M. Winston Tilghman, M.D., STD controller, San Diego County Health and Human Services Agency
Sheldon Morris, M.D., Assistant Professor, UC San Diego School of Medicine, studies infectious disease epidemiology focusing on the prevention of STI and HIV.
Related Story: San Diego's STD Rate Higher Than National Average
MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. Our top story today, the same types of diseases your high school health class teacher warned you about are having resurgence in San Diego. The rates of sexually transmitted diseases in the county continue to climb in 2012, with increases surpassing the national average. Disturbingly, it is young people and gay men who seem especially vulnerable to contracting STDs despite years of warnings from public health campaigns. I'd like to welcome Doctor Winston Tilghman and Doctor Sheldon Morris. Welcome to the program. For a moment, take us back to the high school health class I was talking about. What diseases are included under the heading sexually transmitted diseases?
M. WINSTON TILGHMAN: The primary three diseases highlighted in this report from the CDC are gonorrhea, chlamydia and syphilis.
MAUREEN CAVANAUGH: And how does the county track the rate of STD infections? Is it the CDC?
M. WINSTON TILGHMAN: No, we actively trace the rate of infections, and send reports to the county and public health services, as well as laboratories that run diagnostic tests that turn positive for these diseases.
MAUREEN CAVANAUGH: How much do these latest numbers show the rate of infection rising in San Diego?
M. WINSTON TILGHMAN: From 2011 to 2012, the rates of a chlamydia increased by 6%, gonorrhea have increased by 19% and the secondary and primary syphilis increased by 12%.
MAUREEN CAVANAUGH: Is that a disturbingly high increase?
M. WINSTON TILGHMAN: That is a cause for concern, what we're seeing at the national level, although our rates have increased over the national average, in general our actual rates are still comparable to and lower than other metropolitan areas in California. The important thing to remember is that these are important diseases and they are increasing in prevalence. Also we have been doing a better job of screening for these as well. I think there's also increase of prevalence there.
MAUREEN CAVANAUGH: When you get this information sent back to you, you compile the numbers and so forth. Do you find that the rate of increases affecting San Diego across the board or are specific populations at risk?
M. WINSTON TILGHMAN: There are specific populations at risk. For chlamydia, the majority of places are in young women aged twenty-five and under and although Caucasians have the highest total number of cases reported, we're seeing higher rates in African Americans as well as Hispanics. For gonorrhea less a third of the cases are women, we're seeing our biggest increases are in males, and men have sex with other men also affected by this and for syphilis, as is occurring at the national level, men who have sex with men make up 85% of cases.
MAUREEN CAVANAUGH: The rate of increase is expanding in these populations. Doctor Morris you study infectious diseases. Is this increase in STDs is a surprise to you?
SHELDON MORRIS: I don't think so, we have always given the message out but there is a new cohort of people and as you've seen most of these people are under the age of twenty-five. Most of the groups that we target screening to our age 15 to 25 to they have heard those messages and they still do what they do and we have a lot of younger single people in San Diego and being metropolitan, there is a fair number of people having different partners or new partners and that is where it is prime for STDs to spread it's sort of like a rising and tide, where some groups get more than others because the dynamics of sexually transmitted diseases, where you have a group such as men who sex with men who are much smaller populations and is very concentrated and you see more impact in the group.
MAUREEN CAVANAUGH: Are these the same diseases that have been always there, or are new STDs developing new strains and need new treatments?
SHELDON MORRIS: They are the same diseases. It takes an extra push to get rid of them. The gonorrhea we are seeing a lot of drug resistance and we know we have good drugs against them but there has been reports of resistance to known antibiotics that we use for gonorrhea, so we do not have superbug gonorrhea yet, but we're trying to plan ahead of time to intercept that, and that would be a problem.
MAUREEN CAVANAUGH: What are the standard treatments for STDs?
SHELDON MORRIS: Antibiotics. These are bacteria that are easily treated with antibiotics. Same thing for chlamydia and gonorrhea. The issue is that there is not a lot of impetus to develop new antibiotics for drug companies, so I targeting STDs is not a priority for them financially. That may be one of the reasons but we need new drugs to be developed to keep on pace with rising resistance.
MAUREEN CAVANAUGH: Is it possible for people and especially women to have a STD and not know it?
M. WINSTON TILGHMAN: It is possible for all three of these diseases for people to have the disease and be asymptomatic and not know it. This is critically important, because if untreated many of these diseases can lead to severe complications in particularly women. Chlamydia and pelvic inflammatory disease and ectopic pregnancy.
MAUREEN CAVANAUGH: How does how long does someone have the disease for that symptom to develop?
M. WINSTON TILGHMAN: The complication rate is low, but the longer untreated, the higher the risk of complications developing.
MAUREEN CAVANAUGH: When and how often should people get tested for STDs?
SHELDON MORRIS: Depends on the risk, so a big push as Doctor Tilghman noted about the morbidity we see in women, every sexually active woman under the age of twenty-five should get screened yearly and if they are going to look primary care to provider, we have a reminder if they want screening, and they should say yes because those are the people who may be asymptomatic and should be tested. Other people, when they are pregnant and that is another target group of people at risk. If people are in the special populations such as men who have sex with men or have new partnerships, they can get screened every year for these diseases and sometimes we do not screened for all of them and it is best to talk to the provider for what they need to be screened for as there is broad range of STDs and most people are at risk for a smaller number of those.
MAUREEN CAVANAUGH: When you talk about screening what does that entail?
SHELDON MORRIS: It is easy now, and there was a day when we had to put a swab in someone's penis. But we do not have to do that anymore. The test is very easy now people who are at a risk for syphilis get a small amount of blood drawn and pair that with HIV testing, or for people getting chlamydia and gonorrhea screening, it's a urine test but as Doctor Tilghman noted that it is also people having anal sex that need an anal swab or oral sex and we think that there are some cases in groups where it can be very high.
MAUREEN CAVANAUGH: Is this the type of thing that a primary care doctor with ordinary look for a screened for it the normal physical exam?
M. WINSTON TILGHMAN: I think that a lot of primary care present providers are screening for the diseases based on the sources of our reports of chlamydia and gonorrhea in particular. There is also always room for improvement. With all of the things on the plate of primary care providers, it is often easy to pass over sexual health issues, and sometimes discussing sexual health issues makes people on uncomfortable but providers and patients, so this gives us a good opportunity to try to increase medication between patients and providers regarding diseases.
MAUREEN CAVANAUGH: I understand there's a free home test that is being offered to women in San Diego County for gonorrhea and chlamydia, tell us about that.
M. WINSTON TILGHMAN: The program that your you are referring to is called ìDon't Think No. This was started in 2009 in Los Angeles County and was very successful. The program offers a home screening test to women ages 20-25 and it is free and confidential. They can receive their results through a password protected website one week after sending in the sample. They can be directed to people and places that can they receive treatment.
MAUREEN CAVANAUGH: Have a lot of people taken advantage of that, andhow is that going?
M. WINSTON TILGHMAN: It is in early stages and we're excited about it and hoping to get the word out to people who need it.
MAUREEN CAVANAUGH: Doctor Morris, STDs are a concern because of the connection with HIV, talk to us about that.
SHELDON MORRIS: I think we widely recognize that people who have the sexually transmitted diseases are more susceptible and may be more likely to spread HIV. It makes sense that you have information going on in this may make you more susceptible. That is also another reason why we would like to treat all groups and get everyone screened and groups such as men who have sex with men who have a high risk of being exposed to HIV and having one is making you more likely to get the other and more likely that you make it guess is the best estimate that we have, so it is important to treat the STDs to reduce their HIV transmission risk as well and this is why we need to find screening in public settings such as STD clinics and community centers where we're seeing special populations and people reporting to the primary care providers.
MAUREEN CAVANAUGH: And safe sex to stop the transmission of HIV and to stop the transmission also of STDs, using condoms and monogamy, would that indicate when someone comes to your office with an STD, that they are not practicing safe sex and are more at risk for STDs and HIV?
M. WINSTON TILGHMAN: In general that is true that they are transmitted the same way, HIV generally you do not get easily through oral sex or with general sex, you might expect that people with HIV or STDs are having unprotected sex, but is complicated with men who have sex with men who choose their partners based on their HIV status, and if you are having a lot of men who have sex with men who are HIV-positive have sex with other positive men they do not tend to use condoms but they are not at risk of getting HIV because they already have it.
MAUREEN CAVANAUGH: You talked about home testing for women under age 25, is there any other way that San Diego County is working to outreach for a new safe sex public health campaign in light of these statistics for STDs rising in San Diego?
M. WINSTON TILGHMAN: We're also involved in programs to increase screening for STDs in the juvenile population in the county, in respect to syphilis we are gathering a group of community members and providers from communities most affected by syphilis in order to develop a strategy and increase community involvement and we also run a dedicated STD clinic so people who do not have healthcare providers can receive as the diagnostic treatment services.
MAUREEN CAVANAUGH: I want to thank you both for coming in to talk about this important topic. I have been speaking with Doctor Winston Tilghman and Doctor Sheldon Morris, and thank you both very much.