Some Coachella Valley health care providers are worried about a differentpublic health concern amid the coronavirus pandemic: sexually transmitted infections. After seeing positivity rates increase and routine testing waver due to COVID-19 restrictions, doctors have become concerned that asymptomatic carriers are unknowingly spreading infections.
Palm Springs health care provider Desert AIDS Project saw more gonorrhea infections last month than any month in 2019. The clinic also saw a roughly 40% increase in new syphilis infections from April to July compared to those months last year, though that rate has since decreased.
Doctors at nearby Planned Parenthood clinics also saw an increase in syphilis positivity since the start of the pandemic, though by a smaller margin, up from between 2% and 5% to between 7% and 8%.
Though some infections may have been transmitted prior to the state’s response to the pandemic, the rise in positivity rates may be due to initial declines in routine testing.
At Planned Parenthood clinics in Rancho Mirage and Coachella, a large proportion of people who’ve been tested for STIs since March are doing so because they have symptoms, Dr. Kyle Bukowski, associate medical director of Planned Parenthood of the Pacific Southwest, said late last month. “This is concerning,” he said.Someone without symptoms can still be contagious, which means asymptomatic people may be unknowingly spreading STIs like syphilis, chlamydia, gonorrhea or HIV.
“My biggest concern is the rebound effect that we’re going to see six to 18 months from now,” Bukowski said.
Untreated STIs can lead to an array of complications later including pain, infertility or other pregnancy complications, genital warts, various types of cancer, or lowered immunity. STIs can also increase susceptibility to other infections, including HIV.
The only way to prevent a “rebound effect,” Bukowski said, is by regularly testing people without symptoms. And that’s what local health care providers hope to do.
Routine testing is especially important for individuals who participate in higher risk behaviors, like having multiple partners, having unprotected sex or having sex with strangers. Though syphilis infections are more common among men who have sex with men, they are also a concern for pregnant women as congenital syphilis — syphilis passed to a fetus — can cause major problems. “Reducing the rate of congenital syphilis in newborns is public health concern,” Bukowski said.
Everyone should be tested once in their lives for HIV, while those at a higher risk, including sex workers, should be tested regularly.
“If we take our finger off the pulse of the existing HIV and STI epidemic, we will undo the progress we’ve made in preventing new transmissions,” said C.J. Tobe, director of community health at Desert AIDS Project. “The lack of routine testing and treatment is only going to add to the tragedy of COVID-19.”
Why did routine STI testing go down?
Despite social distancing regulations related to the pandemic, plenty of people are still engaging in sexual activity — both unprotected and with new partners, Tobe said.
“The reality is, people like natural sex here,” Tobe said. “A lot of people move here just for the freedom of their sexual health and sexuality.”
Stress caused by factors related to the pandemic, he said, may be leading to more high-risk behaviors, including unprotected sex.
“It’s a multifaceted problem,” Tobe said. “A majority of people are still having sex.”
To date, DAP has actually conducted more STI and HIV testing compared to 2019, but, Tobe said Thursday, this slight uptick is expected year over year. Additionally, he added, much of that testing happened in the first three months of the year.
DAP had started off the year strong when it came to HIV testing, nearly doubling its numbers in the first three months of 2020 compared to those same months last year. Testing rates across the board took the greatest dip in April, Tobe said, when COVID-19 related shutdowns were still new.
Decreased testing, especially in the first few months of the pandemic, is being attributedto COVID-19 restrictions and patient anxiety related to the virus, Bukowski said. For those trying to social distance, the fear of contracting COVID-19 at the doctor’s office may have outweighed their concerns over routine STI testing.
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DAP staff noted clients felt “fatigued from social isolating and nervous about coming indoors for testing and medical visits,” in an update posted online earlier this summer. In the last six months, the clinic posted multiple updates on its website and social media channels informing people of their testing options and precautions taken at the facility to protect patients from the coronavirus. They also have advertisements on LGBTQ dating apps like Grindr and Scruff.
Because of the pandemic, theavailability of STI testing appointments also decreased, Bukowski said, especially for people who were asymptomatic. These tests might have seemed less essential compared with testing for COVID-19 and, he added, some areas of the country have experienced shortages in the swabs typically used for certain STI tests because of the high demand to use them for coronavirus testing.
Tobe said this summer that most people coming in for STI testing were those experiencing symptoms. “But a lot of people don’t have symptoms,” he said.
If or when symptoms do show up, they could include blisters, sores, lumps or skin growth around the genitals, unusual discharge or bleeding, pain or burning during urination, pain during sexual intercourse, rashes or itching, or, in the case of HIV, flu-like symptoms.
After seeing the increase in syphilis and chlamydia, DAP’s clinical team started prescribing some higher-risk individuals Doxycycline, which is believed to help prevent these infections. Since then, the clinic has seen a decrease in those cases.
Now, however, it is seeing an increase in gonorrhea cases.
“There’s not really an explanation for that except for, maybe, people are engaging in more sex since things are more open,” Tobe said, referring to the county’s gradual reopening.
“What’s alarming is the amount of positives we’re seeing,” Tobe said, “especially the first couple months of the year.”
Coachella Valley already had rising STI rates
The Coachella Valley was already experiencing an increase in sexually transmitted infections before the pandemic.
Palm Springs is a “hotspot” for syphilis infections, according to a communicable disease report released in 2018 by Riverside County. In the county itself, incidence rates for syphilis have more than doubled since 2012.
With syphilis, people may not notice any symptoms at first or, if they have a sore, it is painless and therefore may not prompt someone to get checked out. “They don’t even know they have syphilis unless they’re getting testing,” Tobe said.
Between April and July of this year, DAP reported 88 new syphilis infections, according to data provided to The Desert Sun from the clinic. During those same months last year, there were 62 new syphilis infections.
If left untreated, syphilis can spread to the brain and nervous system or to the eye, according to the U.S. Centers for Disease Control and Prevention. Even if the sores go away on their own, it doesn’t mean the syphilis has and treatment is still necessary.
DAP also saw a slight increase in chlamydia infections between April and July — 159 new cases. During those same months last year, there were 153 new cases.
Chlamydia was the most commonly reported disease in Riverside County in 2018. Palm Springs reported a 30% increase in cases that same year. However, the report noted that “chlamydia is often asymptomatic and overall numbers may actually be higher.”
Though DAP initially reported a slight drop in gonorrhea casesin the spring, those numbers have started to inch back up. There were 42 new cases reported last month. The average number of cases so far this year, however, is still slightly lower than the number reported this time last year; the number of tests administered is slightly higher.
Gonorrhea cases have more than doubled in the county since 2010.
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This spring’s uptick in syphilis cases was concerning for area doctors, who noted thatcontracting the STI can make a person more susceptible to other infections, including HIV. The sores caused by syphilis act the same as any open sore and allow HIV to more easily enter the body. “When we see an increase in syphilis, HIV normally trends the same direction,” Tobe said.
Palm Springs and neighboring cities are already considered hotspots for HIV. More than half of all people living with HIV/AIDS in Riverside County are residents of the Coachella Valley.The prevalence of peopleliving with HIV in Palm Springs is more than 20 times higher than in California overall, according to the county report.
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From May through July of this year, DAP reported a total of 11 new cases of HIV, compared tonine new casesduring the same months last year. Seven of this year’s new cases were reported in June alone — June 2019 saw only two new cases.
So far this year, DAP has reported 28 new HIV infections. During this same period last year, there were 21.
About half of people who test positive for HIV test positive for another STI, often syphilis, Tobe said. Though syphilis is more commonly reported in younger adult men, Tobe said that it disproportionately affects people with HIV over the age of 55.
Out of Riverside County’s 308 new cases in 2018, 83% were male and nearly 29% were “co-infected” with HIV.
Prevention and care in the time of COVID-19
DAP has tried to address concerns about in-person testing appointments by offering more at-home services, including at-home HIV testing kits. All the test requires is an oral swab. Results take 20 minutes.
At-home testing kits have opened the door to people who’ve never been tested for HIV before, Tobe said. Just last month, the clinic mailed out 120 at-home HIV tests to patients who requested them.
After taking the test, DAP can help connect people to other services and even help figure out health insurance issues. For those who need it, DAP has case managers who check-in with them, help them arrive to appointments, and provide help with food or other basic services.
“If people are scared to test, reach out,” Tobe said. “We’ll make sure that we can do everything we can to ensure that access is there for all medical services to our patients.”
Clients who receive a kit also get free condoms.
Planned Parenthood, which serves predominately younger women, also offers telehealth services and free condoms.
Using condoms can help protect people from STIs. Anyone who wants them can either have them delivered curbside or pick them up at DAP’s front desk. Just send an email to [email protected]
Despite this low cost, Tobe said, many people opt out of using condoms.
In a recent post to DAP’s website, Tobe said that despite COVID-19, he’s gotten invites to participate in group sex. In the same post, Tobe suggested several ways people can have safer sex — things like masturbation, sexting, or video and phone sex.
If you are going to have sex, try pre-screening partners for the coronavirus and, he said, maybe wear a mask while you’re doing the dirty or choose just one pandemic partner.
Then, he added, use condoms — even for oral sex.
“If everybody used condoms, we would see a significant decrease in STIs,” he said.
Maria Sestito covers aging and the senior population in Coachella Valley for The Desert Sun. She is also a Report for America corps member and new to the desert. Please say “hello” via [email protected] or @RiaSestito.