One of the beauties of living in the South is that when someone seeks service here and remarks that where they come from they do it such-and-such a way, one can think, “We really don’t care how they did it where you came from.” But there are some good ideas out there that can be modeled.
For instance, Los Angeles County began a program in which young women can order home collection kits from the health department for chlamydia and gonorrhea testing. In its first year, 2,927 kits were ordered, 1,543 were returned with testable specimens and the findings revealed 131 women, or 8.5 percent, had positive test results. Other studies have shown that self-testing had similar quality specimens when compared with samples taken in the clinic.
Robeson County had 2,211 cases of chlamydia and 580 cases of gonorrhea during the past 24 months. While some people may have a burning sensation or discharge, many have nothing. It is thought that up to 95 percent of adolescents are asymptomatic, so many people go untreated and undiagnosed.
One of the adverse outcomes is pelvic inflammatory disease. The rate of infertility is 11 percent after one episode of PID and doubles with each subsequent infection. Because both chlamydia and gonorrhea are bacterial infections, they are easily treated and cured with antibiotics. Of course, the trick after detection is getting patients in for treatment, but that is always the case.
The highest rates for infection are in women ages 20 to 24 followed by women 15 to 19. Men represent only about 10 percent of the cases in Robeson — but women are far more likely to be screened and detected. Chlamydia and gonorrhea are two of the disparate conditions, with African Americans representing more than 40 percent of infections, American Indians 31 percent and whites 13 percent, and the rest multiple races or unknown.
This type of testing for sexually transmitted infections shows much promise. Unfortunately, the costs that are involved with this effort — besides the kits there is an outreach program — is not something that can be undertaken when we are struggling to find funding to convert to an electronic health record, which is required. But the start-up is something that might be meaningful enough for a grant. That is where our hope will lie.
William Smith is director of the Robeson County Health Department.