WASHINGTON – Reports of gonorrhea, syphilis and chlamydia skyrocketed in Eastern Shore counties in 2001, pushing rural counties ahead of many larger jurisdictions and making them second only to Baltimore in sexually transmitted disease rates.
And state health officials say the numbers do not give an accurate picture of the problem’s severity.
“The burden of disease is much higher, much greater than what the numbers reflect,” said Dr. John Krick, director of Epidemiology and Disease Control for the Maryland Department of Health and Mental Hygiene.
After Baltimore city, Wicomico and Dorchester counties had the highest rates of chlamydia and gonorrhea, respectively, in 2001, with nearly all other Eastern Shore counties ranking among the 10 worst in the state. Talbot County followed Baltimore with the second-highest rate of syphilis in 2001, when the county’s caseload rose fivefold.
Wicomico County Health Officer Judith A. Sensenbrenner said her county’s ranking was “a dubious honor, at best,” but that the numbers were not surprising.
“Everyone thinks that rural areas should not have the problems that urban areas have,” Sensenbrenner said. But she added that the Shore is “along the drug-running corridor of the East Coast, and a lot of the behavior has to do with drugs.”
Krick said that while trading sex for drugs has long driven the epidemic rate of STDs in Baltimore, he could not point to a specific reason for the surge in Maryland’s rural areas. He said possible culprits include an increase in sexual activity among “and variations in use of protection.”
“Sometimes condoms are the golden rule and other times they are simply dismissed,” Krick said.
While local officials conceded the high rates of reported cases, they also noted that a minor surge in cases can cause a major surge in infection rates because of the counties’ relatively small populations.
“Even though it may have been only a few people in the community that have a disease, it makes our rate very high because our population is small,” said Kathleen Foster, health officer for Talbot County.
Better reporting could also be responsible for the rate increase in rural areas, said Mary Adda Moore, the communicable disease director in Kent County, where the gonorrhea rate more than doubled from 2000 to 2001.
Moore said that because Kent County Health Department workers periodically visit local medical offices to make sure the doctors are treating, testing and reporting all cases, more physician report, which drives up rates.
“If you’re out there beating the bushes and bringing people in to be tested, then more cases can be identified. The only way to get good case rates is to visit with the private physicians,” she said.
“What we have here is numbers based on reports of disease that are coming out of labs or physicians’ offices,” he said. “But there are flaws in the system.”
Many practitioners treat only the symptoms without diagnosing the patient, which allows for “slippage” between the actual number of cases in the community and the number reported to local health departments, he said.
“This is serious stuff and we don’t have our hand around it as we should because of the problems that make it difficult to control,” Krick said.
But the small population that can inflate rates in rural counties has also helped them deal more aggressively with the problem than the bigger counties, officials said.
Foster said Talbot County’s small population let the health department identify the source of a syphilis outbreak and control it through “contact investigations,” in which officials interview the infected patient, determine their sexual history and then locate and treat all their sexual partners.
“Our knowledge of the community makes it easy for us to locate patients,” said Foster, adding that her department even keeps track of the county’s homeless population.
Larger counties have a harder time tracking down the sex partners of every patient who is treated for a sexually transmitted disease.
“You find disease by doing contact investigations, but we are not well staffed to do this for all diseases in all counties,” Krick said.
Although the state conducts “pretty aggressive follow-ups for diagnoses of syphilis,” Krick said, “there is a fair amount of chlamydia that is treated where a contact investigation is not done.”
Some local health departments have begun putting condom machines in local businesses, to fight sexually transmitted diseases at the community level.
Foster said the Talbot County Health Department has placed condom stations “in barber shops, beauty shops and bathrooms.” The county hands out 10,000 condoms per month to the community at the various stations, she said.
“Any place that is interested in having a condom station can have one,” Foster said. “They are being well used. But unfortunately, they are not all being used by the people who need them.”