The Sex Talk 

Chlamydia, syphilis on the increase while myths surrounding STDs, birth control abound

Lorraine Fortunati, preventive health services coordinator and reproductive health program manager at Central District Health Department, has been a nurse practitioner for 21 years.

Laurie Pearman

Lorraine Fortunati, preventive health services coordinator and reproductive health program manager at Central District Health Department, has been a nurse practitioner for 21 years.

Local health officials don't want to scare anybody.

"It's always a concern that information can be blown out of proportion," said Lorraine Fortunati, preventive health services coordinator with the Central District Health Department. "Scary information can cause alienation to some who may need care the most. That's the exact opposite reaction we want."

But when Fortunati said that the region's syphilis rate was "concerning" it may be too much of an understatement. In fact, CDHD's region--also known as Idaho District No. 4--covering Ada, Boise, Elmore and Valley counties, has already reported 21 confirmed cases of syphilis in 2012, compared to only 11 cases in all of 2011.

"Right now, we're up 200 percent," said Sarah Correll, CDHD epidemiologist. "When you consider that each of the confirmed cases is typically linked to multiple partners, it grows exponentially. And, yes, if it continues at this rate, it looks like we could be up 400 percent from last year."

CDHD tracks syphilis for a good reason: The consequences are horrifying.

"When we confirm syphilis, epidemiologists dive into the case," said Nikki Sakata, program manager of CDHD's Community Health Division, which includes Communicable Disease Control. "We simply don't know if there's an outbreak until, quite frankly, after the outbreak. You're identifying a case here, a case there. All of a sudden you have an outbreak."

The majority of confirmed syphilis cases in CDHD's region identify Treasure Valley men, aged 25-45 as primary victims.

"And there's little discrimination among partners," said Fortunati. "They have little or no knowledge of their partners' history."

Fortunati--a nurse practitioner for the past 21 years and whose duties include management of CDHD's reproductive health program--described how untreated syphilis can spiral to a grisly fate.

"A person develops a chancre, a painless ulceration, within the first 10 to 90 days," she said. "Because it's painless they may not even know it's present. If there's no treatment, it may resolve on its own and go into the second stage."

Fortunati said the second phase--anywhere from three to six months--could result in swollen lymph nodes and/or white patches on the inside of the mouth.

"Again, these symptoms can be very mild," said Fortunati. "There's no, 'Oh my gosh. What's this rash?' reaction."

Years may go by as the bacterium incubates in the human body, but the worst may be yet to come.

"Eventually, it can go into a third stage, when the spirochetes may invade the brain, the spinal cord or the heart. Victims can get heart disease, develop dementia or become paralyzed and potentially die."

The disease is chilling but, Fortunati said, the diagnosis is still rather foreign to many younger caregivers.

"A lot of physicians have little to no memory of when we saw a good many cases of syphilis in this country, back in the 1950s," she said. "Today's doctors aren't trained to say, 'Hey, this is syphilis.'"

As frightening as syphilis is, chlamydia is by far the most common sexually transmitted disease. In Idaho 4,705 cases were confirmed during 2011, of which 1,630 were reported in District No. 4.

"Chlamydia is on the increase," said Sakata. "It has probably increased 100 to 200 cases a year, just in our district."

Chlamydia, though not as lethal as syphilis, can't be dismissed either.

"Guys may experience a clear discharge, some burning in urination or just an itch that can't be scratched," said Fortunati, describing a diagnosis that could lead to sterilization in men and infertility in women. "Females may experience bleeding between periods or burning in urination. A lot of women mistakenly think they have a bladder infection."

In spite of volumes of science and statistics surrounding STDs, CDHD's panel of experts said a number of myths still prevail.

"There is a lot of misinformation out there. It's hard to say whether it's naivete or bad information from the Internet but there's a definite lack of knowledge on basic anatomy," said Daniel Allen, youth outreach director with CDHD.

Allen spends his days straight-talking with young adults, most of them male. He's perplexed by some of the outright lies that people accept as truth.

"Have you ever heard the one that says you can't transmit an STD or get pregnant by having sex in a hot tub? Or even a shower or swimming pool?" he asked, shaking his head. "Absolutely false. Plus, some people are convinced that you can't get pregnant or an STD while having sex in different positions."

Allen was equally worried about something else he heard.

"I almost don't want to repeat it, but it's too outrageous. Some people actually believe that STDs could be prevented by douching with chemicals," he said. "Unbelievable. But this is the stuff they hear."

Allen said just when he thought he had heard it all there was always something new, "Because they can ask me anything. And they do."

"Getting people to open up is a big deal," he said. "There are several hindrances, not the least of which is to get people to walk through our door. If I had my wish, it would be to de-stigmatize STD testing."

Approximately 800 clients walk through the doors of the CDHD Boise office on Armstrong Place each month. More than half of them are getting tested for STDs.

In addition to the district's regular clinic hours, Monday through Friday, a special teen clinic is open 2-5 p.m. each Thursday.

"Any boy or girl, 14 or older, can seek evaluation or treatment for STDs without parental consent," said Fortunati. "But it's important to add that we encourage parents' involvement. We need parental approval for an STD evaluation for anyone younger than 14."

According to the 2011 Idaho Youth Risk Behavior Survey, 40 percent of Idaho high school students report they have had sexual intercourse. Nearly 14 percent of the students said they have had intercourse with four or more persons.

The survey data, gleaned from questions suggested by the Centers for Disease Control and Prevention, are key statistics for health-care professionals to craft policy and develop prevention programs.

"We're in a culture that doesn't like to talk about anything sex related," said Allen. "Whether it's religious views or political views, sex is just one of those things we don't like to discuss. Particularly with men. Guys think they're supposed to have all the answers."

But there's a good reason why nobody in Idaho has all the answers: Some questions aren't even being asked. In fact, the State Department of Education made the decision not to ask teens a series of questions regarding pregnancy prevention.

"When teens are given the opportunity to answer the questions, you can guide your practice and outreach more effectively," said Fortunati. "Why should Idaho teens be any different from teens anywhere else?"

Fortunati was much more direct with her commentary when asked about medicine being politicized.

"It's most frustrating," she said. "And it makes our work more challenging. When men or women are denied services because of political reasoning that isn't based on science, then all of our communities suffer. Infections tend to go up. Unintended pregnancies tend to go up. And therein lies the problem."

But Fortunati is an optimist.

"As a health district, we're always working so hard to create good relationships with our community. STDs can be prevented," she said, "And this is the place to come get tested and treated."

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