By Talia Beechick and Madison Hopkins
Diverse sexual trends called “sexual sorting” may be driving Chicago’s young adults to some of the highest sexually transmitted infection rates in the country.
Chicagoans are twice as likely to have chlamydia and nearly three times more likely to have gonorrhea than residents of other areas in the U.S., according to data from the Chicago Department of Public Health.
The most recent data available shows that the 2014 rate of reported cases of chlamydia in Chicago was about 1,012 per 100,000 residents, more than two times the national incidence. For gonorrhea, the Chicago rate was about 308 per 100,000 people, almost three times the U.S. rate.
The Centers for Disease Control and Prevention estimated in 2008 that 110 million people in the U.S. have had an STI. This number includes anyone who contracted an incurable condition, such as HIV/AIDS or herpes, and conditions that may be contracted more than once during a person’s lifetime, such as gonorrhea and syphilis.
Dr. Michael Angarone, assistant professor of Infectious Diseases at Northwestern University’s Feinberg School of Medicine and a physician at Northwestern’s STI clinic, said that Chicago has historically been on the higher end of STI rates in urban areas, and that it is both predictable and surprising that Chicago is still seeing such high rates.
Because large cities have people with diverse backgrounds and sexual practices, they tend to experience sexual sorting—people seeking other individuals with the same sexual interests and preferences, Angarone explained.
“Large urban areas tend to have more sexually transmitted infections due to many changes in the populations that are there,” Angarone said. “Whenever you see numbers that are higher than you want them to be, however, is surprising. It’s surprising that all the efforts we do to educate people and make people aware aren’t having a greater effect.”
He continued. “New people come into those groups, and may get infected or bring something into those groups.”
Chlamydia and gonorrhea rates by Chicago community areas
Chlamydia continues to be the most common communicable disease in Chicago, with more than 27,000 new infections reported to the CDPH in 2014, about 8 percent higher than 2010. Continuing a trend from previous years, the number of women with a new chlamydia infection was about two times higher than diagnosis for men.
Women may see higher rates of chlamydia diagnoses because more of them are being screened for the infection, while men may go undiagnosed, according to the CDC.
Left untreated, approximately 40 percent of women with chlamydia contract pelvic inflammatory disease (PIV), and one in five women with PIV become infertile.
The AIDS Healthcare Foundation Wellness Center, which opened in Chicago in January 2015, offers free STI and HIV screening on a walk-in basis Monday and Thursday from 4-8 p.m. to encourage city residents to get tested more often.
“We test people using swabs, urine samples and blood samples,” said Sharell Collins, care coordinator at the center. “The average age of our clients is between 20 and 30 years old.” Collins hopes the center can offer daytime services in the future, but continuing to keep them free of charge may prove difficult.
“Clinics have budget cuts due to the state budget, so it is harder to offer free STI testing,” Collins said. “I think as time goes by, as it gets warmer, more people will want to come to be tested.”
Collins said the center’s youngest clients are 18 and Northwestern’s clinic requires clients to be at least 18. However, data shows that adolescents and young adults account for the vast majority of STI diagnoses in Chicago. People aged 13 to 24 account for approximately 60 percent of gonorrhea cases and nearly 67 percent of chlamydia cases.
“One of the trends we’ve been seeing over the past few years is that there are younger individuals that are being affected, especially by chlamydia and gonorrhea,” Angarone said. “We have to look at what we are missing in terms of education about prevention from STIs.”
Out of the five most populous cities in the U.S., Chicago had the second highest rate of reported chlamydia and gonorrhea cases in 2014, according to data from the CDC. Chicago was second in both categories only to Philadelphia.
Rate of reported gonorrhea cases in select metropolitan areas
Rate of reported chlamydia cases in select metropolitan areas
New healthcare technology may be transforming the process of finding out STI test results faster and more easily. Healthvana offers cloud-based technology to improve communication between physicians and patients. It delivers test results with next steps directly to patients’ phone or email, as well as electronic reminders and an STI testing locator.
Physicians who offer STI screening often only call the patient if the test results come back positive, according to Healthvana CEO Ramin Bastani. However, patients often end up calling the doctor’s office anyway, to make sure they are STI-free.
“No news is good news—we despise that statement,” Bastani said. “You feel embarrassed about calling doctor so many times and the lack of transparency. We want to destigmatize these things and empower patients.”
Healthvana is currently in use at about 20 clinics across the country, according to Bastani, with the goal of adding 80-100 more U.S. clinics by the end of 2016. The technology platform has reduced phone calls to the clinics by 75 percent, since patients are now able to check their medical records, test results and other medical data electronically.
“This allows for greater capacity to see more patients in the same amount of time,” Bastani said. “Patients who do test positive are coming in for treatment faster, thus reducing the spread of STIs.”
The AHF Wellness Center is registered with Healthvana, and Collins said the software has been helpful for both patients and staff members.
“Patients can register before they come, so all they have to do is bring their ID,” Collins said. “We put them into our system, and they get test results faster.”
In 2014, the number of gonorrhea cases among women reached its lowest level in five years, while men saw the opposite, reaching a peak in diagnosis the same year. The CDPH noted in its annual STI surveillance report that it is unclear if this trend is due to increased transmission among men, or better diagnostic practices. This inverse resulted in a moderate increase in overall diagnoses of about five percent in the city.
According to Angarone, the frequency at which individuals should get tested depends largely on their lifestyle and types of sexual practices.
“Individuals that may have one or two sex partners a year can probably get tested once or twice a year,” Angarone said. “If you have multiple sex partners, such as a different one each month or week, you should get tested every 3 to 6 months.”
Angarone noted that CDPH offers numerous clinics where patients can receive free STI screening, evaluations, and educational material to know their status and practice safe sex.