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STD rates become focus of local health initiative

Thursday, April 10, 2008 | 10:46 p.m. CDT; updated 7:32 a.m. CDT, Sunday, July 20, 2008

COLUMBIA — Chlamydia and gonorrhea infection rates in Boone County exceed the state average and even surpass those in St. Louis County, and local health officials are in the early part of a three-year effort to make sexually transmitted diseases a priority.

In 2007, Boone County had a chlamydia rate of 555.3 cases per 100,000 people compared to last year’s statewide rate of 399.2 cases per 100,000 people, making Boone County’s rate 39 percent higher. Last year, Boone county’s rate of gonorrhea cases was 232.8 per 100,000 people, which is 37 percent higher than the statewide average of 169.2 cases per 100,000 people.

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“When you have rates that exceed state averages, that’s something to worry about,” said Stephanie Browning, director of the Columbia/Boone County Health Department. “STDs lead to other diseases such as chronic pelvic pain and infertility. This is an area we can bring people together and have some impact.”

At its second annual Health Assessment Initiative meeting in February, the Health Department decided to use Centers for Disease Control and Prevention guidelines for STD prevention in a two-year plan.

The guidelines include informing “policy makers ... about the health issues and need for fundraising.”

The Health Department has identified the need for a full-time disease intervention specialist who would “make sure a person’s sexual contacts are treated,” Browning said. Funding for the position will be submitted as a supplement request as part of the Health Department’s budget request to the City Council for the 2009 fiscal year.

Mary Martin, the Health Department’s public health manager, said until someone can be hired the staff is looking for ways to convince infected patients to reveal who their partners are so that they can also be treated to prevent the further spread of disease.

The Health Department wants to train its clinicians as a way to improve screening services and make treatment more efficient in reaching patients in a timely manner.

Currently, the Health Department provides free family planning and STD services five days a week by appointment and on Tuesday evenings as a walk-in clinic.

“We have a limited number of nurse practitioner staff and limited hours,” Martin said. “We have women’s health clinics for reproductive health planning. We’re not going to give that up to accommodate more STD visits.”

Martin said the Health Department is looking into creating a marketing campaign that focuses on at-risk populations to answer general questions they might have so they don’t unnecessarily come into the clinic.

“It’s not as efficient to educate people one by one in a clinic as it is to put out a message at large,” Martin said.

One of the desired outcomes of the local initiative is to better reach minority populations. The targeted groups are teenagers ages 15 to 19; women of childbearing age; non-white, minority populations; and persons testing positive for an STD more than one time within a year.

In 2007, there were 2,549 STD-related visits to the Health Department. Forty-three percent of the patients were white and 22 percent were black, according to the Health Department’s data. While those numbers align closely to the population totals at large, Martin said, a black person was 10 times more likely to test positive for an STD than a white person.

Two MU graduate students, Caren Moore and Todd Robinson, are working to determine how to best educate teenagers in the area. So far, they have interviewed all staff members at the Health Department working with STDs. The students’ next step is to sit in on adolescent focus groups to gauge their thoughts on sexual intercourse.

“They are basically trying to determine, ‘How do we reach the population at risk?’” Martin said.

One option is to use Web-based strategies such as a Facebook page that has a link to a private e-mail address where people can send their questions. Those questions would then be screened to determine if the situation warranted a clinic visit.

In the action plan, the Health Department said this “intervention” would be enacted in year two.

Within the next year, the Health Department will update its Web site to make STD information more accessible.

Every three years the Health Department is required by its contract with the state to review statistics and identify public health issues that need attention. Last year it completed the third leg of its outreach plan for chronic diseases, specifically diabetes and hypertension.

Black females from 13 to 18 years old in Boone County were much more likely to test positive for an STD than their white counterparts in 2007.

Eleven percent of black females in that age range from Boone County tested positive for Chlamydia compared to 2 percent for whites. Three percent of black females tested positive for gonorrhea, while 0.5 percent of white females tested positive.

Mike Herbert, an STD specialist with the Missouri Department of Health and Senior Services, said that because black females were more likely to come from an urban background, they were less likely to have insurance and access to screening for the diseases.

The race gap in Boone County reflects statistics reported in a recent study by the CDC.

The study looked at 838 girls, 14 to 19 years old, who participated in the 2003-04 National Health and Nutrition Examination Survey. The young women were tested for human papillomavirus, chlamydia, trichomoniasis and herpes. The study found that nearly half of black teenage females were infected compared to 20 percent of white teenage females.

In 2007, 191 cases of Chlamydia were reported for 13- to 18-year-old females in Boone County, for an overall rate of about 3.2 percent. The national rate for Chlamydia among females aged 14 to 19 was 4 percent in the CDC study.

Aneesh Tosh, a physician and assistant professor of adolescent medicine at MU, said that, in general, teenagers living in urban areas and belonging to lower socioeconomic classes are more likely to have an STD. “However, the most common STD, HPV, is not related to any socioeconomic demographic and anyone is at risk,” he said. “HPV can go from person to person and doesn’t care where you live.”

In the national study, HPV was found in 18 percent of the teenagers in the survey.

HPV is non-reportable in Missouri because the fact that it is so prevalent makes it unnecessary to survey the disease, Herbert said.

“We know where it’s at,” he said. “We survey diseases to see what populations are disproportionately affected. They developed a vaccine for HPV recently, which is an effective form of prevention. Otherwise, there is nothing else we can do as far as public health other than advocating for protected sex and abstinence.“

Martin said she doubted the validity of the national study, especially since it was based on a population of less than 900 girls. Since the study came out, Martin said, she has been trying to find out the research methods used but has been unsuccessful. CDC spokeswoman Nikki Kay said her agency stands by the validity of the study, which was presented orally at the 2008 National STD Prevention Conference in Chicago on March 10-13. Kay said she was “not entirely sure how the data was collected.”

Martin said a sample size of 900 girls was too small to extrapolate for the rest of the country.

“Maybe I’m being naive, but one of the things I do is work at an STD clinic,” she said. “I feel like it’s really hard to take this study seriously.”


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