We're # 1! We're # 1!

Not only does St. Louis rank among America's most dangerous cities, apparently we're quite highly appraised in our ability to contract and spread communicable diseases!

Why am I itching?

Please don't mind my internal editorial comments.

St. Louis Has Worst Gonorrhea Rate in Nation

By Deborah L. Shelton
ST. LOUIS POST-DISPATCH
11/08/2005

St. Louis leads the nation in rates of gonorrhea, according to statistics released Tuesday by the Centers for Disease Control and Prevention. The city ranked second in chlamydia (YAY! We're scratching our way into a leadership position for ANOTHER disease!) and fifth in rates of syphilis nationwide.

St. Louis has long ranked high in cases of sexually transmitted diseases.

The CDC report provided 2004 data on three STDs - gonorrhea, syphilis and chlamydia. Young people, minorities and men who have sex with men were at greatest risk.

Syphilis and chlamydia rates rose nationwide, while gonorrhea rates dropped to a historic low.

Health officials estimate that 19 million new sexually transmitted infections occur each year, almost half among people from 15 to 24. Most of the infections go undiagnosed.

Doctors are required to report cases of gonorrhea, syphilis and chlamydia. Even so, STDs are vastly underreported. There's no mandatory reporting requirement for some highly prevalent sexually transmitted viral infections such as human papillomavirus and genital herpes.

Chlamydia was the most common STD nationwide, with a total of about 930,000 cases reported last year, according to the CDC report. Federal health officials said the actual number of cases is far higher, about 2.8 million new cases each year.

Chlamydia rates rose in 2004, largely because of expanded and improved screening for the disease, the CDC said.

Gonorrhea hit an all-time low nationally, with about 330,000 cases reported. The national rate of 113.5 cases per 100,000 people was the lowest since the government started tracking cases in 1941.

But syphilis has been steadily increasing since it hit a historic low in 2000. The rate of reported early-stage syphilis was 2.7 cases per 100,000 in 2004, up 29 percent since 2000.

Locally, 2,440 cases of gonorrhea were reported in St. Louis, a rate of 734 cases per 100,000 people (Blazing a trail from our genitals to THE TOP of the disease world!) - and 4,130 cases of chlamydia were reported, a rate of 1,243 cases for every 100,000 people.

Fewer than 50 cases of primary and secondary syphilis were reported last year in St. Louis. Primary and secondary syphilis are the most infectious stages of the disease.

Dr. William Kincaid, director of the St. Louis health department, said officials are focusing on improving public health surveillance, strengthening community involvement and making sure clinical services are accessible to those who need them.

"We're aware of this problem and have already acted to deal with it in a strategic way," he said.

STD clinical services were recently moved to St. Louis ConnectCare, where services are free for those without health insurance, Kincaid said.

"We want to get the word out that these diseases are treatable, and we want to get people into treatment as fast as we can," Kincaid said. "We know if people are having unprotected sex and are spreading chlamydia, syphilis and gonorrhea, they are also spreading HIV."

All three diseases increase the possibility of HIV transmission.

Dr. Ronald Valdiserri, acting director of the CDC's National Center for HIV, STD and TB Prevention, said STDs "pose a significant and ongoing threat to millions of Americans, especially young women, men who have sex with men and people of color."

Untreated sexual infections also can lead to pelvic inflammatory disease, infertility, neurological damage and death.

The rise in the national primary and secondary syphilis rate was largely due to increases among men, particularly men who have sex with men, Valdiserri said. Overall, the syphilis rate among men increased 11.9 percent from 2003 to 2004 and 81 percent since 2000.

Although surveillance data were not available by risk behavior, a separate CDC analysis suggested that about 64 percent of all adult syphilis cases in 2004 were among men who have sex with men, up from an estimated 5 percent in 1999.

Valdiserri attributed the increase to a rise in risky sexual behavior.

Chlamydia disproportionately affects young women, and the long-term health consequences of untreated disease are more severe for females. The chlamydia rate for females was 3.3 times higher than for males. Young women between 15 and 19 had the highest rates.

Chlamydia is a bacterial infection that can be easily treated with antibiotics. But it typically doesn't show any symptoms. Up to 40 percent of women with untreated chlamydia develop pelvic inflammatory disease, and 20 percent of those could become infertile. Women with chlamydia are five times more likely to become infected with HIV if exposed to it.

African-Americans also are disproportionately affected by STDs. Although the rate of gonorrhea among blacks fell 3 percent from 2003 to 2004, rates for African-Americans were 19 percent higher than for whites. Syphilis rates among African-Americans rose for the first time in a decade, up 19.9 percent.

The CDC report said poverty, limited access to quality health care and a higher prevalence of disease probably contributed to the racial disparity.