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Risk

Risk

Sexual Healing (continued)

By Jim Duffy

The department also worked with Jonathan Ellen, a Pediatrics professor at the School of Medicine with joint appointments in Epidemiology and PFRH, to upgrade its informatics capabilities and employ geographic information systems.

"We're not doing our outreach by looking for high morbidity ZIP codes anymore," Herrera says. "Our outreach is based on indexed cases and interviews. We target individual houses where we know there's been commercial sex work activity. We target particular corners where we know the exchange of sex for drugs is going on. And we do this in a turnaround time that can be as short as 24 hours. We're getting to areas while they're still hot."

Last year, the Health Department lobbied successfully in the state legislature to make Baltimore one of the first jurisdictions in the nation to employ expedited partner therapy (EPT), in which a patient diagnosed with gonorrhea is given a prescription to take to his or her partner, even though that partner has not yet seen a health care provider. The program is only a few months old, but preliminary data are encouraging, says Joshua Sharfstein, Baltimore's health commissioner.

The clinics are geared to deliver services that make the most of the surveillance and outreach improvements. "They're a critical safety net," Erbelding says. "You can't rely on the private sector here. Most of our patients don't have insurance, so they'd be self-pay patients, and it might take them three weeks to get an appointment. That's just unacceptable. Someone could transmit to five or 10 or 20 people in that time."

Two other STIs are disproportionately high in Baltimore, but the trend lines are harder to read for chlamydia and HIV. Chlamydia is an infection contracted mostly by adolescents and young adults. In most cases, it has no symptoms, and the infection often goes undiagnosed. But it has been linked to health complications including pelvic inflammatory disease, which, in turn, can cause infertility and tubal pregnancy.

Screening for chlamydia has increased dramatically in the last 15 years. This clouds the long-term trends for the infection, with more and more cases getting diagnosed that previously went undiscovered, says Charlotte Gaydos, DrPH '93, MPH '89, an associate professor of Infectious Diseases with the School of Medicine who has joint appointments in Epidemiology and PFRH.

In 2005, Baltimore's Health Department put the city's chlamydia rate at roughly 1,000 per 100,000 population. "When all these screening efforts began, we initially made a nice dent among high school girls," Gaydos says. "But since then, it's just been level, level, level—to be frank, things are not going that great."

One key to progress will be expanded educational interventions. In a forthcoming paper, Gaydos will evaluate an effort to identify at-risk youths through clinics at five Baltimore high schools and then target them with educational messages about the disease, its risks and prevention strategies. That effort successfully reduced prevalence among its participants, she says.

Gaydos is also involved in gauging the effect of a Web-based project that delivers educational messages and enables users in Maryland, Virginia and Washington, D.C., to order a free self-administered vaginal swab test for chlamydia. Users at the website are asked to complete an extensive survey.

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