Although more people in Los Angeles County (LAC) have access to health insurance than ever before, the complexities of navigating the system have also increased and both public and private sector providers are not routinely screening for STDs. In 2017, LAC reported more than 90,000 cases of STDs, including 59,000 cases of chlamydia (CT), 24,000 cases of gonorrhea (GC), 7,000 cases of syphilis, of which of which 63% were staged as early syphilis, and 44 cases of congenital syphilis (CS). Syphilis is the highest priority in LAC. In the past five years, syphilis has increased 77% and CS increased 450% during the same time period.
The majority (92%) of CT, GC, and syphilis cases in 2017 was diagnosed by a private provider and 85.5% of STDs were treated by a private provider making these providers a critical component of a robust STD prevention and control strategy. During this project period it is imperative that DHSP identifies ways to engage the private healthcare system. Other contributing factors are declining condom use, especially among men who have sex with men (MSM); smartphone technology is changing the way people access sexual partners; many residents at risk for STDs are not appropriately screened or treated by their medical provider; and high prevalence of syphilis among men is fueling the congenital syphilis epidemic. Given the record number of STD cases in LAC and the disproportionate burden of the disease in communities of color and among youth, MSM, and transgender persons, supporting a multi-prong approach is necessary to arrest the rising rates.
The following activities were selected as Los Angeles County’s highest priorities: increase accuracy and efficiencies in STD and HIV surveillance activities through the implementation of a new data system that collects records for communicable diseases and promotes faster and easier reporting of STIs across the County and faster assignment and tracking to PHIs; launch three new state-of-the-art Sexual Health Express Clinics (SHEx-C); scale up screening, diagnosis, and treatment in existing community based sexual health clinics; develop and promote two social marketing campaigns to increase syphilis awareness, screening and treatment among MSM and women of child-bearing age; promote and expand provision of EPT/PDPT; and improve and expand disease investigation (partner services) activities. The narrative and workplan include many activities that cannot be supported by the funding available from CDC, but that are vital to stemming the ongoing STD epidemics and improving sexual health in LAC.