Jennifer Howell is the sexual health program coordinator for Washoe County. In this Q&A feature, she provides a wealth of information about sexual health and the prevalence of STDs in our community.
Whatโs your role as sexual health program coordinator?
So, my role is to integrate HIV, STD and family planning as much as possible into a cohesive sexual health program for the community. And often our programs are in silos, because of funding streams and different things. Our program works to break down those silos and create bridges as much as possible, so it seems like seamless services for our clients and for the community.
In that, my role is on the prevention and data side, and also training. And then our clinical side is handled by our nursing supervisors. So what I do is all of the reporting for our various funders โฆ coordinate the services between programs, and really push us to continue implementing things using best practicesโand thatโs in prevention, education, outreach, disease investigation โฆ and surveillance, which is having diseases reported to us that are required to be reported by law. And then itโs up to us to determine what level of response we give, communitywide.
OK. Iโve got to ask the dumb question. There are diseases that youโre required to report by lawโlike if you have them?
Health-care providers are. If they diagnose them, and if laboratories have a positive test for certain diseases, theyโre required to be reported, by law. And thatโs so we can investigate them and stop the spread of infection.
What STDs are among those?
Chlamydia, gonorrhea, syphilis, HIVโthose are the main ones.
I had no idea.
Yeah, NRS 441.A. That gives us authority over โฆ a lot.
Letโs talk STD numbers. What STD is most common in our community?
The most reported communicable disease overall, actuallyโin local, state and nationalโis chlamydia, and it just happens to be an STD as well. Itโs super common. Itโs curable, and it just continues to grow about five to 10 percent each year of reported cases to us. It can cause negative health outcomes for males and females. โฆ And then if itโs passed on to a newborn from an infected mother, there can be issues as well.
So itโs treatableโ
Itโs curable. Itโs not just treatable. Itโs curable. But it can cause damage. A person can get re-infected, and that can cause more damage. So itโs not without concern, even though itโs so common. โฆ We encourage people to get tested because a lot of times people wonโt have symptoms for most STDs.
Is chlamydia one of those that you might not have symptoms for?
Mm-hmm, yep, and gonorrhea.
The things you learn.
Exactlyโso people donโt know unless they get tested, really, a lot of the time.
Hereโs a question I think people wonder about. Should people in long-term, committed, monogamous relationships continue getting tested?
If they got tested at the beginning of their relationship and both of them tested negative and the test was out of the window period [the amount of time it takes for a disease to show up on a test] โฆ then they donโt needโand if theyโre confident that they are in a committed, monogamous relationship, and thatโs a relationship agreement, and they are confident in that, then they donโt need to be tested.
Makes senseโI guess it would depend on how confident you are in the whole monogamy side of things.
Yep, because we got a lot of cases reported where a personโs like, โIโve only been with this one person for this long.โ And then we talk to the other person, and theyโre like, โWell, Iโve only been with that person.โ Well, it takes three to make an infection, so, one of you is not truthful.
So, back to the numbersโcan you tell me the disease with the lowest rate of contraction here locally?
The lowest prevalence we have in our community?
I misspoke. Yeah.
Our lowest numbers are in HIV, but that doesnโt mean that it doesnโt have a huge impact on our community. It just means that thatโs not as common of an STD in our community. Itโs still there. Itโs still being diagnosed every month, somewhere in the community. It just isnโt as prevalent as chlamydia or gonorrhea and, even now, syphilis. Syphilis has made a huge comeback in our community, to the point where weโre in an outbreak of syphilis, statistically.
Iโve seen reports of syphilis outbreaks across the news in recent years.
Yeah, ours started in August of 2013โis when the spike really started to happen. Thatโs when we were like, โWhoa, whatโs going on here?โ And thatโs infectious syphilis. There are multiple stages of syphilis. So, in the first year, a personโs infectious. After that, it just does internal damage if itโs not cured. So we started seeing all of this infectious syphilis that we had never seen before. We would get like one or two cases a year โฆ and then we got hit with like seven in a month, and we were like, โWhoa!โ Itโs starting to go down a little bit, but we donโt know what our new normal is because itโs made a comeback across the country. So different states or local jurisdictions are trying to ascertain what their new level of disease is.
Sure. That makes sense. What can you tell me about general trends, as far as the prevalence of STDs in the community?
Most occur in people under the age of 25. There are multiple reasons for that. Itโs biological. Their bodies are still developing and not able to kind of ward off diseases like a mature reproductive system would. They tend to have multiple partners, casual partners. Thatโs not to say that doesnโt happen in all age groups. That age group, it tends to happen more. Their brains are also not developed to think as abstractly. That doesnโt happen until a person is like 25 to 27โwhere their brain is fully developed. So, you have sexโitโs a concrete thing, like, โIt feels good. Yea! OK, done with that.โ And then theyโre not thinking of the consequences of, โThere could be an STD, and I need to think about that.โ So, unfortunately, itโs kind of how the brain works. But thatโs not a license or permission to just not take responsibility for oneโs actions. Itโs an explanation as to why people do what they do.
And then โฆ the younger a person is when they first have sex, the more likely theyโll have an older partner. So that older partner has probably been exposed to STDs and could pass it to the younger partner.
Is the general number of reported cases across various STDs in our community going up or down? Or is it pretty stable?
Oh, no. Itโs going up. Itโs going up. And some of it can be attributed to more screening, more tests being done, better testing technologyโwhere the tests are more sensitive, and theyโre picking up more diseaseโand just a real increase in the number of people who are infected. So itโs all of those things that contribute to that. Syphilis, we know. We were testing the same. The technology has stayed the same, and our number of cases just went shuum [rocketing up]. So we know that thatโs a real increase in disease, not attributed to these other factors.
Interesting. So, I hate to say something is common sense, because who is it common sense to?
Exactly.
So, what should people do if they think, โIโve got somethingโ or โI donโt want to get somethingโ? Where do they go?
What we tell people is, โIf youโre sexually active, get tested.โ Depending on what your behaviors are, like if you tend to have multiple partners or change partners, then test regularly. Thereโs no shame in that. Itโs taking what the reality of your situation is and addressing it in a responsible way.
Weโre very sex-positive. Sex is a natural occurring, pleasurable thing. And we donโt want to shame that for anybody. We want people to feel comfortable coming to us and telling us what they need to tell us, so we can help them appropriately. If theyโre not telling us what kind of sex theyโre having or the situation surrounding their sexual history, then we canโt help them. So with that being said, if a person is having a very robustโand multiple partnersโsexual experience, then they need to test regularly. And I would say every three to six months.
If a person is getting into a new relationship with a partner, they need to testโor I would suggest that they test. I wouldnโt say they need to. Thatโs their choice. I would suggest they testโboth of themโmake sure theyโre out of the window period for whatever disease, so that test result is accurate for them, and then move forward with how they want to proceed with their results. Bottom lineโit comes to, if youโre having sex, at some point, get tested. If youโre not having sex, you donโt need to get tested.
Is that a thing? Do peopleโ
Itโs a thing.
OK. Itโs a thing.
I guess experiencing what itโs like to go through the process, I get that. โฆ But you donโt need to get tested if you havenโt been sexually active.
What are the current costs to get tested through the county?
For us, itโs on sliding pay scale based on a personโs income and on what testing that they have provided to them at that time. โฆ But itโs a pretty low cost compared to other providers in the community. We donโt turn away anyone because of an inability to pay. We donโt send people to collections. They can pay on their bill as long as theyโre able to.
Anything you want to add?
Just that being sexually healthy is part of life. It should be a goal in someoneโs life. Weโre all sexual beings, and so itโs better to be healthy about it. And people should have an HIV test at least one time in their lives, more if theyโre at riskโas well as other STD testing. The recommendation is to have at least one HIV test. โฆ Itโs part of the Affordable Care Act, that STD testing doesnโt charge a co-pay to the patient. โฆ So people should seek services. Itโs available. Itโs accessible. People like us, HOPES, Planned Parenthoodโwe want to help. We want promote people knowing what their HIV and STD status is. ฮฉ