Tracking down partners to stop STDs
The U.S. is in the middle of a steep and sustained increase in sexually transmitted diseases.
So how are public health officials responding?
In northwest Oregon’s Clackamas County, health officials have decided to ask anyone who comes in with an STD who their sexual partners are — and then track those partners down.
That job falls to two women: registered nurse Mary Horman and disease intervention specialist Liz Baca. They do most of the work over the phone, telling people they’ve had a partner (no name is revealed) who has tested positive for gonorrhea, HIV, chlamydia or syphilis.
It’s a difficult conversation. And many people can’t be reached via phone. So about once a week, Horman and Baca jump into a car and start knocking on doors.
“It can definitely be scary at times,” Baca said, “especially those rural areas where you’re really relying on the GPS to get you there, and sometimes there are roads that lead you to nowhere.” So far, they haven’t gotten lost.
Plenty of residents in the county’s outskirts own firearms, Baca said, and are comfortable displaying them if they feel they need to protect their property.
The women travel as a pair and never enter a home, she said. And they always carry a cellphone to keep the home office informed of their whereabouts.
David Harvey, the executive director of the National Coalition of STD Directors, says the efforts of fieldworkers like Baca and Horman are vital.
“Disease intervention specialists are doing heroic work,” he said. “They’re helping to navigate and get people into care.”
Twenty years ago, Harvey said, there were as many as 4,000 disease intervention specialists like Baca in the U.S. Now, because of public health costs, the number is down to about 1,400.
The public health officer for Clackamas County, Dr. Sarah Present, said partly because of a surge in syphilis among babies, Clackamas now dedicates more resources to aggressively tracking down partners and encouraging testing — even if those notifications might lead to family strife. Syphilis in newborns can cause serious neurological complications and even death, she said.
“We have now multiple cases of congenital syphilis in our county — just in this year,” Present noted, “whereas that had been fairly unheard of for at least the last decade, if not more.”
A study released by Clackamas County earlier this summer shows rates of syphilis have increased 1,300% over eight years — in part, because the numbers involved used to be so small.
And Clackamas County is no outlier. A new report from the Centers for Disease Control and Prevention found that over the past several years nationally, the number of gonorrhea cases has increased 67%, and syphilis cases are up 76%.
Clackamas County and the two other counties that make up the Portland metro area have received substantial state and federal grants to help pay for extra public health outreach.
They are taking several steps to stop the transmission of STDs — like strengthening prevention activities, enhancing screening, testing high-risk populations and educating the public.