Officials take aim
at STD spikes
by Matthew S. Bajko
With rates of sexually transmitted diseases continuing to rise in San Francisco and across California, public health officials are taking aim at the rate spikes with new testing practices and treatment regimens.
They are also deploying mobile devices as a way to reach sexually active gay and bisexual men. The messages sent via cellphones can alert subscribers to the service about upcoming appointments to be tested for STDs or deliver targeted texts with specific health information.
The simple mantra that sexually active men who have sex with men should get tested every three to six months is also being retooled. In addition to the advice to get checkups on a quarterly basis, gay and bisexual men are being urged to ask their doctor or health care provider to conduct pharyngeal and rectum tests for such STDs as gonorrhea and chlamydia.
The concern is that if sexually active men only undergo urine tests and blood draws for STDs, then infections in their throat or anus may go undetected.
"What we find these days is that gay men tend to be very knowledgeable about how HIV is transmitted. But there is not the same level around other STIs," or sexually transmitted infections, said Steve Gibson, director of Magnet, the men's health center in San Francisco's gay Castro district.
Particularly when it comes to STDs like gonorrhea and chlamydia, said Gibson, the three sites that can get exposed are the "dick, butt, and mouth." Thus, it is recommended that sexually active men have both a butt and throat swab done every three months, he added.
"If you use it, you should check it," said Gibson. "It is not hard to do this. It should be the standard of care."
The new efforts come as rates of STDs continue to climb, both locally and statewide. Gay men continue to be one of the hardest hit groups.
This month the California Department of Public Health posted to its website data showing that syphilis cases rose 18 percent in 2011. Men who have sex with men account for 80 percent of the infectious, or primary, syphilis cases statewide.
About half of the cases are among men who are HIV co-infected, report state officials.
"We are really seeing increases everywhere. It is not just the Bay Area and it not just southern California," Dr. Heidi Bauer, chief of the state STD Control Branch, told the Bay Area Reporter in a phone interview this week. "I think the size of the jump is what is concerning."
San Francisco has witnessed six straight years of increasing STD rates. And the trend has continued in 2012, based on data for the first half of the year.
According to the most recent monthly STD report issued by the city's Department of Public Health, there were 492 reported cases of syphilis between January and June of this year. During the same period in 2011 there were 392 cases.
A similar rise was seen in gonorrhea, with 1,278 cases reported during the first half of 2012. The total was an increase of 263 cases seen during the same period in 2011.
Chlamydia cases also increased by 124 cases during the half of the year compared to 2011 for a total of 2,412. The spike in cases are expected to continue throughout the rest of 2012, meaning the city will have marked a seven-year stretch of increased STD rates.
"I am not personally frustrated. I feel we have a lot of work to do," said Dr. Susan Philip, the city's STD chief. "There is a difference between we have a long way to go to being frustrated. Our goal is to decrease these numbers."
But doing so remains "very complex," said Philip.
At least in San Francisco, health officials point to a variety of reasons for the increased STD rates. A main driver is the fact that many sexually active gay and bisexual men are adhering to a regular testing schedule.
"We continue to have high demand for services," said Philip.
Another factor is that HIV-positive men in the city continue to practice what is known as sero-sorting, where they seek out other positive guys for sex partners. In doing so they are choosing to forgo condoms, which makes them susceptible to contracting STDs.
"I think people are pretty savvy and pretty knowledgeable about what constitutes risk. We don't prescribe that people should do things in any way," said Philip. "People know condoms are good against chlamydia and gonorrhea. Decreasing the number of partners and using condoms can be effective, but people we know use different strategies."
The STD unit, limited by a lack of funding in what it can do, is looking at what "overall approaches we think can both be acceptable by people and potentially decrease new infections," said Philip.
One challenge Philip is working on is how to notify sex partners that people meet through social applications for smartphones, such as Grindr and Scruff. On the board of the National Coalition of STD Directors, Philip said the professional group is looking at how such apps can better assist them in notifying men who may have been exposed to an STD that they should get tested.
"Internally, we are figuring out what will be most useful and then we will approach the app makers," she said.
Text service reminds of STD test
Cell phones are being deployed in another way to stem the rising tide of STDs.
Magnet, a program of the San Francisco AIDS Foundation, has been working with the Oakland nonprofit Internet Sexuality Information Services, known as ISIS, on a new text messaging notification system that will be publicly unveiled in September. It received funding from the city's Department of Public Health to roll out the system.
Once it debuts men will be able to sign up to receive monthly sexual health tips via their mobile device. Staffers of Stop AIDS, another SFAF program, have been testing out certain messages drafted by Gibson with men in the community.
One example of a typical text that Gibson shared with the B.A.R. this week would read: "Love to suck and fuck a lot? Swab UR butt and throat for STDs every 3 months."
Clients of Magnet will also be given the option to sign up for reminders about upcoming appointments or the need to come in to be screened for STDs. Because it requires signing a consent form, only those men who go to Magnet will be allowed to enroll for that part of the new messaging system.
ISIS Executive Director Deb Levine told the B.A.R. that the text service would be a first of its kind to be offered by a private clinic.
"Especially combining the educational messaging with the reminders," Levine wrote in an emailed reply. "We are in the midst of contracting with the state of Oregon to do the same, implementation this fall."
She added that the ultimate goal for the services is "to normalize sexual health," while the more immediate goal is "to increase regular STD and HIV testing for people who are sexually active."
The state STD control branch has been piloting a similar system geared toward gay and bisexual men in San Diego. Several clinics in the city have offered it to their clients since early 2011.
Anyone can enroll in the program via the website Wealltest.org. Those signed up receive a text reminder every three months to be tested for STDs and are directed to visit a local clinic.
"It is popular. We have hundreds of people signed up," said Bauer.
Bauer is looking to expand the program statewide by the end of 2013 and wants to particularly include clinics in urban settings.
"I think it will be pretty easy to scale up," she said. "We are in the process of looking at the infrastructure and funding needs."
Based on surveys conducted with the men in San Diego, the system seems to be working, said Bauer.
"For a good portion of people they reported to us they liked the system and went to get tested because of it," she said. "The system is not linked to their medical records to make sure people felt comfortable about their confidentiality."
The state is also encouraging gay and bisexual men not only to get tested but also to ask their medical providers to conduct the right STD screenings, particularly for gonorrhea.
"The big message for gay men is to ask for the test to screen the throat and also to screen the rectum," said Bauer, who noted that most public health labs as well as Kaiser are using those tests on a routine basis.
But overall there appears to be a lack of such testing, she said.
"Even though it has been available, we are not seeing what we would expect to see in terms of screening for those two sites. Most people are still doing a urine screen," said Bauer. "You need to ask from your provider or the STD clinic to do throat and anal screens for gonorrhea."
Stop AIDS and SFAF are hosting a community forum September 12 about the practice of sero-sorting and if men are choosing to use condoms based on their sexual partners' HIV status. It will begin at 6 p.m. at the LGBT Community Center, 1800 Market Street.