Blog Public Health Data & Training Center Infectious Disease Sexual Health

Studying St. Louis, sexually-transmitted infections, and superusers

Written by Ben Cooper, MPH, manager of the Public Health Data and Training Center at the Institute for Public Health

St. Louis is known for many things… our beloved Cardinals, frozen custard, and toasted ravioli to name a few. Regrettably, another thing we are known for are the high rates of sexually transmitted infections (STIs), particularly in the city.

While many have disputed this designation, it remains a real fact that STIs are a problem to be dealt with in the gateway city. As Washington University professor Bradley Stoner, MD, PhD, points out in an article on St. Louis Public Radio, one factor that might contribute to the increased rates is the closure of facilities offering STI treatment in city at little or no cost. This phenomenon is driving patients into emergency rooms and clinics that are not always well equipped to handle these patients in large volumes.

I recently began working with Hilary Reno, an Institute Scholar and a faculty member in the department of infectious disease here at Washington University. Dr. Reno and her colleagues are exploring the patterns of STIs presenting at the Barnes hospital emergency room from July 2012 to June 2014. During that time, over 180,000 visits occurred and over 6500 (4%) resulted in STI testing to 5400 patients. Of those tested, 77% were female, 79% African-American and median age was 26. Overall, 6% had gonorrhea and nearly 12% had chlamydia. We have included a map showing the overall distribution of gonorrhea patients within St. Louis City. Gonorrhea is important as a primary driver for patients coming to ER as patients with this infection are more likely to show symptoms than chlamydia.

One interesting phenomenon we observed related to those visiting the ER for an STI related issue more than once during the two-year observation period. These “superusers” were significantly more likely to have a positive test as well as test positive for gonorrhea (vs. chlamydia). As we continue to explore this problem in our city, we need to better understand which factors can lead to more effective and tailored intervention strategies in populations most at risk for infection.