008 as the spread of HIV has declined slightly, raising alarms among local health care professionals and county public health officials.
The seemingly contradictory trends have local health experts trying to figure out the possible causes. Some point to mobile “hookup” apps that have greatly facilitated consensual and casual sex, or the use of HIV prevention and treatment methods that inhibit the spread of the virus but may be encouraging risky behavior such as no longer using condoms.
Others say county budget cuts have adversely affected prevention and treatment programs aimed at reducing sexually transmitted infections, or STIs. Meanwhile, the number of Sonoma County residents being screened for STIs has grown, likely due to increased access to health care under Obamacare and more intensive screening.
Between 2008 and 2016, the number of reported cases in Sonoma County of chlamydia rose from 910 to 1,893; gonorrhea cases jumped from 69 to 554; and syphilis went from a low of four to 63.
“I do not have the answer for all the reasons why there’s an increase in sexually transmitted infection — people are having a lot of unprotected sex and our ability to prevent HIV transmissions is improving,” said Dr. Karen Holbrook, Sonoma County’s deputy health officer.
Holbrook said the ability to inhibit the spread of HIV may be causing some to relax their use of “barrier methods” such as condoms. She said the spread of the HIV virus can essentially be halted through the strict use of HIV medicines by those who are HIV positive and pre-exposure prophylaxis, or PrEP, by those who are HIV-negative but engage in risky behavior.
But these methods do not prevent transmission of other STIs, Holbrook said. She said there is likely also a general lack of understanding of the risks of unprotected sex.
“I think there are also people who are having sex who don’t understand the risk and they don’t understand that the partners they’re having sex with are at risk for all of these infections,” she said.
Infection rate soars
HIV treatment therapies effectively reduce the “viral load” in a person’s body, inhibiting their ability to transmit the virus to others. For those who are not HIV positive but at substantial risk of getting it, PrEP has been shown to significantly reduce that risk by as much as 92 percent, according to the federal Centers for Disease Control and Prevention.
Dr. Gary Green, head of infectious disease at Kaiser Santa Rosa Medical Center, said the increases in STI rates were nothing short of “astronomical.” He is convinced the spikes in STI rates were due to the widespread use of online apps that greatly facilitate casual sex. He made a distinction between “hookup” apps like Grindr and Tinder and “dating” apps like Match.com or eHarmony.
“Technology has made sex incredibly convenient,” he said.
Green said Truvada, an HIV antiviral drug used for PrEP, has been a game-changer in terms of reducing HIV infections. But it has its downsides, he said.
Condom use declines
Since the mid 1990s, when AIDS “miracle drugs” began saving lives, health care providers used a multipronged strategy to fight the spread of HIV, Green said. These strategies included recommending patients limit their number of partners, know their partners’ status, use condoms especially for anal sex, and use HIV drugs to reduce their viral load and, consequently, lower their risk of transmitting the virus.
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