Gonorrhea is a nasty disease. It causes burning, pain, and discharge for men and women in most cases, and at worst can affect the heart and nervous system. Chlamydia is no better. It starts with the same common symptoms but can lead to blindness and a form of arthritis.
Both diseases are more prevalent in Howard County than anyone would like to accept. And they’re on the rise. In 2011, there were just 14 reported cases of gonorrhea in the community. That jumped to 51 cases last year and is on pace to exceed that number by year’s end.
Chlamydia affected 156 people in Howard County in 2011, which increased to 182 last year. The 2013 numbers will fall within that range.
According to Jennifer Sexton, public health nursing administrator for the Howard County Health Department, there is something her organization could do to help address the problem, but the resources necessary to do so have been placed out of reach.
“We can treat the disease, but we don’t have the ability to test for it,” said Sexton. “We were given an opportunity to start testing for gonorrhea and chlamydia, beginning in 2014. It’s a program through the state department of health. They would provide us with urine and vaginal or rectal swab collection kits, free of charge.
“They are self-collected tests, so there would be no exam needed. The only thing the local department would be responsible for is the shipping and administration of the case, along with education. And we already ship hepatitis specimen every week. It’s not overly expensive. We’re not talking a ton of money.”
The testing would be available for adults under the age of 29 who are either uninsured or under-insured and who also are symptomatic for the diseases. But it isn’t going to happen.
“It’s something we want to do, but the block is time and staffing,” said Sexton. “The block is not having the people to do the job. Every time we do one of these tests, the person has to be placed into a database. Guess who does that? It’s clerical work that could be done if we had adequate clerical staff. And it also takes nursing time to counsel them.”
The health department is responsible for tracking and reporting incidences of a number of communicable diseases, and it relies heavily upon the state department of health, physicians, and hospitals for much of that information. That doesn’t mean that the department isn’t contacted by the community regularly about diseases and testing.
Sexton said that the department receives an average of 20-25 calls a week from citizens seeking testing for chlamydia and gonorrhea -- but there is little they can do to help.
“Because we see the value in having local contact with people who have these disease, we do follow up with them,” said Sexton. “We ask those who report to provide the information to us so that we do not have to rely solely on the disease information specialist at the state.
“Each client with one of these illnesses -- chlamydia, gonorrhea, syphilis, HIV -- we ask them if they have partners who need to be treated. We send them information about the disease, a letter, pamphlets, and suggestions on how to avoid getting it again. We also provide information about our hepatitis testing services, since there is a correlation between those diseases. If you have contracted an STD it is likely because you are having unprotected sex, which puts you at a higher risk for other diseases.”
Sexton argued that the STD cases reported annually are lower than what actually exists in the community, and there is a reason for that. Those who are exposed to the diseases are also more likely to not have access to healthcare.
“Absolutely, we would catch more incidences of the disease with this testing,” said Sexton. “There is nowhere to refer people right now for testing. We can refer them to their private physician, but the population we’re talking about typically doesn’t have a private physician or the money to pay for the test.
“We can refer them to Indiana Health Center, which is a great entity, but they have to become a client and go through hoops. And there is still a cost involved. We can refer them to Clinic of Hope or Project: Access, but they are probably not the best choice for testing.
“So, where do they go? They go to the emergency room -- the most expensive way to get this done. And private citizens end up subsidizing the cost through their insurance premiums for something that we could do for the cost of shipping the test. It’s a shame.”
The issue all comes down to funding. The Howard County Council and Howard County Commissioners have declined to extend additional resources to the department, and the department’s budget has been severely slashed over the past three years. The cuts actually will end up putting more services at risk, Sexton explained, because investigating these diseases is a requirement even if testing isn’t.
“I will spend a lot more time investigating 400 cases of gonorrhea, chlamydia, and other diseases if I can’t test and educate to try to lower those rates,” said Sexton.