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Primary Care and Prevention Administration
Sexually Transmitted Diseases Control Program
News
The Newsletter of the Division of Sexually Transmitted Disease Control Preventive Health Services Administration, Department of Health Washington, DC
Impact of Closure of a Sexually Transmitted Disease Clinic on Public Health Surveillance of STDs Washington, DC, 1995
In April 1995, a public sexually transmitted disease (STD) clinic in the Northwest (NW) ward of the District of Columbia closed, leaving one public STD clinic in the Southeast (SE) ward to provide public STD services for the entire city. The District of Columbia Department of Health’s STD program requested CDC to investigate and evaluate the impact of the NW STD clinic closure on STD case reports. The findings of this investigation indicate that the clinic closure resulted in a marked decrease in reported syphilis in the NW ward, and suggest that NW ward residents with syphilis and their partners may not have received proper diagnostic testing, therapy, and counseling.
To determine the number and characteristics of patients seen at the STD clinics, the Health Department’s STD clinic reports from May 1, l994, to April 30, 1996 (the 12 months before and the 12 months after the clinic closed) were reviewed. To assess ward-and clinic-specific trends in case reporting, syphilis and case reports in the Health Department’s STD surveillance database were analyzed. For this analysis, data for the year before and the year after the clinic closed were available for primary and secondary (P&S) syphilis cases, and data for 4 months before and 4 months after the clinic closed were available for gonorrhea cases.
Compared with the 12 month period before the NW STD clinic closed, during the 12 month period after the clinic closed, the number of reported cases among women residing in the NW ward did not change, whereas reported cases among women residing in the SE ward increased by 41%. However, among men residing in the NW ward, the number of reported cases decreased 78%, while reported cases from men residing in the SE ward decreased by only 13%.
The number of P&S syphilis cases reported for NW residents at the SE STD clinic did not change substantially following the NW STD clinic closure.
CDC Reports a 30 Percent Increase in Herpes
One in five Americans age 12 or older is infected with genital herpes, and the number of people living with herpes has increased 30 percent since the late 1970s, according to a national survey conducted from 1990 to 1994 by the Centers for Disease Control and Prevention. The findings were reported in the Oct. 16 New England journal of Medicine.
The study also found that almost 45 percent of African Americans are infected with herpes simplex virus type 2 (HSV-2), the usual cause of genital herpes, as compared with about 22 percent of the population overall.
Since the CDC's last national survey of HSV-2 prevalence, conducted from 1976 to 1980, herpes has spread most dramatically among young people. HSV-2 prevalence among white teens is five times higher than it was in the late 1970s. People ages 20-29 are now twice as likely to have HSV-2 as they were in the last survey.
Judith Wasserheit, MD, MPH, Director of the CDC’s Division of STD Prevention, says, "We believe herpes plays a major role in the heterosexual spread of HIV in the country. Herpes can make HIV-infected individuals more infectious. Preventing herpes can help us stop both epidemics."
The CDC is working in consultation with other public health experts to develop a national plan specifically targeting the prevention of herpes. The plan will address development of comprehensive national prevention guidelines, outline enhanced monitoring of levels of herpes in the US and propose new educational activities for health care professionals and the public.
Source: STD NEWS, A quarterly newsletter of the American Social Health Association, Vol.5, No. 3, page 11.
Public Health Advisors Look Back on 50 Years of Fighting STDs
In 1948 Dr. Johannes Stuart, a federal government economist alarmed by the rising tide of postwar sexually transmitted disease, was searching for measures that would interrupt the transmission of syphilis. Penicillin had been shown to be highly effective in curing syphilis and thereby stopping the transmission. The problem was how to find the people who needed treatment. If people who had been exposed by having sexual intercourse with an infected person could be found and treated before they became infectious, the train of transmission could be broken.
Stuart decided to try a new approach—taking case finding and contact interviewing to the field. To accomplish this, he would need people willing to work under trying circumstances and, importantly, with an interest in the problems of persons with disease. He saw as a potential source of field workers the large numbers of veterans graduating from college who had not made career plans.
Bill Watson, now the Associate Director of the Task Force for Child Survival and Development, was one of those—a recent graduate of the University of South Carolina. The University Placement Office sent Watson an announcement that there would be a job interview by the Public Health Service and he said, "Why not?"
The interviewer gave Watson no details about the position, but a few weeks later he was offered a job in the PHS and told to report to Washington. It was not until he had been hired that his duties were explained to him, and he was given training to prepare him for the assignment. Watson was to work with the state health department in Maryland to interview people diagnosed with syphilis, identify their sexual contacts, find those contacts and convince them to receive testing and treatment—a far cry from his history and political science background in college.
Assigned to the Eastern Shore of Maryland, Watson did such a good job that within six months he was transferred to the Capital in Annapolis. This was the beginning of a 36-year career in the Public Health Service, culminating as Deputy Director of the Centers for Disease Control in Atlanta from 1972 to 1984.
Watson was one of six original workers recruited as Public Health Advisors in 1948. This year as the group celebrates its 50th anniversary, members can look back on five decades of leadership in the fight to control STDs in this country as well as abroad. The original group of six grew to more than 600 in the 1960s. Most were assigned to work for state and local health departments, starting off as field investigators and progressing to become supervisors, managers and principle assistants to state STD control officers. These officers were for the most part clinicians with little training in the public health aspects of the problem, and the PHAs quickly fit into a mold of being the implementers, never trying to pose as the expert in disease, but functioning as the good right hands of the clinicians.
The PHAs were the ones who would work in the clinics in the inner cities, knock on doors in the tenements and interview prostitutes in the bars, always maintaining their professionalism, yet improvising new methods to gain cooperation. Many would leave the federal government to work with state and local governments. As public health became more management oriented, the PHAs became the lead managers, taking technical guidance from the medical staff.
From the beginning of the program, other disciplines in public health recognized the value of the PHAs and recruited from their ranks to work in chronic disease control programs, accident prevention, tuberculosis control, immunization and multitudes of other health activities. The PHAs brought a particular skill to management. They had worked in the basic activities of the public health program and had an appreciation for the needs of the people served, not just the needs of management.
These skills have served the PHA well, and the nation’s health programs well. PHAs have become state and local health officers as well as state program directors. And, importantly, they have served the management needs of the Centers for Disease Control and Prevention. They have occupied the principle management positions not just of the CDC itself, but of all its Centers.
Although the control of STDs has been the major preoccupation of the group, their talents are widespread and they have brought their enthusiasm and willingness to work in strange environments to bear on global issues. A highlight in the history of the PHAs is their contribution to the worldwide eradication of smallpox, the only disease that has been eradicated. Over 100 of them worked in Africa and Asia with CDC staff assigned to the World Health Organization and the US Agency for International Development. Their attention to details of management and logistics were key factors in the eradication of this disease.
PHAs are now working toward the global eradication of polio and guinea worm, and soon many may be turning their attention back to their origins—syphilis elimination, one of the goals of the CDC. Achieving this goal will require the national will to make syphilis elimination a priority, and recent federal appropriations for the CDC's Syphilis Elimination Project may forecast growing support for this effort. Just as they did in the battle against smallpox, PHAs will play a key role.
Source: The American Social Health Association, STD NEWS, Vol. 5 No. 4, Summer 1998.
Did You Know?
Sex Happens After 50 (And So Do STDs)
The Centers for Disease Control and Prevention reports that people age 50 and older make up more than 10 percent of total AIDS cases in this country, and that HIV rates are increasing among people in their 60s and 70s. (ASHA STD News, vol.5 no.4)
What They Don’t Know is Frightening
Three out of four cases of non-HIV STD’s infect young people ages 15-24-about 3 million every year. Many of those youths never know they’re infected because they have no visible symptoms. (Wash. Post, March 20. 1999)
CHLAMYDIA IN THE NEWS
An estimated 75% of WOMEN and 50% of MEN Who are infected with Chlamydia HAVE NO SYMPTOMS.
What puts adolescents at risk?
Part of being a teenager is taking risks. Teens may act as though they’re invincible. They test limits and question authority. But in this day and age, the impact of unsafe sex can be irreversible. It’s like playing a game of Russian roulette: maybe you won’t get infected, but maybe you will. Thankfully, most STDs can be treated. But no one has yet been cured of AIDS.
Teenagers are having sex earlier than ever, often with multiple partners. By the time they reach age 20, 77% of girls and 86% of boys have had sex.
And most teens do not consistently use condoms. The 1991 National Survey of Adolescent Males found that condom use is likely to be highest at the beginning of a relationship and then decline once the partner is perceived as "safe". Teenagers with the largest number of sexual partners were the least likely to use condoms.
African-American adolescents are especially vulnerable to HIV. For youths aged 13-19, African-American females accounted for 73% of new HIV infections in 1993; African-American males accounted for 48%.
Especially vulnerable to HIV and other STDs are teens who are gay, drug users, juvenile offenders, school dropouts, runaways, homeless or migrant youth. These youth are often hard to reach for prevention and education efforts, and have limited access to health care and service-delivery systems.
Source: HIV Prevention: Looking Back, Looking Ahead a project of the Center for AIDS Prevention Studies, University of California, San Francisco, and the Harvard AIDS Institute.
DIVISION SERVICES
The Southeast STD Clinic is located on the grounds of the District of Columbia General Hospital, 19th & Mass. Avenue SE. The clinic is open Monday through Friday, 8:00 am - 3:00 pm All services are free. The clinic staff performs routine STD testing, diagnosis and treatment. The Disease Intervention Specialists (DIS) whose responsibilities include counseling, contact tracing and partner notification services are located at the SE Clinic. The phone number is (202) 698-4051
HIV Antibody Counseling and Testing is available during clinic hours. There is no cost for the counseling or for the confidential HIV Antibody testing. Patients who test HIV Antibody positive are counseled and referred for early intervention services.
Surveillance Unit gathers, analyzes and distributes statistical data reflecting the current state of STD infections in the District of Columbia. The unit monitors the reporting of positive STD laboratory results; initiates follow-up for patients who may require medical attention and/or counseling to the DIS; and maintain a Central Syphilis Morbidity File. The phone number is (202) 727-9863.
Training and Education Unit provides STD/HIV materials to external organizations. The Unit performs STD/HIV in-service, presentations, and lectures to community-based organizations, universities, neighborhood health clinics and others; provides educational in-services and materials to the field staff; and provide training, presentations and technical assistance to the STD/HIV educational programs of the District of Columbia public school system. For STD information and requests for presentations please call (202) 727-9861.
The STD Hotline is a 24 hour telephone and information service for the residents of the Metropolitan Washington, DC area. The hotline phone number is (202) 832-7000.
ANNOUNCEMENTS
The Division of Sexually Transmitted
Disease Control
Supports the District of Columbia
Department of Health
As It Observes
"National Public Health Week April 5 – 10, 1999"
Project WISH, women Into Staying Healthy, offers free breast and cervical screening services to DC residents who have limited or no health insurance. Free transportation to and from the appointment available. To make an appointment, call Project WISH’s 24 hour toll-free number, (888) 833-9474.
The DC Department of Health has moved
825 North Capitol Street, NE
Washington, DC 20002
DOH "Info Line"
(202) 442-9191
Hotlines
National STD Hotline
(Monday - Friday, 8:00 am - 11:00 pm EST)
(800) 227-8922
National AIDS Hotline
(7 days a week, 24 hours/day)
(800) 942-2437
Division of STD Control Hotline
Twenty-four hours a day
(202) 832-7000
STD Notes, the newsletter of the Division of STD Control, Department of Health (DOH) is a quarterly publication for the DOH employees, community based organizations and neighborhood health care facilities.
The District of Columbia Department of Health
825 North Capitol Street, NE
Washington, DC 20002
Marlene N. Kelley, M.D.
Interim Director
Division of STD Control Program
717 14TH Street, NW Suite 750
Washington, DC 20005
Phone (202) 727-9860
Fax (202) 727-4934
John Heath, Program Manager
Valerie M. Mitchell, Publications Editor
Contributors to this issue: Division of STD Staff Members with special thanks to Gonzalo Saenz, C. Lyn Trotter, Michelle Amar, and Karey Hall
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