Sexually transmitted infections still being battled in Douglas County

BY JUDITH NYGREN
WORLD-HERALD STAFF WRITER

• Confidentiality a cornerstone of the battle
Dr. Amy Lacroix has a simple rule for determining which of her teenage patients need to be tested for sexually transmitted infections.

If they have had sex, even once, they should be tested.

A positive result generally means a return visit for a second test three months later - the time it takes for many to become re-infected, said Lacroix, who teaches adolescent medicine at the University of Nebraska Medical Center.

Douglas County is in the midst of a four-year epidemic of sexually transmitted infections that is hitting teens and 20-somethings particularly hard, health officials say. Although certain behaviors - binge drinking, drug use, sex with multiple partners - put the young at greater risk, many who are infected don't fit into any high-risk category.

The county's STI rate - "sexually transmitted infections" is the preferred term nowadays - is risk enough because prevalence creates more opportunity for catching an infection, health experts said.

Last year, Omaha ranked 12th among 43 large U.S. cities reporting chlamydia, the most common and fastest-growing STI in the country. Omaha ranked 26th for gonorrhea.

Those two, chlamydia and gonorrhea, account for the bulk of STIs in Omaha. Both can strike without symptoms and, if untreated, make sufferers infertile.

As happened in many communities, health experts said, the Douglas County rates soared because people didn't recognize the growing problem. Even though awareness and education have increased in recent years, the rates remain high.

Now public health officials are calling on the county to redouble its efforts against STIs.

"Much gallant effort to educate and draw attention . . . has been made," said Richard Brown, chief executive of the Charles Drew Health Center. "But it continues to thrive. . . . We need to take a more aggressive approach."

One area in which Douglas County already is aggressive is testing, state and local officials agree. That also is one reason the county shows up as a hot spot on STI tracking maps. Other communities probably would find higher rates if they tested as much, said Dr. Joann Schaefer, Nebraska's chief medical officer.

Lancaster, Thurston and Dawes Counties in Nebraska also have higher-than-average infection rates compared with the rest of the nation.


Their rates reflect issues unique to those counties, including large numbers of Native American and college-age residents, two high-risk groups. Still, their rates don't approach Douglas County's.

Although the Omaha area's infection numbers haven't fallen, they also haven't increased significantly since 2003, when the county announced the epidemic was at hand. That indicates the county has been able to contain infections, said Dr. Adi Pour, Douglas County health director.

The challenge, said Schaefer, is to identify what has and hasn't worked, and to find new tactics for reaching the most vulnerable group: those ages 15 to 24.

That age group accounted for more than 70 percent of the 2,745 chlamydia cases reported in Douglas County in 2007. More specifically, about 990 of the infected were ages 15 to 19. About 975 were ages 20 to 24.

Women of all age groups are the hardest hit by chlamydia. In Douglas County, women accounted for 2,020 - nearly 75 percent - of the infections reported last year.

The Women's Fund of Greater Omaha has devoted more than $450,000 in grants and private donations to raising awareness about the infection and testing sites.

The group knows its money has been well spent, said Ellie Archer, executive director. Immediately after it runs ads in high school newspapers, more teens come in for testing, she said.

Money is a major obstacle for any community dealing with high infection rates, said Karen Thompson, who manages Iowa's STI programs. Most states, Iowa and Nebraska included, rely almost entirely on federal funds to run infection programs, and that money has been declining in recent years, she said.

Iowa's federal STI money of $785,000 covers only about 60 percent of the cost of preventive programs, Thompson said. Nebraska gets about $450,000 of the federal funds, more than $280,000 of which goes to Douglas County.

Local health officials estimate they would clean out the state's entire prevention fund in a single day if they were to test and treat every infected resident in Douglas County.

At its current funding levels - which includes $5,000 in Medicaid funds for treatment and $554,000 in county money - Douglas County has seen its testing rate increase nearly 50 percent during the past four years. Roughly 6,355 free tests were performed at the county's two infection clinics in northeast and midtown Omaha.

Thompson credits Douglas County with putting its money to good use. Neighboring Pottawattamie County doesn't have free clinics devoted to sexually transmitted diseases. As a result, she said, Omaha probably tests some Council Bluffs residents, who then show up in Douglas County's statistics.

Testing is so critical to reducing infection rates that Douglas County health officials have asked that a third free clinic be opened, in west Omaha. Private doctors report that teens in suburban areas often have health insurance but don't want their parents to know they are sexually active or have an infection.

Lacroix encounters this in her practice. Her advice: Have the test - often as simple as providing a urine sample - then talk to mom and dad. Lacroix even offers to be the one to break the news to parents that their child is sexually active.

For those who resist her advice, Lacroix provides information on free and subsidized testing at the county or Planned Parenthood clinics. Sometimes she offers her patients a payment plan, allowing them to pay $10 or $20 a month to avoid an insurance claim.

Lacroix also has a matter-of-fact conversation with patients about behaviors that increase risk. She talks about the hazards of multiple partners, about using condoms and about never mixing alcohol or drugs with sex.