HEALTH

Report: Teens, young women make up 44% of Knox County chlamydia cases, and numbers are up

A nationwide trend of increased cases of sexually-transmitted diseases has prompted public health officials to encourage prevention and more frequent testing.

Teens and young adults in Knox County should be concerned about chlamydia — and that's nothing new.

Since 2013, it's been the most commonly reported sexually transmitted infection in the nation, and the incidence is even higher in Knox County.

But it's highest among ages 15-19 and 20-24, and it continues to increase, said a report released last month by Knox County Health Department.

And young women, in particular, are at risk, said the health department's 2018 "Status of Sexually Transmitted Infections" — with infection rates triple those of males the same age.

Symptoms, risks, complications

Women ages 15-24 account for 44.5 percent of the 2,599 chlamydia cases reported countywide in 2017. 

Part of that is because women's anatomy is more conducive to hosting the infection, said Sarah Hall, a disease intervention specialist with Knox County. Part of it is that infected women are less likely than men to show symptoms, at least initially.

"Males tend to have symptoms more often, so females can carry this longer than males without knowing," Hall said.

The STD report uses 2017 data from across the county, not just from patients in the health department's own clinics, which provide confidential STD testing to anyone 13 and older per state law.

Microscope image made available by the the Centers for Disease Control and Prevention shows chlamydia trachomatis bacteria magnified 200 times. The number of cases of STDs - in California reached a record high in 2017, and officials are particularly concerned by a spike in stillbirths due to congenital syphilis, state health authorities said.

The problem "is definitely countywide," including on college campuses, Hall said. "STDs don't discriminate; they can affect anybody."

The health department makes an effort to do educational programs for at-risk youth organizations in areas where clusters of cases crop up — in people who are in the same social networks, for example. 

But Hall said it's paramount for parents talk to their children about their risk for STDs, especially since it's likely many in the 20-24-year-old age group actually contracted the infection at a younger age and it's gone untreated.

"It is an awkward conversation to have" with young teens, "and we hear from parents that they just aren't sure how to start it," said Katharine Killen, director of community relations for the health department, who recommends the "My Body, My Future" website as a starting point. "It's not one conversation. It's multiple conversations over time, and it's all about being an 'askable' parent."

Left untreated, chlamydia can affect fertility and develop into pelvic inflammatory disease, and babies born to women with active infections also carry health risks. The report also notes a disparity in the youngest age category: While white women have higher rates of the disease, black women are more likely to have complications, perhaps because they go longer without testing and treatment, Hall said. 

Gonorrhea, another sexually transmitted infection, has increased similarly, with Knox County's incidence higher than state and national rates. Locally, women 15-29 years old and men 20-34 have the highest incidence of gonorrhea.

"Gonorrhea and chlamydia typically go together," Hall said. "They're spread the same way."

But symptoms from gonorrhea can be more obvious, she said, so it's likely to be detected sooner. In addition, it's not only possible but common to have both infections at the same time.

Who should be tested?

In a primary-care setting, testing for STDs is typically based on risk factors, Hall said. But if patients aren't honest about their risk — which teens might not be — they may not be tested, she said. In addition, they may not realize they can and should be tested. 

While the health department sends case counts and suggestions for creating a "comfortable environment" for testing to local doctors, she said, teens who aren't honest about their risk "are going to be missed."

Those who have had unprotected sex with more than one partner need to be tested for STDs every three months, she said. Those who have unprotected sex occasionally need to be tested between three weeks and a month afterward, she said, since the infection doesn't always show up immediately.

And anyone who has sex should be tested yearly, Hall said.

"If you're sexually active, you're at risk," she said. "So if you haven't been tested before or haven't been tested within the last year, come get tested. That's the only way to know what you've got going on."

Talk to your child about sex, risks

The U.S. Department of Health and Human Services' Office of Disease Prevention and Health Promotion notes teens who talk to their parents about sex are more likely to put off sexual activity until they're older, and more likely to use protection when they do have sex.

"Most teens say that it would be easier to make decisions about sex if they could talk openly and honestly with their parents," the site says, offering these tips:

  • Talk early and often. You don’t have to fit everything into one conversation.
  • Be ready to answer questions. Children’s questions can tell you a lot about what they already know.
  • Listen carefully, even if you don’t agree with your child’s opinion.
  • Try using things that come up on TV or in music to start a conversation.
  • Be honest about how you are feeling. For example, if you are embarrassed or uncomfortable, it’s OK to say so.