The sex talk

Jennifer Howell is the sexual health program coordinator for Washoe County. In this Q&A feature, she provides a wealth of information about sexual health and the prevalence of STDs in our community.

What’s your role as sexual health program coordinator?

So, my role is to integrate HIV, STD and family planning as much as possible into a cohesive sexual health program for the community. And often our programs are in silos, because of funding streams and different things. Our program works to break down those silos and create bridges as much as possible, so it seems like seamless services for our clients and for the community.

In that, my role is on the prevention and data side, and also training. And then our clinical side is handled by our nursing supervisors. So what I do is all of the reporting for our various funders … coordinate the services between programs, and really push us to continue implementing things using best practices—and that’s in prevention, education, outreach, disease investigation … and surveillance, which is having diseases reported to us that are required to be reported by law. And then it’s up to us to determine what level of response we give, communitywide.

OK. I’ve got to ask the dumb question. There are diseases that you’re required to report by law—like if you have them?

Health-care providers are. If they diagnose them, and if laboratories have a positive test for certain diseases, they’re required to be reported, by law. And that’s so we can investigate them and stop the spread of infection.

What STDs are among those?

Chlamydia, gonorrhea, syphilis, HIV—those are the main ones.

I had no idea.

Yeah, NRS 441.A. That gives us authority over … a lot.

Let’s talk STD numbers. What STD is most common in our community?

The most reported communicable disease overall, actually—in local, state and national—is chlamydia, and it just happens to be an STD as well. It’s super common. It’s curable, and it just continues to grow about five to 10 percent each year of reported cases to us. It can cause negative health outcomes for males and females. … And then if it’s passed on to a newborn from an infected mother, there can be issues as well.

So it’s treatable—

It’s curable. It’s not just treatable. It’s curable. But it can cause damage. A person can get re-infected, and that can cause more damage. So it’s not without concern, even though it’s so common. … We encourage people to get tested because a lot of times people won’t have symptoms for most STDs.

Is chlamydia one of those that you might not have symptoms for?

Mm-hmm, yep, and gonorrhea.

The things you learn.

Exactly—so people don’t know unless they get tested, really, a lot of the time.

Here’s a question I think people wonder about. Should people in long-term, committed, monogamous relationships continue getting tested?

If they got tested at the beginning of their relationship and both of them tested negative and the test was out of the window period [the amount of time it takes for a disease to show up on a test] … then they don’t need—and if they’re confident that they are in a committed, monogamous relationship, and that’s a relationship agreement, and they are confident in that, then they don’t need to be tested.

Makes sense—I guess it would depend on how confident you are in the whole monogamy side of things.

Yep, because we got a lot of cases reported where a person’s like, “I’ve only been with this one person for this long.” And then we talk to the other person, and they’re like, “Well, I’ve only been with that person.” Well, it takes three to make an infection, so, one of you is not truthful.

So, back to the numbers—can you tell me the disease with the lowest rate of contraction here locally?

The lowest prevalence we have in our community?

I misspoke. Yeah.

Our lowest numbers are in HIV, but that doesn’t mean that it doesn’t have a huge impact on our community. It just means that that’s not as common of an STD in our community. It’s still there. It’s still being diagnosed every month, somewhere in the community. It just isn’t as prevalent as chlamydia or gonorrhea and, even now, syphilis. Syphilis has made a huge comeback in our community, to the point where we’re in an outbreak of syphilis, statistically.

I’ve seen reports of syphilis outbreaks across the news in recent years.

Yeah, ours started in August of 2013—is when the spike really started to happen. That’s when we were like, “Whoa, what’s going on here?” And that’s infectious syphilis. There are multiple stages of syphilis. So, in the first year, a person’s infectious. After that, it just does internal damage if it’s not cured. So we started seeing all of this infectious syphilis that we had never seen before. We would get like one or two cases a year … and then we got hit with like seven in a month, and we were like, “Whoa!” It’s starting to go down a little bit, but we don’t know what our new normal is because it’s made a comeback across the country. So different states or local jurisdictions are trying to ascertain what their new level of disease is.

Sure. That makes sense. What can you tell me about general trends, as far as the prevalence of STDs in the community?

Most occur in people under the age of 25. There are multiple reasons for that. It’s biological. Their bodies are still developing and not able to kind of ward off diseases like a mature reproductive system would. They tend to have multiple partners, casual partners. That’s not to say that doesn’t happen in all age groups. That age group, it tends to happen more. Their brains are also not developed to think as abstractly. That doesn’t happen until a person is like 25 to 27—where their brain is fully developed. So, you have sex—it’s a concrete thing, like, “It feels good. Yea! OK, done with that.” And then they’re not thinking of the consequences of, “There could be an STD, and I need to think about that.” So, unfortunately, it’s kind of how the brain works. But that’s not a license or permission to just not take responsibility for one’s actions. It’s an explanation as to why people do what they do.

And then … the younger a person is when they first have sex, the more likely they’ll have an older partner. So that older partner has probably been exposed to STDs and could pass it to the younger partner.

Is the general number of reported cases across various STDs in our community going up or down? Or is it pretty stable?

Oh, no. It’s going up. It’s going up. And some of it can be attributed to more screening, more tests being done, better testing technology—where the tests are more sensitive, and they’re picking up more disease—and just a real increase in the number of people who are infected. So it’s all of those things that contribute to that. Syphilis, we know. We were testing the same. The technology has stayed the same, and our number of cases just went shuum [rocketing up]. So we know that that’s a real increase in disease, not attributed to these other factors.

Interesting. So, I hate to say something is common sense, because who is it common sense to?

Exactly.

So, what should people do if they think, “I’ve got something” or “I don’t want to get something”? Where do they go?

What we tell people is, “If you’re sexually active, get tested.” Depending on what your behaviors are, like if you tend to have multiple partners or change partners, then test regularly. There’s no shame in that. It’s taking what the reality of your situation is and addressing it in a responsible way.

We’re very sex-positive. Sex is a natural occurring, pleasurable thing. And we don’t want to shame that for anybody. We want people to feel comfortable coming to us and telling us what they need to tell us, so we can help them appropriately. If they’re not telling us what kind of sex they’re having or the situation surrounding their sexual history, then we can’t help them. So with that being said, if a person is having a very robust—and multiple partners—sexual experience, then they need to test regularly. And I would say every three to six months.

If a person is getting into a new relationship with a partner, they need to test—or I would suggest that they test. I wouldn’t say they need to. That’s their choice. I would suggest they test—both of them—make sure they’re out of the window period for whatever disease, so that test result is accurate for them, and then move forward with how they want to proceed with their results. Bottom line—it comes to, if you’re having sex, at some point, get tested. If you’re not having sex, you don’t need to get tested.

Is that a thing? Do people—

It’s a thing.

OK. It’s a thing.

I guess experiencing what it’s like to go through the process, I get that. … But you don’t need to get tested if you haven’t been sexually active.

What are the current costs to get tested through the county?

For us, it’s on sliding pay scale based on a person’s income and on what testing that they have provided to them at that time. … But it’s a pretty low cost compared to other providers in the community. We don’t turn away anyone because of an inability to pay. We don’t send people to collections. They can pay on their bill as long as they’re able to.

Anything you want to add?

Just that being sexually healthy is part of life. It should be a goal in someone’s life. We’re all sexual beings, and so it’s better to be healthy about it. And people should have an HIV test at least one time in their lives, more if they’re at risk—as well as other STD testing. The recommendation is to have at least one HIV test. … It’s part of the Affordable Care Act, that STD testing doesn’t charge a co-pay to the patient. … So people should seek services. It’s available. It’s accessible. People like us, HOPES, Planned Parenthood—we want to help. We want promote people knowing what their HIV and STD status is. Ω