Since COVID-19 cases have slowed, Cowlitz County health officials have turned their attention to tackling rising rates of the other most commonly reported illnesses — sexually transmitted infections.
“Unfortunately, STIs are growing nationwide, in Washington state and in Cowlitz County,” said Dr. Steve Krager, deputy county health officer, on Tuesday.
Above-average STI rates aren’t a new problem for the county, but the trend is driving the health department and other community agencies to seek to bring prevention and care back to pre-pandemic levels or better. .
In October, Cowlitz County commissioners approved the use of core state public health funding to hire a nurse to focus on tracking and preventing STIs.
At Tuesday’s board of health meeting, county health officials reviewed data from the past 10 years and suggested some strategies to deal with the rise in cases.
Health care providers and labs are required to report confirmed cases of most STIs to the public health department, which follows up with individuals to confirm treatment and often searches for at-risk contacts, Krager said.
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Cowlitz County’s per capita STI case rate increased by approximately 71%, from 448 per 100,000 people in 2010 to 765 per 100,000 in 2019. The increase is greater than the increase in county population during those years, Krager said.
Cases rose statewide in the same decade, but Cowlitz County’s per capita rate is about 10% to 15% higher than the statewide, he said.
In the last three years of complete data, from 2017 to 2019, the county recorded 690 STI cases per year. About half of them are young people between the ages of 15 and 24. Every year, one in 24 residents in that age group tests positive for an STI, Krager said.
From 2017 to 2019, chlamydia was the most commonly reported STI, accounting for 73% of cases, or 498 per year on average. Gonorrhea accounted for 17%, syphilis 6% and herpes simplex 4%, according to Health Ministry data.
Krager said while the number is relatively small compared to the county’s overall population, the increase is concerning.
“It’s getting worse and that’s something, at least from my perspective, to be careful about,” he said.
Along with increases in the more common chlamydia and gonorrhea, the county also saw a significant increase in syphilis cases, Krager said. The numbers are still low, with an average of 27 cases per year from 2017 to 2019, but have doubled or tripled from less than 10 cases in previous years.
Krager said the biggest concern is congenital syphilis, when a pregnant mother passes it on to her unborn baby. Cases were very rare before 2017 in the state and county. For the past three years, Cowlitz County has seen fewer than 10 cases per year, but seeing cases is concerning, he said.
Without treatment, syphilis can cause serious illness and death, as well as miscarriages and babies born very sick, Krager said.
The most common STIs — chlamydia, gonorrhea, syphilis — can be treated and cured, but if left untreated, they can lead to serious and permanent health problems like infertility, Krager said. Genital herpes is incurable.
“We advocate for people to talk openly about STIs, testing and treatment with both partners and healthcare providers,” Krager said. “It makes sense for many people, especially younger people, to get tested regularly. And for certain groups of people, it may be a good idea to get tested more often, especially if you have a new partner or multiple partners in a year or shorter period.
Treatment is essential and relatively simple, Krager said.
“If we can reach people, if we can find these infections, if we can treat them, we can prevent passing them on to other people and break the chain of transmission,” he said.
Why the increase?
Several factors play into the increase in STIs, including an increase in “riskier” sexual behaviors and drug and alcohol use, Krager said. Drug use, poverty and unstable housing are also barriers for people receiving care for STIs, he said.
There is also some correlation between rising cases and reduced funding for state and local control and prevention programs, Krager said. The county’s ITS work has been inconsistent for the past 20 years, he said.
In response to an outbreak of gonorrhea that began in 2004, the county health department stepped up outreach, testing, treatment and contact tracing to tackle cases, according to TDN records.
The county’s efforts slowed around 2011 after the loss of funding and in recent years staff have been doing what they had the ability to do, mostly entering data into the system, said Gena James, assistant director of health services and social services.
“We haven’t been able to do this in-depth work to get to the preventative side of STIs, so we’re hoping to get back to that,” James told the commissioners.
Krager outlined other possible strategies to deal with rising rates, including increasing staff, improving access to information, testing and treatment; support health care providers by informing them and helping them to contact infected people; and work with agencies to target populations most at risk.
Since the county department no longer offers testing, one element moving forward is how to partner with vendors who do to allow them to do more dedicated ITS work, Krager said.
Testing and treatment
The Cowlitz Family Health Center, which began as a family planning clinic, resumed more community testing about a decade ago as the county downsized, said Jim Coffee, chief executive. The clinics offer STI testing and treatment, as well as HIV testing as part of its harm reduction program.
“We’ve had a very strong program for years,” Coffee said in an email. “The pandemic has unfortunately slowed things down a bit, but we are seeing it pick up again recently.”
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A newer county agency, Cascade AIDS Project, offers HIV testing and support services and is looking to expand to include other STI tests in the coming months, said Jasmine Gruenstein, director of services. of southwestern Washington.
The non-profit organization, located in downtown Longview, offers free and confidential rapid HIV and hepatitis C testing every Wednesday from 12 p.m. to 5 p.m. Cascade AIDS Project also offers medical case management, housing services and peer navigation services for residents living with HIV.
The organization began in Portland in the mid-1980s and expanded to cover southwestern Washington. In 2018, the nonprofit took over the provision of HIV services in Cowlitz County from Lifelong, a Seattle-based organization, and began providing testing in October 2021 after receiving a grant from Gilead Sciences. , said Gruenstein.
Before opening in Longview, Gruenstein said it was told about needs in Cowlitz County but could not expand north until it received funding. The agency continues to build trust, but is dedicated to growing services in the county, she said.
“There’s so much potential to serve the community and take root in it,” Gruenstein said. “Providing comprehensive care is important. By getting people to the door and connecting them to treatment, we also want to replicate that in Cowlitz County. »