How to talk to your doctor about your sexual health
Durham County ranked second in North Carolina in the rate of new syphilis cases in 2016, with a rate nearly five times the national average.
Syphilis is on the rise nationally, with most of the growth among men having sex with men.
It it easily treated and cured, but left untreated, syphilis can damage your heart, brain, eyes, and other organs. This damage may not show up for many years and can kill you.
Durham County had 120 new syphilis cases last year, or 39.2 per 100,000 people, according to the N.C. Department of Health and Human Services. That was roughly twice the state’s rate of 18.7 per 100,000 people (1,894 actual cases).
Among North Carolina’s 100 counties, only Mecklenburg County had a higher rate: 46.4 cases per 100,000 people.
The first symptom of syphlis is a painless, round and red sore that can appear anywhere you’ve had sexual contact.
Nationwide, the Centers for Disease Control and Prevention reported 27,814 cases last year, or 8.7 cases per 100,000, a 17.6 percent increase over 2015.
It’s too early to forecast this year’s numbers, but the trend is alarming, said Arlene Seña, a CDC consultant and medical director of the Durham County Department of Public Health. If you do have syphilis, you also have a higher chance of getting HIV, the virus that causes AIDS, and you can spread both diseases more easily.
“When you have two infections [syphilis and HIV] occurring together they can be synergistic,” making early treatment and detection crucial, Seña said.
From 2010 to 2016, the rise in syphilis nationally occurred mostly among men, according to the CDC. Of those infected, about 80 percent were men having sex with men. About 75 percent of syphilis cases in Durham are in that group, said Seña, who is also is an associate professor in the UNC School of Medicine.
The Alliance of AIDS Services-Carolina, has seen an increase in cases, executive director Hector Salgado said. It recently conducted testing at N.C. Pride events in Raleigh and Durham and “in both cases we found new syphilis cases,” Salgado said.
Some media reports have suggested an increase in sexually transmitted infections because of greater use of pre-exposure prophylaxis, or PrEP. This prescription pill, sold under the brand name Truvada, can prevent HIV infection, as much as 90 percent, according to the Centers for Disease Control.
However, the Centers also stated that the increases in syphilis (along with chlamydia and gonorrhea) in 2016 “are unlikely to be completely attributable to the use of PrEP,” stated an email from Donnica Smalls, a spokesperson for the Centers for Disease Control. “While CDC estimates more than 1.2 million people who are at high risk for HIV infection would benefit from using PrEP, the magnitude of individuals currently on PrEP is not large enough to account for all of the STD increases in 2016,” the email stated.
Experts stress prevention and education in reducing sexually transmitted diseases, and local health departments offer free testing for HIV and other STDs.
Durham Knows is a program of the Partnership for a Healthy Durham, which encourages people to know their HIV status. It recently teamed up with the Pinhook club downtown to hold an education session and connect people to testing sites and other resources, said Marissa Mortiboy, the health department’s coordinator for the partnership.
Durham and Orange counties also participate in Integrated Targeted Testing Services, a state program that provides STD testing in homeless shelters, bars and places where those needing testing may spend time. People need to feel comfortable in the places where they are tested, said Annette C. Johnson, program manager at the Durham County health department.
The Alliance of AIDS Services is using social media apps like GROWLr, where men meet other men, to encourage testing. The sites’ anonymity encourages people to speak more candidly, and Salgado said the alliance already is having success with this outreach. “There’s still a stigma around testing,” he said.
In November, state officials met with representatives from counties with high rates of syphilis, Seña said. One result of that meeting is that Durham is using a new rapid test for syphilis for quicker diagnosis, Seña said.
Beginning in January, Durham and three other counties will participate in a CDC grant to reach out to transgender women and men, and men having sex with men.
More education is needed to remove the continued stigma of being tested, experts say. These infections “are just like other infections,” Seña said. “These are common infections, and infections that we need to be more open about.”
Where to get tested
▪ Durham County offers an “STD Testing Only” service, which provides free and confidential testing for HIV, syphilis, chlamydia, and gonorrhea. Clients who have no symptoms and report no known exposures to an STD can choose to be screened for STDs without having to be examined by a medical provider, though a medical exam is available to any client who requests one.
The STD Testing Only service is available Monday-Friday from 8:30 a.m. to noon and 1 to 5 p.m. On Tuesdays, this service is available until 6 p.m. For more information call 919-560-7601.
▪ Durham County Public Health. Registration is available daily from 8 a.m. to 4:30 p.m. Monday-Friday and 8 a.m. to 6 p.m. Tuesdays in Lobby 1, Durham County Human Services Building, 414 E. Main St. Call 919-560-8819.
▪ Orange County. Testing is by appointment with same day or next day availability. For information or to schedule an appointment, call 919-245-2400. Testing is available at the Hillsborough office, 300 W. Tryon St., and the Chapel Hill office, 2501 Homestead Road.
▪ For more testing site information, visit durhamknows.org.
Other STD numbers
▪ Orange County had 11 syphilis cases in 2016, or 7.8 per 100,000, a decrease from 15 in 2015, or 10.7 per 100,000.
▪ Wake County had 251 syphilis cases in 1016, or 24 cases per 100,000, a slight decrease from 249 cases in 2015.
▪ Durham County had 2,426 chlamydia cases in 2016, or 792.3 per 100,000, an increase over 2,284, or 759.9 per 100,000 in 2015.
▪ Orange County had 692 chlamydia cases in 2016, or 488 per 100,000. In 2015, Orange County had 634 cases, or 450.6 per 100,000.
▪ Wake County had 5,514 chlamydia cases in 2016, or 526.8 per 100,000, a decrease from 4,966 cases in 2015.
▪ Durham County had 965 gonorrhea cases, or 315.1 per 100,000, an increase over 739 in 2015, or 245.9 per 100,000.
▪ Orange County had 174 gonorrhea cases in 2016, or a rate of 122.7 per 100,000. That rate was slightly lower than in 2015, when the county had 182 cases or 129.4 per 100,000.
▪ Wake County had 1,626 gonorrhea cases in 2016, or 155.3 per 100,000. Wake had 1,452 cases in 2015.
Source: N.C. Department of Health and Human Services