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According to the World Health Organization, more than 1 million sexually transmitted infections are received worldwide each day.
Also referred to as sexually transmitted diseases, STIs are transmitted between individuals through sexual contact. According to WHO, there are more than 30 unique, transmittable bacteria, viruses and parasites with their own immediate effects and consequences.
Among that list of infections are four curable ones: Syphilis, gonorrhea, chlamydia and trichomoniasis, which together make up an estimated 374 million new infections globally each year, WHO says.
Statistics on syphilis, gonorrhea and chlamydia are tracked by state departments of health, including the Ohio Department of Health.
State officials receive their numbers from county and city health departments. The Jefferson County General Health District is responsible for Jefferson County cases, said Dr. Jane Culp, JCGHD medical director and infectious disease specialist, who noted the county health department goes beyond case reporting by performing testing, offering treatment and conducting contact tracing to help stop the spread of certain STIs.
Chlamydia and gonorrhea can cause fertility issues, as well as urinary problems and pelvic inflammatory disease, Culp said. Gonorrhea can cause septic infections if it enters the bloodstream, while syphilis -- which occurs in stages -- can cause increasing neurological problems and can eventually lead to death if left untreated.
"The longer you go without treatment, the more likely you are to have problems," Culp said of each.
"These are reportable (to the state) because they cause enough problems down the line for a person's health. ... Each person who becomes positive because of these can have problems and transmit. It becomes exponential as it goes. ... These further complications can be expensive to treat, so it's better to get it stopped early."
***Reporting***
Hospitals, express care facilities, walk-in-clinics or free clinics where STI testing is offered report their results to the health department where the patient is a resident, in the case of a positive test, Culp said. Any resident of Jefferson County, no matter where they get tested, has his or her positive results submitted to the county health department. The JCGHD also offers testing for chlamydia and gonorrhea.
Culp said numbers vary throughout the state, with more populated areas being expected to have more positive cases.
What holds true are the age groups testing positive for specific infections. Chlamydia and gonorrhea are primarily found in those 20 to 24 years of age, followed by those 15 to 19. Syphilis is seen primarily in the 25-to-29 age group and older age groups -- Culp said this is likely due to individuals getting tested after experiencing later-term complications.
The most complete statistics for Jefferson County are from 2022, Culp said. Jefferson County's numbers have varied but have seen a consistent average for the last several years. Case in point: There were 179 chlamydia cases in 2028 and 178 in 2022, and 81 gonorrhea cases in 2018 and 86 in 2022.
Culp said Jefferson County's numbers fall in the middle, compared to other counties.
Although counties report their case numbers, the state adjusts those figures to a rate of cases per 100,000 citizens. That helps to better compare a disease's prevalence in counties of varying sizes, Culp said.
For example, 200 cases in a county with a population of 1 million would result in an adjusted 20 cases per 100,000 citizens, whereas 200 cases in a county with a population of only 40,000 would result in an adjusted 500 cases per 100,000 citizens, thereby displaying the smaller county's higher comparative case rate.
These numbers need to be looked at critically, Culp noted, as lower case rates may signal that a county is under-testing rather than mitigating actual cases. To Culp, higher positive numbers are preferred to under-testing, as getting individuals tested is the first step to treatment.
"I want these people treated, and the only way to treat them is to give a diagnosis, and the only way to give a diagnosis is to do the testing. ... We want to have truly low numbers rather than low numbers and not meeting needs."
***Contact tracing***
After the health department receives a person's positive test results, staff members will attempt to contact the individual to encourage them to list others with whom he or she has had sexual contact. Known as contact tracing, this is when the health department attempts to stop the STI's spread by informing the contacts about their possible exposure and encouraging them to also get tested.
If the person does not feel comfortable giving that information to the department -- which keeps it confidential -- the department will encourage the individual to inform the contacts himself or herself.
Contact tracing for syphilis cases in Jefferson County is handled by the Stark County Health Department.
If whichever medical facility gave the test hasn't already, the health department will encourage positive individuals to begin treatment, which consists of oral antibiotics for chlamydia and intramuscular or intravenous antibiotics for gonorrhea.
Typically, contacts should wait until they get a positive test to start treatment, Culp said, but exceptions may be made on a case-by-case basis. Contacts may need to re-test later in case the first test was done before the infection was prevalent enough to be detected.
"The ideal is to get treatment in a timely manner and offer the same to the contacts," Culp said.
The health department offers screenings for HIV and does outreach on STIs and protected sex using condoms, which act as a barrier against STIs but are not 100 percent effective, Culp said.
As the likely time of release for Jefferson County's 2023 STI statistics nears, Culp noted that STIs have "been here for centuries" and are not going away. With that in mind, she said, the best thing the health department can do is continue testing and education to mitigate the spread.