Jefferson County has a sexually transmitted infection problem. The prevalence of Common STIs like chlamydia and gonorrhea is the highest in the state, at 707 cases per 100,000. By comparison, Crook County had 450 cases per 100,000 people in 2020, when the data was last reported for the state.
Jefferson County has long been among the highest in the state for its prevalence of STIs. However, over the last few years STI cases in Jefferson County, and across the country, have increased exponentially.
According to the Center for Disease Control, several factors impact the rate of STIs in communities: cultural norms, ethnicity, educational resources and access to healthcare. Rural communities across the country have higher rates of STIs, and STIs are more likely to affect Native American and Latino people, a large portion of Jefferson County's population.
"There is a lot of cultural stigma that goes along with STIs," said Jefferson County Public Health Communicable Disease Investigator Nicole Pierce. "If we can break past these cultural, political and religious fears and stigmas about getting tested, we can be a much healthier community."
When thinking of syphilis, one often thinks of a disease of yesteryear, with epidemics dating as far back as 1495. While it was once nearly eradicated in the U.S., it's back, and cases are soaring.
"We thought syphilis was a thing of the past," said Pierce. "It is back and rising at an exponential rate. Its increase will cause major impacts in our community."
The case count of syphilis in Jefferson County went from zero in 2018 to 19 cases in 2021. While 19 cases may not seem like many, it represents a part of a much larger problem. Syphilis often progresses without symptoms for months or even years. So, the disease goes undetected. People don't report it, while they continue to spread the disease throughout the community.
Syphilis is contracted through direct contact with a sore and comes in multiple stages. In the first stage, sores appear on the location the infection entered the body. The secondary stage involves skin rashes and spreading sores. These sores are often painless, some may not even notice them. After that, the infection goes into a latent phase when it presents no symptoms.
Without treatment, syphilis spreads throughout the body, infecting the brain, nervous system, eyes and ears, and can lead to death.
Luckily, the treatment for syphilis is simple. Penicillin resolves the infection relatively quickly and painlessly.
However, syphilis spreading in the community has other major impacts. As cases have risen across the country, so has a byproduct, congenital syphilis. This occurs when a pregnant person passes syphilis in utero. In the U.S., congenital syphilis rates have risen 235% since 2016.
It has significant impact on fetal health, and often results in neonatal death and stillbirth. It is also treated with penicillin, and with proper testing, early identification and treatment, it is highly preventable.
Chlamydia is one of the most prevalent STIs in the world, and one of the most easily treatable. According to the CDC, the U.S. saw 1.6 million cases of chlamydia in 2020. In Jefferson County, the prevalence rate is the second highest in the state at 583 per 100,000. Malheur County is the highest in the state at 713. Oregon's chlamydia rate is 374.
Symptoms of chlamydia are often only experienced by women, leading to a much higher prevalence rate in females. It's most prevalent among 20 to 29-year-olds but is especially prevalent among those 15-19. That group has seen the most increase over the last few years.
"The increase among young people is a big problem," said Pierce. "Young people are less likely to come in and get tested, because of things like fear of telling their parents, and it makes it much more likely to spread more and more." In 2021, Jefferson County had 193 reported cases of chlamydia among those ages 15-19, and Pierce says she expects more are out there without being diagnosed.
Chlamydia, like most STIs, is transmitted by sexual contact with an infected person. The only 100% effective prevention method is to not have sexual contact, but proper use of condoms and dental dams are highly effective in preventing transmission of the infection.
Infection from chlamydia usually begins showing symptoms one to three weeks after infection, but it often remains asymptomatic for months or even years, especially among men. Symptoms include burning while urinating, abnormal discharge and swelling.
The treatment for chlamydia is easy: one pill of the antibiotic doxycycline twice a day for two weeks. If left without treatment, chlamydia can cause permanent damage to the female reproductive system. Chlamydia can cause pelvic inflammatory disease which can lead to infertility.
The CDC recommends anyone under the age of 25 get tested yearly for chlamydia, and those over 25 that have increased risk factors like multiple sexual partners, or partners with STIs get tested regularly as well.
Since 2016, cases of gonorrhea in Jefferson County have skyrocketed. In 2016, rates were at 69.3, in 2021, rates jumped to 282.1. While rates have been rising across the state and country, rates in Jefferson County represent some of the highest in the state.
Gonorrhea is transmitted similarly to chlamydia and other infections, and affects the genitals, rectum and throat. It's common across the country, and the U.S. saw a 45% increase in cases from 2016 to 2020.
In Oregon, it is most common among African Americans, Native Americans and the Hispanic population. It's most prevalent in those ages 20-29, but in Jefferson County it's especially prevalent in those ages 15 to 24.
Symptoms of gonorrhea are like chlamydia, and testing recommendations from the CDC are the same. A single injection of ceftriaxone is the treatment, and long-term effects of going untreated include infertility, scar tissue, ectopic pregnancy and long-term pelvic and abdominal pain.
What are we going to do about it?
One of the most effective ways to prevent the transmission of STIs is through practicing safer, protected sex and getting regularly tested. Using condoms and dental dams drastically decreases the chance of exposure. Getting regularly tested ensures you receive quick treatment and prevent spreading the disease to others.
Testing is available for free at the public health building near St. Charles, at Indian Health Services in Warm Springs, and through many healthcare providers locally. At the Jefferson County Public Health Building, testing and treatment are totally anonymous, and only the nurse administering the test knows who is testing.
Stigmas around sex, STIs and sexual education come from a variety of sources. However, Pierce says the lack of education and prevention hurts the entire community.
"There is no shame in getting tested, in having an STI," said Pierce. "Getting tested, talking about protected sex with your kids, and understanding that it's important for the health and safety of the entire community is so important."
While Jefferson County has long held the title of highest STI prevalence in the state, Jefferson County Public Health, along with other partner agencies, is working to fix that. Thanks to funding and grants, they recently hired Pierce as a full-time communicable disease investigator. Previously, they had someone working only a few hours a week to trace, prevent and treat STIs in the county. The new position has allowed them to catch up on test tracing and notification of sexual partners for the first time in many years.
Now that the backlog is resolved and a full-time person is available, public health can move beyond tracing and focus on education and prevention.
"Having the resources to help address the issue before it becomes an even bigger issue is a huge relief," said Dr. Michael Baker, director of Jefferson County Public Health.
Through relationships with local health providers, local community groups, the schools and Indian Health Services, Pierce and Dr. Baker hope to see a decline in STI rates in Jefferson County.
"Through education, prevention and working to build relationships to destigmatize getting tested, I know we can make a difference, and help the community," said Pierce.
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