Conversations around physical intimacy are never easy. They either feel graphic and inappropriate, like watching a middle school film strip on the subject on one end of the spectrum. The other extreme is a cheesy, heavy handed Hollywood version of romance and love. People fall head over heels for each other, and wake up smiling and happy.
Somewhere in between is the reality, where people either don’t discuss or understand their bodies and functions or they are afraid to bring up what can be a truly awkward conversation. Even at a doctor’s office, people don’t like to speak up about a concern unless they are scared of what is happening to them.
There are consequences for not telling medical professionals everything they might need to know. One of those is the dreaded result of a test no one wants to hear.
“You have an STD.”
That bad news is spreading as the rates of diseases that once were much lower are now climbing again, and that has public health officials who track the figures concerned that a specific population isn’t taking the threat of sexually transmitted diseases seriously enough.
Now STDs have always been a problem, in ancient and contemporary times alike. The diseases have been there, spreading through unprotected populations since lovers began running off into the bushes with one another.
The battles for doctors and nurses never end with the viruses and bacteria that invade via intimate acts, but can be prevented on an individual level. All it takes is smart thinking and better understanding of these diseases and the ways they spread.
As health officials wound down their recognition of STD Awareness Month nationally, their hopes are with providing as much education as possible, the number of cases being reported will decline in years to come.
They aren’t going away anytime soon, these “social diseases” that like any other are hard to control. So long as individuals understand how to protect themselves, and have difficult conversations with one another in appropriate settings, it will make the job of medical professionals much easier in the long run.
First though, there is an immediate problem that won’t be easy to solve: how to stop the spread of diseases as easy as they do in a globally connected world?
Diseases spread in a lot of different ways. Flu is spread through coughs and sneezes, as well as contact between individuals. Think a hug or handshake.
Other more dangerous diseases like say, Ebola, require contact with infectious people’s fluids, say a bloody cough or cleaning up after someone getting sick.
Chlamydia and gonorrhea, well they require a different sort of intimate contact, and one that in times before the internet was a lot easier to track.
It took much more effort and time to find partners prior to instant contact and dating apps that now use algorithms to act as matchmaker, instead of intermediaries such as friends. Dating was also an entirely different set of circumstances. There was no such thing as “Netflix and Chill.”
The modern age of independent intimacy
High school dates of the days before the internet came and changed up the whole process were setup between two people over a landline, or via notes passed back and forth between class. Dates could be as simple as a couple cruising up and down Main Street in Cedartown, or as complex as a trip out of town to a concert.
Much of that still happens, is a standard part of the life of teenagers. What has changed the social norms developed and slightly changed over generations is the advent of smart phones which coupled with dating sites like Tinder make up a combination no one expected before: anonymous intimacy.
It is easier than ever before for teenagers who have never met before to find each other, take part in adult acts, and during all that time never so much as doubt their safety. Yet what do they really know about each other? Who has either party potentially been with before?
These are questions that teens aren’t asking, according to local health officials. Ones that are seeing immediate results in the number of reported STDs tracked through state and national medical databases used in public health.
Among all ages in Polk County for instance, the reported number of gonorrhea cases had trended back and forth in peaks and valleys, starting with 49 cases in 2010, saw a dip to 29 cases in 2011 and going as high as 51 in 2012, then saw a steady decline through the next two years. It was a low as 16 reported cases in 2014.
During the next two years before there’s no more data for the moment, gonorrhea has made a return. There were 38 cases reported in 2015, and 70 cases reported in 2016.
Polk County’s 15 to 24 year old population made up more than half of the cases in 2015 at 19, and those within that age group saw 33 of the 70, or nearly half of all those diagnosed. During a period over the last six years, more than half of those cases were reported for gonorrhea alone were patients in their teenaged years through their early 20s.
That doesn’t even account for Chlamydia, which has remained steadily between 60 to 80 cases between 2010 and 2013 for the age group, and then has sharply increased starting in 2014 with 93 cases reported in the 15 to 24 age group, then 111 cases in 2015, and only a slight decrease in 2016 to 108 cases.
More than half of all Chlamydia cases reported during that time are made up of youth 15 to 24 as well.
Ultimately the one reason that Polk County Health Department Nursing Director Malindy Ely believes the problem has grown is a lack of education. Thus a greater understanding of the dangers of STDs is one area Ely wants to improve the knowledge for local residents.
“Education is a big part of our role here at the Health Department,” she said. “A lot of people, especially a lot of younger people, have this ‘it’s never going to happen to me’ mentality. So just getting them to understand the statistics and make it real to them. Numbers are just numbers until you get down to the bare facts.”
One of the many diseases health officials have been tracking and trying to curtail is one everyone knows as HPV.
It is an infection technically that cases warts in various parts of the body, depending on the strain. One particular strain, and one that officials now recommend children as young as 9 should be vaccinated for, can cause long term problems in female reproductive systems.
The HPV (Human papillomavirus) vaccine is one area where the health department has been promoted because of the large number of teens and young adults who have it and likely don’t know they are spreading it. According to the CDC, they estimate some 79 million teens and people in their 20’s carry it, and it comes with some varying risks, including cancers.
“We try to stress to people that even though people — including the health department — promote abstinence as the best way to prevent STDs and unplanned pregnancies, you never know who your child is going to marry,” Ely said. “You never know how many sex partners that person may have had. They could be infected with HPV that then they could give to your child.”
Education is one big part of the health department’s mission to help stamp down the problem of spreading diseases, but another is ensuring that when people come in for family planning discussions, they also get tested.
Ely said that ensuring that information and resources are available for those who need help via the health department is a big way they try to prevent further spread of sexually transmitted diseases, but the real silver bullet is people having a better understanding of how these viruses and bacteria attacking the body works.
She said the program locally is comprehensive, and utilizes a lot of help throughout the process of ensuring that local residents are getting treated for sexually transmitted diseases and numbers reported upward to the state.
Where the problem comes in is making people understand that even though health officials can treat a disease like Chlamydia or gonorrhea, if they don’t fix the underlying problem of who they’re being intimate with in the first place getting treated they’ll show up again needing another round of antibiotics.
“Chlamydia can cause reproductive health issues for ladies, can cause eye problems and pneumonia for babies following delivery if a mother is pregnant and still infected,” Ely said. “So those are the types of things that we focus on with individuals on how it can impact your life.”
She stresses that health officials are completely professional about talking about sex issues since it is a problem that needs to be taken seriously and can cause real consequences for the community.
“Most of the people that come to us, they trust public health and the health department. They trust the nursing staff,” Ely said. “They’re used to having difficult conversations about very private information. You just have to be very open, honest and non-judgmental, and we stress to our clients the confidentiality of everything they tell us.”
Going to the health department is like going to any other doctor’s office. Information is gathered about a patient just like any other medical establishment and decisions are made about confidentiality and where to contact a client for results. Forms are filled out and payment options are discussed.
Ely said that “practicing under protocol, our nurses do provide some medications for things they are treating,” and thus a clear medical history just like with any other first visit to a doctor is just as important in their department as anywhere else.
The health department will take some private insurance to help cover the costs of tests, but people can still pay out of pocket or come use their services if on Medicaid, for instance.
STD tests are the same anywhere too. Swabs are taken or blood is drawn. They take those samples onward to the lab to culture and see what grows. People are contacted about the results.
People might not always come in specifically for STD testing, since clients come into the health department from a variety of sources. Referrals come in from other medical offices or physicians who are treating people and find a problem.
“Sometimes they come because they’ve engaged in some risky behavior, and they’re just worried,” Ely said.
She said the state also requires through their Chlamydia and gonorrhea program to try and get tests from certain populations at higher risk who come in for birth control counseling as well in an effort to curtail the increased numbers seen in the past years.
“If we’re doing an exam, and we notice something that we think is an infection, we’ll certainly do additional tests,” she said.
Health officials can’t stress enough the importance of regular STD testing, even if someone is in a monogamous and stable relationship, usually once a year unless they have some symptoms.
Those who are being intimate with multiple partners on a more regular basis should consider getting tested every three to six months, depending on their risk factors.
More information about confidential STD testing and treatment at Northwest Georgia health departments may be found at https://bit.ly/2JjGcDE.
The Polk County Health Department is located at 125 E Ware St. in Cedartown, and those wanting more information about how they can utilize services can call 770-749-2270.
Check back in the May 9 edition for more on STD rates and how health officials keep track of numbers in part two of this story.