With numbers of sexually transmitted illnesses rising across the nation, local and state public health officials are particularly worried about the impact of a new and unique illness: the Zika virus.
Zika is transmitted by infected mosquitoes, but unlike other such illnesses, it can also be transmitted by sexual contact, the U.S. Centers for Disease Control and Prevention reports. The CDC also warns that the virus can live in sperm for up to six months. Researchers still don’t know how long the virus can live in other bodily fluids.
The discovery might be less troublesome if other sexually transmitted illnesses weren’t also increasing, especially in young men. While rates of HIV/AIDS remain mostly stable, other illnesses are on the rise. The number of early syphilis cases diagnosed in North Carolina in 2015 was 1,866, with a rate of 18.6 per 100,000 population, according to the state Department of Health and Human Services. This number is an increase from 2014, when 1,137 early syphilis cases were diagnosed (11.5 per 100,000 population). The majority of the cases were men, with the largest percentages in men ages 20 to 29.
“This is an age when people have less realization of their own vulnerability and mortality, and that’s a developmental norm,” says Dr. Victoria Mobley, medical director of the HIV/STD Program at the NC DHHS Division of Public Health. “We’re seeing these increases in sexually transmitted illnesses nationwide; it’s not just here,” she says.
Dr. Jennifer Mullendore, medical director for the Buncombe County Department of Health and Human Services, says online “hookup” apps are part of what is fueling the increase in STDs. “People are meeting online for the purpose of having sex, and they don’t know anything about their partners — even their contact information,” Mullendore says.
That makes it more difficult for public health officials to trace outbreaks. When STDs are reported, patients are asked to list their sexual partners. If sex is anonymous, partners can’t be notified, and STDs spread faster and farther.
Part of the problem is the stigma still associated with being gay in some parts of society, says Kelley Johnson, an Asheville therapist specializing in sexual behaviors. “Men who have sex with men don’t always identify as being gay,” she says. “And they’re often the ones who seek anonymous sex. If a doctor asks, they’ll identify as straight.”
In addition, some people find risky sex is more exciting, Johnson says.
In the 1970s, sex carried some risk, but STDs were curable, for the most part, or at least treatable. Then in the early 1980s came HIV-AIDS, which for many years was a certain death sentence.
“I think we’re experiencing some condom burnout,” Johnson says. “People know now that HIV is manageable, and you can live a normal life, so if you don’t use a condom, it isn’t necessarily a death sentence.”
But there are consequences, even if death is unlikely. Illnesses such as gonorrhea and chlamydia can cause infertility in women, and syphilis can kill if left untreated. Syphilis also can cause birth defects and death in infants exposed before birth, and while the numbers are not as large, women are getting syphilis in increasing numbers. The risk of permanent harm is even greater where women are concerned, because they can transmit it to their unborn children.
According to the state health department, there has been an increase in infants diagnosed with congenital syphilis, which can lead to birth defects and stillbirths: 12 cases in 2015, up from seven in 2014. DHHS also reported increases in ocular syphilis cases, including cases resulting in severe or complete vision loss, increasing to 42 cases in 2015, up from 21 in 2014.
And although gonorrhea has remained fairly stable, co-infection with HIV (diagnosed before or within 30 days of the gonorrhea infection) has doubled among men in the past five years.
And now Zika has joined the list of STDs.
“This is an entirely new twist,” Mullendore says.
What makes it most concerning is not the illness in adults, because it usually is no worse than a mild flu-like illness. But Zika causes devastating birth defects, most notably microcephaly, which causes the brain to not develop properly. Even in children who are born with normal-sized brains, the virus can cause cognitive problems.
U.S. Sen. Richard Burr, R-N.C., released a statement calling on Congress to address the threat.
“The unique threat Zika poses requires us to act. … Nothing is more important than the health of our children, and now is the time for congressional Democrats to work with Republicans to confront the Zika virus head on. … It would be a shame for the brokenness of Washington to make an already tragic situation with Zika worse. North Carolinians are counting on Congress to prove that we can tackle tough problems by working together, keep our children and families safe, and act responsibly with the finite resources we have.”
The CDC has released guidelines for couples who want to know more about prevention of Zika transmission. These include a recommendation that people who have been exposed use condoms and that the condoms be worn from initiation to completion.
If neither partner is pregnant, the post-exposure wait is eight weeks before having unprotected sexual contact. However, if one partner is a man who had symptomatic illness or was diagnosed with Zika, the wait period is six months.
If the unexposed sexual partner is a pregnant woman, use of condoms or abstention from sex with any exposed sexual partner is recommended for the duration of the pregnancy.
Probably the most important thing any sexually active person can do to prevent STDs is to be tested and to insist sexual partners also be tested.
“You can insist on it with a sense of humor,” Johnson said. “I’m single, I’m dating, and I tell potential partners that I have my papers and I’d like to see theirs.”
Free Buncombe County Test Sites
Buncombe County Department of Health* 250-5000
53 S. French Broad Ave., Asheville
8:30 a.m.-4:30 p.m. Monday, Wednesday, Thursday, Friday; 8:30 a.m.-3:30 p.m. Tuesday.
Eligibility Requirements: None.
*Free testing is available at all county departments of health in North Carolina.
Asheville VA Medical Center 298-7911
1100 Tunnel Road, Asheville
8 a.m.-4:30 p.m. Monday-Friday.
Emergencies: 24 hrs.
Eligibility Requirements: Eligible veterans only.
WNCCHS/Minnie Jones Health Center 285-0622
257 Biltmore Ave. Asheville
8 a.m.-5 p.m. Monday – Friday (except for designated holidays)
Eligibility Requirements: For established patients only
Walk-in testing for HIV is available.
The N.C. Department of Health and Human Services publishes a series of fact sheets about STDs: http://epi.publichealth.nc.gov/cd/stds/figures.html.
The CDC has released guidelines for couples concerned about transmission of Zika: https://www.cdc.gov/zika/transmission/sexual-transmission.html.
Information about Zika and birth defects: http://www.cdc.gov/zika/healtheffects/birth_defects.html.