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Baltimore officials fear the coronavirus pandemic will exacerbate another public health issue: STD rates

Assistant Professor of Medicine Johan H. Melendez demonstrates how to feed specimen samples into the Panther instrument to test for chlamydia and gonorrhea. Johns Hopkins University's "I Want The Kit" program allows people to request an at-home STD test instead of going to an in-person clinic during the coronavirus pandemic.
Assistant Professor of Medicine Johan H. Melendez demonstrates how to feed specimen samples into the Panther instrument to test for chlamydia and gonorrhea. Johns Hopkins University's "I Want The Kit" program allows people to request an at-home STD test instead of going to an in-person clinic during the coronavirus pandemic. (Ulysses Muñoz/The Baltimore Sun)

At first glance, Baltimore’s numbers for sexually transmitted diseases look promising.

During the first seven months of 2020, according to preliminary data provided by the Baltimore Health Department, reports of STDs were down in the city. Compared to last year, reports of chlamydia decreased by 20%. Reports of gonorrhea and HIV dropped, too.

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But these numbers may be deceiving, thanks in large part to complications caused by the coronavirus pandemic, warned Dr. Adena Greenbaum, assistant commissioner of clinical services at the city’s health department. In fact, she and other sexual health experts are bracing for STD rates to get worse.

“That’s just STDs that were reported — it doesn’t mean that they weren’t there,” Greenbaum said of the preliminary data, which has yet to be finalized. “I don’t think the actual decrease in STDs was that severe during that time. I just think it really shows what happens when the reporting system closes down, or really gets reduced capacity.”

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The pandemic has forced clinics and health care providers to cut back on in-person testing services and outreach efforts. With a new infectious disease to track, Baltimore City needed to divert its contact tracing manpower away from STDs.

Even before COVID-19 hit, STDs were at an all-time high across the United States. According to an analysis done by a health services research group on data released by the Centers for Disease Control and Prevention, Baltimore City had the highest rate of STDs in the country, with 2,004 cases per 100,000 people as of 2018.

Yet, the concerns of Baltimore experts are echoed nationwide. A National Coalition of STD Directors survey at the start of the pandemic found that 83% of STD programs reported deferring services or field visits as a direct result of the coronavirus, and 66% of clinics reported a drop in sexual health screening and testing. All jurisdictions surveyed expressed concern about how the restrictions of services would impact their vulnerable populations.

In Baltimore, before the pandemic, no appointment was necessary to visit one of the city health department’s two sexual health clinics. Now walk-ins aren’t permitted, and the city only offers limited testing to those who are symptomatic — encouraging others to request a personal test kit from a program run by the Johns Hopkins University. Additionally, the city has yet to send its mobile outreach vans back out into the community.

Upon request, someone can receive swabs to send back to Johns Hopkins University's lab to test for chlamydia and gonorrhea, seen on the left, as well as an at-home testing kit for HIV which they can perform themselves.
Upon request, someone can receive swabs to send back to Johns Hopkins University's lab to test for chlamydia and gonorrhea, seen on the left, as well as an at-home testing kit for HIV which they can perform themselves. (Ulysses Muñoz/The Baltimore Sun)

Chase Brexton Health Care, however, has continued offering HIV testing on a walk-in basis. The health network’s social workers also “intensified” outreach to their existing patients with HIV, reaching quite a few who had fallen out of care, said Dr. Sebastian Ruhs, Chase Brexton’s chief medical officer. Perhaps as a result, he said, the number of patients who have an undetectable viral load has improved slightly during the pandemic.

However, the network hasn’t been able to continue offering testing for other types of STDs for those who aren’t Chase Brexton patients, due to COVID-19 restrictions and staffing issues.

Typically, during the warmer months, the network holds a series of outreach events — including testing — in areas where access to health care may be limited, said Christina Daly, a social work supervisor for Chase Brexton. But this year, the system hasn’t been out in the community as much as it would like to be.

Chase Brexton has done about half as many tests so far this year, 939, compared to 1,807 at this time last year, Daly said.

Though Ruhs said he shares city officials' concerns that STD rates will spike, he added that it will be a while before the effect of the pandemic becomes clear.

“Whether that is going to be true or not, I guess it’ll take another eight to 12 months to find out,” he said.

Sequinta Hill, director of programs at the Pride Center of Maryland, is more certain that the number of STD cases will increase in Baltimore.

“I mean, how could [they] not?” Hill said. “Unless people were being really, really careful. And that was not evident from the amount of phone calls we were receiving.”

The calls for sexual health resources started pouring in to the center as Maryland began lifting coronavirus-related restrictions, Hill said. People had been struggling to find a place where they could get tested for STDs in the city, and were starting to get nervous, she recalled.

Hill was worried too. It takes a lot for some people to work up the courage to get tested, she said, and if they aren’t able to do so when they have the nerve, it may be a while until they try again. At that point, it may be too late.

Eventually, the Pride Center decided to hold its own testing event, even though its budget took a hit after its annual Baltimore Pride festival was canceled. Partnering with Total Health Care, Hill said the center offered $10 to anyone who came to get tested, along with some additional cash if they brought a friend with them. Over the course of four or five weeks, Hill said the center tested at least 40 people.

Hill is frustrated that sexual health services in the city have taken a hit because of COVID-19.

“I think if we’re going to say that HIV is a major health concern, a major public health issue, because that is what we claim it to be, then we should treat it like one, even during another major public health issue,” she said.

However, the Baltimore Health Department’s Greenbaum said there has been a silver lining: More people than ever are requesting a personal test kit from Johns Hopkins. In fact, according to data provided by the “I Want The Kit” program, requests between April and June increased by more than two-and-a-half times from the first three months of this year.

More specifically, Hopkins researchers Charlotte Gaydos and Yuka Manabe said they saw an increase in requests from younger age groups and Black men — two populations that experience disproportionately higher rates of STDs. They also saw an increase in requests for rectal swabs from men, which they said could signal an increase in requests from men who have sex with men, another vulnerable population.

Ultimately, Gaydos and Manabe credited the program’s surge in popularity to the city’s promotion of it. Though it’s likely the kits haven’t completely filled the gap in testing opened by the pandemic, Manabe said she was hopeful that they were doing their part to keep STD rates under control in the city.

“The STI rates nationwide have been increasing,” Manabe said. “So, we need to come up with innovative ways to control the STI epidemic. ... And if this innovation that caught fire a little bit during COVID can continue on and supplement what else might be available when we get back to more openness, then that would be great.”

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