Chlamydia, gonorrhea and syphilis are up in California over the past five years, including in places like San Francisco county, where people are contracting chlamydia at nearly twice the rate of the rest of California. Gonorrhea among women is up 47 percent, and there’s a concerning spike in the number of babies being born with congenital syphilis.
Dr. Karen Smith, director of the California Department of Public Health, says the rise in homelessness statewide has led to more unprotected sex.
“Women who don’t have safe places to live, or who have substance use issues, can find themselves using sex to provide them with a safe place to stay, somebody to protect them,” she said. “So, there’s a whole confluence of social issues that are occurring.”
There’s also an overlap between syphilis and methamphetamine, as using the drug can increase the odds of having unprotected sex and transmitting the disease, according to a recent report from the U.S. Centers for Disease Control and Prevention. They found the trend is most pronounced in the West.
Sonoma County is experiencing a spike in syphilis cases, for instance, and found 43 percent of residents with early stage syphilis last year were experiencing homelessness, and 51 percent were using methamphetamine.
It’s difficult to calculate the prevalence of STDs in homeless versus housed populations, but officials say people living on the street are at heightened risk.
Experts are particularly worried about congenital syphilis, which spreads from mothers to babies and can have fatal consequences for infants. Rates among infants increased 244 percent between 2015 and 2017, the window studied in the latest report.
“There is no excuse for having a single congenital syphilis case,” said Dr. Peter Beilenson, director of health services for Sacramento County. “It’s absolutely preventable, and we should be testing moms.”
But people are often hesitant about getting tested, and may face economic barriers that make it difficult to get to a clinic. Smith says county-run STD clinics where people could get screened discretely were some of the first programs cut during the recession, and those patients didn’t transfer over to general county health centers.
While the syphilis uptick is largely affecting people age 20 to 29, chlamydia rates tend to be higher among teens. Health officials say they’re the least informed about the risks of communicable diseases, and the least likely to get tested.
David Bouttavong is the health education program manager for Fresno Barrios Unidos, a nonprofit organization that does STD prevention in Fresno schools. He says kids are skittish about buying protection and getting screened.
“I wish there were more health centers that were located closer to them and their schools, and in places that they go to,” he said. “I wish it was more youth-friendly and youth-centered.”
Schools have been ramping-up sexual education efforts since the California Healthy Youth Act was enacted in 2016. It requires, among other things, that school districts provide students in grades 7 to 12 with information about how to protect themselves from sexually transmitted infections and unintended pregnancy. Some groups are still fighting the change.
Meanwhile, the state health department’s sexually transmitted disease control branch has launched an awareness campaign encouraging people to use protection and get tested.
Find a list of STD testing sites in Sacramento here.