Has the Rate of STDs in San Francisco Increased?
Sexually transmitted diseases refer to a variety of bacterial, viral, and fungal infections that are primarily spread through sexual contact. Even with advancements in medicine and health care, STDs are incredibly common in the United States. It’s estimated that half of all sexually active individuals will contract at least one sexually transmitted infection by the time they turn 25.
While the United States has a long history with sexually transmitted diseases, perhaps no city is more familiar with them than San Francisco. Boasting a large population of over 860,000 residents, San Francisco offers a rich history, particularly in the civil and gay rights movements. Let’s take a closer look at how the rate of STDs continues to increase in San Francisco.
Sexually Transmitted Diseases in San Francisco
While there have been some down years in certain neighborhoods throughout the city, studies show that the overarching STD rates in San Francisco have increased since the year 2000. The rates were particularly high in 2014 with 1,117 cases of early stage syphilis reported in that year. That was a significant 9.4 percent increase from 2013 and the highest total syphilis cases for a year since 1984.
About a quarter of the 44 neighborhoods surveyed that year reported higher numbers than the city’s average. Data from 2013 also shows that rates of STDs were two to three times higher than the rest of the Bay Area.
Studies show that the highest rates of sexually transmitted diseases, particularly gonorrhea, syphilis, and chlamydia, occur in men who have sex with men (gay and bisexual men). This is why the STD rates are often higher in the Castro District, which is home to the highest number of same-sex couples per capita in the entire country.
The Castro District reports the highest number of cases of chlamydia, syphilis, and gonorrhea with over 4,000 cases per 100,000 residents in 2015. Potrero Hill was the second highest with over 1,500 cases per 100,000 residents. San Francisco on the whole experienced an average of 1,200 cases per 100,000 residents. Each year, the Castro District, Potrero Hill, and most neighborhoods on the Southside are above the city’s average.
The Growth of AIDS and HIV in San Francisco
San Francisco was one of the focal points during the AIDS epidemic in the 1980s. HIV, or human immunodeficiency virus, is a disease that interferes with the body’s natural immune system. Over time, this can keep your body from fighting off even the most basic infections and diseases. If left untreated, HIV can eventually lead to AIDS, or acquired immunodeficiency syndrome, which is characterized by a heavily damaged immune system and a larger number of severe illnesses called opportunistic infections.
While there is no cure for HIV, medicine exists to help control the virus. When taken properly, this medication can significantly prolong the lives of those with HIV, allowing them to live full, healthy lives and lower the chance of spreading it to others.
San Francisco has one of the largest known HIV-positive populations in the United States. Data shows that an estimated 15,995 people live with HIV in the city. Of those living with HIV/AIDS in San Francisco, 9,454 were living with AIDS in 2015.
The disease still affects predominantly gay and bisexual men as well as men and women of color. The prevalence rate of HIV among black men was 1.5 times that of white men in 2014. In that same year, it’s estimated that black women had a prevalence rate 9.1 times that of white women. Hispanic and Latina women had a prevalence rate 2.3 times that of white women.
Among men diagnosed with HIV, the highest transmission category between 2010 and 2014 was male-to-male sexual contact at 80.7 percent of diagnoses. This was followed by:
- A combination of male-to-male sexual contact and the use of injection drugs (11.5 percent)
- Injection drug use alone (3.4 percent)
- Heterosexual contact (2.3 percent)
- Other forms of transmission, including blood transfusions and perinatal exposure (2.2 percent)
For women diagnosed with HIV from 2010 to 2014, the main transmission category was heterosexual contact at 54.9 percent, followed by injection drug use at 36.8 percent. Other forms of transmission, like hemophilia and perinatal exposure, occupied the last 8.3 percent.
About 73 percent of all individuals newly diagnosed with HIV are undergoing proper care and therapy for three to nine months after their initial visit. Among all residents with HIV, about 67 percent achieved a state of viral suppression. This means that a person’s virus is under control and the viral load is so low that it is at an undetectable level. This is high compared to 52 percent of virally suppressed individuals in the state of California.
Sadly, survival rates after an AIDS diagnosis are lowest among black men and women. The five-year survival probability of black men and women diagnosed with AIDS between 2006 and 2013 was at 79 percent. Latino people had a five-year survival probability of 90 percent, while Asians had a 92 percent survival probability.
Potential Causes for Increased STD Rates in San Francisco
Much of the increase in STD rates comes down to societal factors, like homelessness, poverty, and improper use of drugs, combined with a lack of resources, poor sex education, and limited access to health care and quality health services. Much of this falls under a broader umbrella of systemic racism, violence, and discrimination.
One recent contributing factor in rising STD rates is the divergence of care for STDs and AIDS/HIV. Antiretroviral treatments and other medications can successfully suppress HIV/AIDS, but many people taking these medications may forego the use of a condom. So while they may be safe from HIV/AIDS, they are increasing the risk of contracting and spreading other STDs.
San Francisco is not alone in this either. California on the whole ranks 17th for rates of chlamydia in the country, 14th for gonorrhea, and third for syphilis. Louisiana ranks first for gonorrhea with 221.1 people infection per 100,000 residents and first for syphilis with 15 infections per 100,000 residents.
The underlying factor in many areas affected by high STD rates is a lack of sexual education and resources for sexual health. Poor sexual education means that fewer sexually active individuals understand the importance of condoms, birth control, and safe sex in general.
Furthermore, many people without the right sexual education may not understand the basics of STDs, how you can contract them, or how you can spread them to others.
However, a specific cause is still unknown. “We don’t have a single reason, or even a few known reasons, why the rates have all increased. But we’re taking this very seriously,” said Dr. Susan Philip, director of STD prevention for the San Francisco Public Health Department in 2011.
Common STDs in San Francisco
Some of the most common STDs in San Francisco include:
- Chlamydia – Chlamydia is a bacterial infection and one of the most common nationwide. About 3 million people in the United States contract chlamydia every year. Chlamydia commonly has no symptoms or presents symptoms that are so mild that they are mistaken for something else. Common symptoms of chlamydia include burning or painful urination, pain in the lower belly, abnormal discharge from the genitals, and swelling or tenderness in the testicles.
- Gonorrhea – Gonorrhea is a bacterial infection that mainly affects teens and people in their 20s. Gonorrhea is also hard to spot and doesn’t always present symptoms. When it does, gonorrhea can present itself differently based on your gender. Women may experience pain or burning when urinating, abnormal discharge, and bleeding between their periods. Men may experience pain or burning when urinating, discharge from the penis, or painful, swollen testicles.
- Syphilis – Syphilis is also a bacterial infection. It can be hard to spot, and as long as it’s in your system, syphilis symptoms can come and go over time. Some symptoms may be so mild that people mistake them for simple rashes or pimples. What makes syphilis even more difficult is that it occurs in stages. In its early stage, syphilis presents itself in the form of chancre sores that are highly infectious. In its secondary stage, syphilis appears as a rash. When left untreated, syphilis can progress to its last stage where the infection can cause severe damage to your nervous system, causing paralysis, blindness, and tumors.
Preventing Sexually Transmitted Diseases
While trying to lower STD rates in San Francisco will take larger changes within the community, you can do some simple things in your personal life to ensure better sexual health for you and your partner.
The best first step is to get tested. As you can see from the above common STDs in the city, most sexually transmitted diseases don’t always present themselves in obvious ways. You may look or feel perfectly fine, but you may be spreading infections to others.
The only way to truly know if you have a sexually transmitted infection is to get tested. It’s an easy process and you can usually get definitive results within a few days. If you are not in a mutually monogamous relationship or otherwise have multiple sexual partners, make sure you get tested regularly.
Along with testing, make sure you practice safer sex. Unless you’re in a mutually monogamous relationship and use another form of birth control, always use a barrier, which includes condoms, female condoms, or dental dams, when you take part in any sexual activities.
You can also still be intimate while taking part in sexual activities that don’t spread STDs, like mutual masturbation and outercourse. Above all, make sure you always communicate with your sexual partner. That means before, during, and after sex. Talk about what you like, what you don’t like, and any history with sexually transmitted diseases.
If you need to get tested in San Francisco, PlushCare can help you along the way and connect you with San Francisco STD testing clinics and centers to give you the help you need. Contact us today to learn more about getting tested for STDs.
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