Chlamydia and gonorrhea infections in 2015 reached the highest rates ever recorded in Bexar County.

Data from the Texas Department of State Health Services shows that chlamydia, gonorrhea, syphilis and HIV rates all increased in Bexar County from 2014 to 2015, the most recent year state data is available.

Statewide rates of chlamydia and syphilis reached record highs as well.

The state attributes the increases to better and more accessible testing, but Dr. Junda Woo, medical director of San Antonio Metropolitan Health District, said it may also have something to do with how the agency has directed its resources, particularly the decision to focus primarily on decreasing the incidence of syphilis.

Metro Health received nearly $2.8 million in mostly federal money from 2014 to 2016 to fund a prevention project that expanded testing for and education about HIV and syphilis, with an emphasis on preventing mothers from passing syphilis on to their babies during pregnancy or childbirth. The agency received an additional $1.2 million to continue the project this year.

“At least some of (the increase) is from cases actually going up,” Woo said. “We have limited resources, so when we focus a lot of attention on syphilis — and we can see we’ve had some success there — then that is diverting attention away from chlamydia and gonorrhea.”

More Information Metro Health clinic The San Antonio Metropolitan Health District’s STD/HIV Clinic is open Monday through Friday and tests for chlamydia, gonorrhea, syphilis and HIV for as low as $15. Location: 512 E. Highland Blvd. Phone: 210-207-8830

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In 2015, more than 13,000 Bexar County residents were diagnosed with chlamydia and more than 3,900 with gonorrhea. The infection rates were 44 percent and 66 percent higher, respectively, than the U.S. rates, which also increased in 2015.

Those with chlamydia don’t often experience symptoms, leading many to spread it unknowingly. If left untreated, chlamydia can lead to infertility or pelvic inflammatory disease in women. Untreated gonorrhea can threaten both men’s and women’s ability to have children.

Better testing

Metro Health and the Department of State Health Services attribute at least part of the rise in sexually transmitted disease and HIV rates to more people getting tested.

“A large part, maybe all, of the increase appears to be linked to the ability to diagnose more infections through better testing and an increased availability of testing,” said DSHS spokesman Chris Van Deusen.

Testing has become more precise and less invasive in the past 15 years. According to Van Deusen, nucleic acid amplification tests, dubbed by the Centers for Disease Control and Prevention as the best diagnostic tests available, have become more widely used in the past decade.

“We can now test urine for gonorrhea and chlamydia, rather than having to rely on unpleasant urethral swabs,” Van Deusen said.

Similar innovation in HIV testing has made it possible to diagnose someone in less than 60 seconds following a finger prick. Or, for those opposed to needles, an oral swab can return an HIV diagnosis in 20 minutes.

People under the age of 25 and men who have sex with men contract sexually transmitted infections and HIV at the highest rates. For example, 65 percent of people in Texas diagnosed with chlamydia and 55 percent with gonorrhea are between the ages of 15 and 24.

“A big problem with chlamydia and gonorrhea in the gay world is that most of the STD screenings are heteronormative,” said Andrea Moutria-Niño, director of prevention at the San Antonio AIDS Foundation. “If you were to pee in a cup and you had chlamydia in your urethra, they would find it. But if you have rectal chlamydia or gonorrhea, it’s not going to find it. And that’s a huge problem. A lot of people aren’t open with their doctors about who and how they have sex.”

Moutria-Niño said the disease can be easily diagnosed in those who engage in anal sex by testing a rectal swab.

Metro Health launched a mobile unit in April that visits sites across the city several times a week to provide free screenings for chlamydia, gonorrhea, syphilis and HIV. The agency tested 20 percent more people for chlamydia and 17 percent more for gonorrhea in 2016 than the year before.

Targeting syphilis

Bexar County experienced a mostly consistent rise in the number of syphilis cases in recent years until health officials and community groups began taking steps to target the problem. The breaking point came when 17 babies were born with congenital syphilis in the county in 2012.

Congenital syphilis can lead to severe birth defects or death. In September 2015, a law went into effect requiring physicians to test pregnant women for syphilis during the third trimester. Metro Health tested 13 percent more people for syphilis in 2016, the first full year the new law was in effect, than the year before.

By 2015, the number of babies born with syphilis in Bexar County dropped to 10. Still, that is the second-highest number in the state behind Harris County, with 14.

In May, Metro Health announced that the preliminary rate of primary and secondary syphilis cases, the earliest stages during which the disease is most transmittable, decreased in 2015. While technically true — the rate dropped from 11.9 per 100,000 to 11.8 — there were 223 primary and secondary cases in 2015, two more than the year before, according to the most recent state data.

The county’s overall syphilis rate, which includes later stages of the disease, dropped 21 percent from 2013 to 2014 but increased by 5 percent in 2015, when there were 959 new diagnoses.

Rita Espinoza, chief of epidemiology at Metro Health, said the agency monitors the number of primary and secondary cases more closely than the overall case rate because their job is to stop the spread of syphilis, which usually occurs in the first of four stages of the disease in adults.

Espinoza called the 5 percent increase in all syphilis cases “alarming.”

“But I’d be more alarmed if our primary and secondary (cases) were increasing by 5 percent or 10 percent,” she said.

The local increase was well below the national increase — nearly 18 percent — from 2014 to 2015.

The San Antonio AIDS Foundation began testing people for syphilis when they came in for HIV testing in 2013 as part of the communitywide effort to curb the rise of the disease in the county. The foundation performs a rapid test on a blood sample that can return results in 10 minutes.

Moutria-Niño said people with syphilis are more at risk of contracting HIV.

“Textbook syphilis starts off with a small, painless sore wherever the bacteria entered the body, so usually on the genitals,” Moutria-Niño said. “But it’s painless, so it can be mistaken for an ingrown hair or just a bump.”

She said having an open wound makes it easier for HIV to enter the body. Additionally, if the body senses inflammation or irritation, it sends immune cells to help. When someone with an existing sexually transmitted disease comes in contact with someone with HIV, the virus can infect the localized immune cells without having to travel throughout the body.

In a January report, the Department of State Health Services said more than 82,000 Texans “are known to be living with HIV,” but the CDC estimates another 14,315 infected people are living in the state undiagnosed. In 2015, 363 Bexar County residents were newly diagnosed with HIV, up from 319 the year before.

Additional theories

The best way to avoid contracting an STD or HIV is to abstain from sex, or contain sexual activity to a monogamous relationship with an uninfected partner. Otherwise, consistent and correct condom use reduces the risk of spreading or contracting diseases, according to the CDC.

The CDC recommends that men who have sex with men, women 25 and younger and those with more than one sexual partner should be tested for chlamydia and gonorrhea every year. Men who have sex with men should also get tested annually for syphilis and HIV, as should women while they are pregnant.

Catherine Troisi, an infectious disease epidemiologist at UT Health School of Public Health in Houston, said dating apps like Tinder and Grindr might contribute to the number of young people engaging in risky behavior.

The apps “make it very easy to have anonymous hookups and often condoms are not used,” Troisi said.

Taking a health class is not a graduation requirement for Texas high school students, but state Rep. Mary Gonzalez, D-Clint, filed a bill Feb. 6 that would require Texas schools to provide medically accurate information on human sexuality, including information about sexually transmitted infections and how to prevent them. Democratic lawmakers have introduced similar proposals every session since 2009, but the bills never progressed in the Republican-led Legislature.

Troisi said increased education is necessary to promote better decision-making skills, but she wonders if STD rates have increased because of young people becoming numb to the “safe sex” talk.

“Part of it could be prevention fatigue, that people have been told for so long about safe sex and things like that,” Troisi said. “Especially now that we have treatment for HIV, that people are getting less concerned about becoming HIV positive because they know it’s no longer a death sentence.”

The San Antonio AIDS Foundation is trying to target at-risk populations by testing people where they are. Its mobile testing van visits local college campuses and neighborhoods with the highest STD and HIV rates, and the foundation conducts tests at some of the clubs on St. Mary’s Street and Main Avenue.

bmartin@express-news.net

Twitter: @beedotmartin