Highlights Need for Extra-genital Screening
and Reduction in Gonorrhea Morbidity in the U.S.
Washington, D.C. – A gonorrhea
treatment failure in a heterosexual man in the United Kingdom was reported in
the June 23rd edition of The New England Journal
of Medicine. This patient presented
with symptoms of an STD and tests of urine specimens and a throat swab came
back positive for gonorrhea. After receiving
dual treatment, his test of cure 15 days later showed that his urine specimen
was negative but his throat swab remained positive. It was not until nearly four months after the
infection was detected and after additional higher doses of the dual treatment
that the infection was cleared.
No treatment failures have been
reported in the United States, but this is the first reported treatment failure
of a patient treated with dual therapy reported in Europe. While this patient was eventually effectively
treated, this case is considered a treatment failure because the post-treatment
isolate was resistant to ceftriaxone and azithromycin (the recommended drugs to
treat gonorrhea both in the United Kingdom and the United States), all specimens
contained resistance determinants and identical sequence types, and reinfection
was deemed to be unlikely.
“This treatment failure is a wakeup
call for the United States: gonorrhea will develop resistance to the current
last line of drugs to treat it here in the United States,” stated William
Smith, Executive Director of the National Coalition of STD Directors. “To prepare for this reality, we need additional
drugs to fight this infection. But it is
also vital that we work to reduce gonorrhea burden, ensure correct treatment,
and have robust surveillance to monitor gonorrhea here in the United
States. And these functions are only
completed by robust funding of the STD public health system which remains
anemic and on the chopping block year after year,” continued Smith.
| A Statement from NCSD on a Confirmed Sexually Transmitted Case of Zika Virus in Texas | |
| | National Coalition of STD Directors (NCSD): on February 08, 2016 at 01:35:46 PM | For Immediate Release
February 4, 2016
Washington, D.C. – Earlier this week, health officials in Dallas
confirmed that a local resident contracted the Zika virus after having sex with
a partner infected with the virus while traveling in Venezuela. The Zika virus, most often transmitted by mosquitos,
is being increasingly reported across countries in the Americas, and approximately
30 people have tested positive for the Zika virus in the United States. Recent evidence suggests a possible
association from the Zika virus with birth defects in infants born to mothers
infected with this virus. While we do
not want to downplay the public health threat of the spread of Zika virus and possible
implications of infection for individuals and especially pregnant women, we
have several current and pressing STD epidemics in this country that have
reached the point of real crisis that need nationwide attention: rates for the three most commonly reportable
sexually transmitted diseases (STDs) in the United States (chlamydia,
gonorrhea, and syphilis) all increased in 2014, the first time since 2006.
We should not need one confirmed sexually transmitted case of a virus
which is rare in the United States to bring home a message about the risks of
an infection with possible side effects for pregnant women and their
pregnancies. Our current congenital syphilis
epidemic—which can cause birth defects, including stillbirth in many cases—is occurring
around the country at rates not seen in 15 years. As reported by the Centers for Disease
Control and Prevention (CDC) late last year, congenital syphilis increased by
38 percent between 2012 and 2014, and the rate for 2014 is the highest rate
seen since 2001. Congenital syphilis may
lead to serious health problems including premature birth, stillbirth, and in
some cases, death shortly after birth. | The Crisis of Syphilis in America: A Blog from NCSD's Bill Smith Coinciding with CDC Syphilis Summit | |
| | National Coalition of STD Directors (NCSD): on January 27, 2016 at 03:14:52 PM | 
Recent
data from the Centers for Disease Control and Prevention (CDC) show that for
the first time in a decade, the three most common STDs reported to health
departments – chlamydia, gonorrhea, and syphilis – are all up. Of critical concern is syphilis. For the third year in a row, reported cases
of primary and secondary syphilis – the stages where the infection is most
likely to spread – have increased by double digits. In 2012, syphilis increased by 11 percent, in
2013, by 10 percent, and in 2014, by a shocking 15 percent.
There
was not a single demographic that escaped these increases. Males and females, LGBT persons and
heterosexuals, and even babies experienced increases in syphilis. In fact, between 2012 and 2014, congenital
syphilis, which can be a disabling, and often life-threatening infection, increased
by 38 percent, to the highest rate in almost 15 years. Increases have also occurred in cases of
syphilis that are resulting in significant eyesight and vision problems,
including instances of complete and irreversible blindness.
Just
over a decade ago, syphilis elimination in this country was deemed within
sight. In 1999, the CDC launched the
Syphilis Elimination Effort, designed to bring health care providers, policymakers,
and community leaders together with state and local public health agencies, to
reduce syphilis rates. So how did we get
from there to here?
For
starters, since 2003, federal investments in STD prevention have been
stagnant. In fact, due to mostly flat
funding, the real buying power of those dollars has plummeted 36 percent. So while the CDC saw a public health
imperative to move toward syphilis elimination, there were no new dollars. State, territorial and local health
departments across the country charged with syphilis elimination valiantly moved
forward, but the weight of the work was overburdened by a lack of national
investment in these efforts and in public health.
According
to Trust for America’s
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| Desperately Awaiting Approval: When is a Rapid Syphilis Test Coming to Market? | |
| | National Coalition of STD Directors (NCSD): on December 11, 2014 at 01:45:01 PM |
I am about to embark on the fifth year of my tenure as the head of the National Coalition of STD Directors (NCSD) and while I can look back on much progress, it’s the work left unfinished that sticks in my proverbial craw. Foremost among these is the ongoing effort we have spearheaded to support the wide-spread use of a rapid syphilis test (RST) in the United States. Our work has been directed to industry partners to invest in bringing such a product to market, to the Food and Drug Administration to quickly approve such a device, and to prepare the ground in our own member public health departments and with other partners for the roll out of an RST.
Sadly, while we have toiled in the trenches, we have also witnessed an alarming increase in syphilis – here in a country, where just a few short years ago, we talked openly of eliminating syphilis and a funded, focused effort to make that happen was supported by the federal government.
For example, in California, primary and secondary syphilis rates rose 18 percent between 2012-2013, and a shocking 43 percent since 2011. Like many STDs, significant heath disparities exist for syphilis. In California, this has meant that in 2013, rates of primary and secondary syphilis in African-American men were 323 percent higher than the rates in California as a whole. But California is not alone. In Georgia, primary and secondary syphilis rates have increased 38 percent between 2011 and 2012. In Texas, rates have risen 37 percent in that same time period and in New York State, 13 percent.
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| STD Screening and PrEP in Chicago | |
| | National Coalition of STD Directors (NCSD): on May 21, 2014 at 12:02:41 PM |
By Tarek Mikati, Medical Director, HIV/ STI Division, Chicago Department of Public Health
The Chicago Department of Public Health operates five walk-in
STD clinics with an annual visit number of 20,000 clients. The percentage of men
who have sex with men (MSM) who frequent these sites ranges from 10%-44% of the
total male clients. A significant
proportion of these MSM who come in and test negative for HIV and test positive
for an STD such as syphilis and rectal gonorrhea eventually contract HIV. We
have a unique opportunity to intervene with these high-risk MSM before they
contract HIV, and in Chicago we are currently exploring methods to implement pre-exposure
prophylaxis (PrEP) to keep our high risk STI patients HIV negative.
In our experience, we find that there is a lack of awareness
about PrEP, both among our clients, and among providers, who are unsure how to
implement PrEP. So, we have recently joined forces with the AIDS Foundation of Chicago to find out
how to increase PrEP awareness among providers, how to make PrEP accessible,
and how to clear up misconceptions about how PrEP is covered.
Our clients are about 70% uninsured and about 70% African
American, although we have many undocumented clients that are also at high risk
for HIV and also need counseling about PrEP options. When a high-risk client
comes in, we screen for chlamydia and gonorrhea, and at multiple sites of
exposure if needed. Extragenital
screening facilitates a PrEP discussion, and shows the client how their STD
risk and HIV risk are related. With sexual risk as a launching point, our
providers talk with high risk patients about what PrEP might look like in their
life.
Despite the overwhelming evidence that consistent use of
PrEP significantly reduces HIV risk among high-risk individuals, like MSM and
people with HIV-positive partners, uptake has been slow. STD prevention,
screening, and treatment are a part of HIV prevention and we have an
opportunity in STD clinics to discuss PrEP and educate people about an
additional option to protect themselves. We are
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| Advocating for Safer Anal Sex: Finding Empowerment and Equality in the Female Condom | |
| | National Coalition of STD Directors (NCSD): on May 21, 2014 at 11:57:12 AM |
By Emily Snoek, NCSD
Before I started working in the sexual health field, I was
your average 20-something “young professional.” With the recently graduated
glow of having finished what had been the most grueling and enjoyable four
years of my life (up until that point), I moved to Washington, D.C. and stepped
right into the field of STD prevention.
I thought I knew a lot then. I considered myself a
well-educated sex-positive individual. Discussing female orgasm and personal
contraceptive choices with strangers did not faze me, and I was the person that
friends sought out with supposedly awkward questions about sexuality, gender,
and sexual health. This is not, however, how most people in this field are welcomed
into sexual health and STD prevention.
When I came on board at the National Coalition of STD
Directors (NCSD), I saw these issues from an advocacy viewpoint, not a public
health one. But NCSD has introduced me to sexuality as a matter of public
health, and I now see this issue through both these lenses. My interest in
sexuality from an advocate’s standpoint and NCSD’s mission of advancing sexual
health through STD prevention combine in the use of public health for the
empowerment of women and the advancement of LGBT equality—something I find
embodied in the concept of using female condoms during anal sex. Confused? Let
me explain…
1. Female condoms (FCs) are a symbol of
empowerment for receptive partners across the globe.
The female condom is an effective
method of reducing risk for STDs, HIV, and unplanned pregnancy. Not only
that, the female condom represents a way for women and men to take control of
their sexual health. As a barrier method that is inserted into the vagina or
anus, FCs can be controlled by receptive partners and not worn by an insertive
partner like the male latex condom. This is
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| | | National Coalition of STD Directors (NCSD): on May 21, 2014 at 11:52:29 AM |
By
Rosanna Cacace, Health Educator II, Planned Parenthood Pasadena & San
Gabriel Valley
For
the past few years I have been lucky enough to spend my day talking to people
about sex. For some, the word “sex” makes people cringe and run for cover. The
idea of talking about vaginas and penises makes people uncomfortable, but for
me, it is empowering because I know that I am able to provide my community with
the resources they need to make healthy decisions about their body and their
relationships. When I started as a reproductive and sexual health educator for
Planned Parenthood of Pasadena and the San Gabriel Valley in Southern
California, I didn’t have any experience teaching sexual health, but I was
passionate about reproductive health and social justice and was looking forward
to a new challenge. Initially, I didn’t realize that there was such a dire need
for sexual health educators because I just assumed sex education was being taught
in our public schools.
To
my surprise, I found out that comprehensive sex education was not taught in
many of our public schools. According to The California education code, public
schools are only required to teach HIV/AIDS education at least once in middle school
and once in high school—that is it! If a
public school goes beyond that, then the school would have to teach
comprehensive sex ed., but with the recent budget cuts and the lack of
oversight, most schools have either eliminated health classes all together or
just taught the two hours of HIV education. But, without comprehensive sex
education, how can we expect our youth to make safe and healthy decisions if
they do not have the tools to do so?
It’s simple. They can’t. As of last year, the CDC stated that 83% of
teens (15 to 19 years old) did not receive any sex education before they had
sex. And, although teen pregnancy rates are
at its lowest, the United States continues to carry the highest teen pregnancy
rates out of all the industrialized countries; furthermore, U.S’s teens are
still at high risk for contracting STI&
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| STD Awareness for LGBTQ Youth | |
| | National Coalition of STD Directors (NCSD): on May 21, 2014 at 11:50:21 AM |
By Lauren Paulk, Reproductive Justice
Fellow, National Center for Lesbian Rights
April is
National STD Awareness Month! STD, short
for “sexually transmitted disease”, actually refers to a whole spectrum of
sexually transmitted infections (STIs). Unfortunately, there are quite a few
myths about STDs, especially concerning how vulnerable the lesbian, gay,
bisexual, transgender, and questioning (LGBTQ) community is to contracting
them. Three of the most dangerous myths
are addressed below:
Myth #1:
Only gay men get
HIV/AIDS.
While
HIV/AIDS has historically been more prevalent among men who have sex with men,
all populations are at risk for HIV/AIDS, and the prevalence of HIV/AIDS among
youth is growing. In fact, almost 60%
of youth who have HIV don’t know they are carrying the virus. Check here
for safer
sex practices around HIV/AIDS.
Myth #2:
You will only catch an STD if you “sleep
around.”
While
sleeping with multiple people without
using protection can increase your exposure risk for STDs, STDs are contracted
not because of the number of times you have sex, but because of the way in which you have sex. Protection –
even for what is considered “non-penetrative sex”, like oral
sex, frottage/tribadism (“tribbing”),
and | A Systems Interoperability Approach to Replacing STD*MIS | |
| | National Coalition of STD Directors (NCSD): on May 21, 2014 at 11:47:03 AM |
By Jeff Stover, Director of Health Informatics & Integrated Surveillance Systems, Virginia Department of Health
Health
systems integration is one of many approaches to improving the healthcare
delivery model within the United States.
Fortunately, the bridges that have historically divided primary care and
public health are quickly becoming the ties that bind in today’s healthcare
environment. As public health
departments strive to be more data-driven, the inherent value of integrated
data systems and data interoperability becomes more significant.
Virginia’s
Division of Disease Prevention (DDP) is comprised of HIV/STD/TB/HCV
surveillance and prevention programs, HIV care-related services and refugee
resettlement activities. As an
integrated division, DDP had continual demands for improved data accessibility
and subsequent program action. The
recent inclusion of linkage and retention to care within the Centers for
Disease Control and Prevention’s (CDC) Improving Sexually
Transmitted Disease Programs through Assessment, Assurance, Policy Development,
and Prevention Strategies (STD AAPPS) grant further highlights this
increasing need for data inclusivity.
In October 2011, the CDC announced discontinuation of ongoing
development for the Sexually Transmitted Disease Management Information System
(STD*MIS). This required the remaining
5-8 jurisdictions still using STD*MIS to initiate planning for alternative data
management solutions, including either transitioning to vendor-based products or custom-built
applications for their respective STD surveillance programs.
Replacement of
STD*MIS provided an opportunity for
Virginia to assess larger-scale data management operations as a means of
increasing cross-program connectedness.
The DDP assessed numerous options and chose a vendor-based product based
on numerous parameters, such as 1) experience with STD*MIS legacy database
conversion; 2) web-based application infrastructure to allow for improved local
health department accessibility; 3) improved
data management stewardship and access control mechanisms; 4) allowance for
creating a paperless STD surveillance system between DIS, supervisors and
central office staff; 5) ELR infrastructure; and 6) modules for STD/HIV, TB,
hepatitis and HIV care services. View Full | | |
| Becoming a Disease Intervention Specialist: Do You Realize What it Takes? | |
| | National Coalition of STD Directors (NCSD): on May 21, 2014 at 11:44:00 AM |
By Burke A. Hays & Kelly Mayor,
NCSD
April is STD Awareness Month, and we’d
be remiss not spend some time talking about the role that disease
intervention specialists (DIS) play in preventing STDs and HIV.
For those of you that aren’t already familiar with DIS, these folks are on the
front lines of STD prevention. Part of their job is to locate the sexual
partners of patients that present with a STD at health departments. As you can
imagine, it’s an extremely tough and challenging job.
NCSD spent much of last year trying to
raise the profile of these important public health professionals and help the
public understand the job they do for our communities. In fact, NCSD solicited
blogs from longtime DIS and encouraged them to share their interesting, and
often strange, stories from the field. You can read some of those fascinating
tales on NCSD’s blog, “STD
Prevention Gone Viral.” But here we’d like to take a moment
to talk about how someone actually becomes a DIS. We decided to write this blog
because, while most people in public health recognize the pivotal role DIS play
in prevention, many of them don’t realize how DIS are trained for their unique
jobs.
During our investigation Kelly and I
spoke with NCSD associate member, Kris Judd-Tuinier with the Michigan Department of Community Health,
who started her career in public health as a DIS. Kris told us a story about tracking
down a young woman who may have been exposed to a STD. Kris showed up at the
young woman’s house and explained that one of her sexual partners was recently treated
for syphilis, and it was important she be evaluated. Kris offered to take her
to the STD clinic for testing. The young woman agreed to come with Kris to
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