Treponema pallidum, the bacterium responsible for the dangerous sexually transmitted infection syphilis.
Treponema pallidum, the bacterium responsible for the dangerous sexually transmitted infection syphilis. (Science Picture Co / Getty Images)

If your odds of winning the lottery were 1 in 50, you would likely want to buy a ticket. Or, perhaps, 50.

If your chances of getting a sexually transmitted infection, such as chlamydia, herpes or syphilis were 1 in 50, you would likely find a way to reduce your chances. Or, perhaps, ask your health care provider for a screening.


The unlucky reality is, in Baltimore, those odds are real not for winning the lottery, but for getting a sexually transmitted infection (STI).

We are seeing a remarkable rise in the number of STIs across the nation, with 2.4 million new cases identified in 2018, according to the Centers for Disease Control and Prevention. Baltimore ranks highest for the number of cases per capita with 2,004 cases for every 100,000 people, or roughly 1 case for every 50 people, according to an analysis of the CDC data by Innerbody. To put that number in perspective, Chattanooga, Tennessee, the city ranked 100th in the study, had 794 new cases per 100,000 people, or roughly 1 case for every 125 people.

As alarming as these numbers are, as the director of medicine and infectious disease care for Chase Brexton Health Care, one of Maryland’s largest and Baltimore’s oldest community health centers, I believe the community-at-large can reduce the spread of STIs significantly by addressing economic, social and behavioral factors.

In the last two decades, funding to the CDC for STI prevention and treatment programs, which it passes on to states for local efforts, has drastically decreased. This combined with the prevalence of STIs affecting those in poverty with limited access to quality health care, has reduced prevention, testing and treatment programs.

The gradual reduction in funding has meant that non-profit health care clinics like Chase Brexton have also had to reduce outreach efforts to and programming for those patients who struggle to afford the day-to-day necessities. Health care becomes a luxury sought once the infection or disease can no longer be ignored. Unfortunately, for the health care system this also means the illness is much more complex and more expensive to treat.

Considering that most STIs are asymptomatic or only cause very minimal symptoms, and some, such as syphilis, can persist for years, regular screenings are needed to reduce Baltimore’s STI rates. The overall cost of the STI crisis to taxpayers, patients and health care providers would be greatly diminished with a stronger focus on prevention and early intervention.

When symptoms are not experienced, or are seemingly benign, a person can live for years with an STI without knowing it. They unknowingly pass it on to their sex partners, who may unknowingly pass it on to their partners, and so on. Simple preventive measures — condom distribution, education and consistent access to care — are key to reducing this trend. The Maryland Department of Education has proposed a more robust sex education plan that should be supported.

Half of all new STI cases in 2018 were among young people 15-24 years old. The rise in rates of STI infections among teens and young adults may be curbed through education about prevention and risk behaviors. Many teens and young adults circulate within small groups of like individuals. Intimate and sexual connections within these trusted networks are not unusual. This can create the opportunity for STIs to multiply easily. The ripple effect of infection can be substantial.

With a dynamic and informed curriculum that prepares adolescents for the world in which they live and the people with whom they relate, one that addresses all issues of sexual health, including reproduction, sexual orientation, sexually transmitted diseases, sexual behavior and preventive care, we can reverse the trend.

Lastly, we need to address the stigma related to sex, substance use and mental health that can prevent people from seeking care and treatment. As a society, we can shift attitudes to encourage open dialogue about mental health and substance use issues that may lead to higher risk sexual behavior. More importantly, we must address as a community, as peers and as health care providers, our inability to speak comfortably and openly about sexuality, sexual behavior and STIs.

Studies have shown that both medical providers and patients are uncomfortable talking about sex. However, communication is possibly the simplest of the solutions to the STI epidemic. The stigma someone may feel about how their sexual history may be perceived may keep them from treatment. Health care providers can help by making non-judgmental sexual history a part of all annual visits for adolescents and adults. Patients must accept the sexual component of their physical and behavioral health, it is not a topic to avoid.

Dr. Sebastian Ruhs (sruhs@chasebrexton.org) directs the Infectious Diseases Center at Chase Brexton Health Care and is the medical director for Chase Brexton’s Mt. Vernon Center.