Sexually Transmitted Diseases: Update For Louisiana and Cenla

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Dr. David J. Holcombe
Dr. David J. Holcombe

There are many sexually transmitted diseases, but those that are tracked and quantified in Louisiana and nationally usually include gonorrhea, chlamydia and primary and secondary syphilis.  Although HIV/AIDS is also transmitted sexually, it is often tracked separately.  Louisiana has the dubious distinction of ranking in the top 4 states in the U.S. with respect to STDs rates: Gonorrhea (#1), chlamydia (#2), primary and secondary syphilis (#3).  If HIV/AIDS is included, we also rank consistently among the top 5 states (#3 in 2013).  These extraordinary statistics translate into significant morbidity and economic loss, both locally and nationally.

 

Cenla has its share of cases, but does not rank at the top of public health regions with respect to any of these diseases: 5/9 of OPH regions for gonorrhea, 6/9 for chlamydia and 7/9 for syphilis.  Although we are doing better than many other parts of Louisiana, we still have tremendous room for improvement when compared with national statistics.

 

There are some significant demographic differences with respect to STDs both in the nation, the state and our region.  In our region, cases for both gonorrhea and chlamydia are more commonly diagnosed in women—64% and 73%, respectively (not unlike state or national statistics).  Some of this relates to “sampling error” since sexually active women are systematically checked in annual gynecological exams (at least in the context of the health units) and men only seek assistance when symptomatic.  With syphilis, on the contrary, over 85% of those diagnosed regionally are men (similar to state and national figures), which is skewed by the high incidence of syphilis cases in the population of men having sex with men.

 

Not only are there disparities with sex, but also with ethnicity.  For reasons probably related to low income and lower educational attainment rather than race, African-Americans are disproportionately represented in all STDs (and HIV/AIDS) regionally, with 79% of cases of gonorrhea, 60% of chlamydia cases and 69% of those with primary and secondary syphilis.  The same holds true with HIV/AIDS, with about 75% of cases in African-Americans both regionally and in the state as a whole.  Again, there may be some “sampling error” because STD’s are systematically checked in sexually active women in certain age groups in the health units, but not necessarily in the private sector, where more patients with non-Medicaid insurance are seen.

 

With both gonorrhea and chlamydia, the majority of cases in Cenla—69% and 74%, respectively—occur in the 15 to 24 year old range, hardly a surprise.  Syphilis, on the contrary, occurs more often in older adults, with 62% of cases in the 25 to 44 year old group, with most of these cases in men.

 

The high rates of STDs (and HIV/AIDs) in our region and in the state should underline the importance of responsible sexual choices.  The only sure-fire method for prevention is, of course, abstinence, which is laudable, but not necessarily realistic. While they do not prevent STDs, the practice of “safe sex” with the use of condoms greatly reduces the risk of contracting any sexually transmitted disease, including HIV.

 

Since young people are the primary recipients and transmitters of at least some STDs, they should receive adequate education about the risks and consequences of infection in a clear, dispassionate and scientifically accurate manner.  While this ideally should come from the family, parents may lack the knowledge or skill to correctly present this information.  In addition, many people are unaware that they have a STD or HIV, both often asymptomatic, so appropriate testing (and contact tracing by the Office of Public Health for syphilis and HIV) can help reduce the risk of transmission in the general population.

 

Adolescents, by their neurobiological makeup, are saturated with hormones and yet lack the development of the frontal lobe where reason and impulse control originate.  Their impulsive decision making and lack of control provides a perfect storm for high-risk behavior, whether it is drug or alcohol use, driving without a seatbelt, or engaging in unprotected sex.  Proper education (from whatever reliable source), avoidance of high-risk environments and role-playing for adolescents to develop automatic healthy behaviors can offer hope for improving our dreadful state and regional STD statistics.