The Alarming Rise in 3 Common STIs with Dr. Oluwatosin Goje

Podcast Transcript

Deanna Pogorelc:  Hi, welcome to this episode of The Health Essentials Podcast brought to you by Cleveland Clinic. I'm your host Deanna Pogorelc, and we're recording today at the Cleveland Clinic main campus with Dr. Tosin Goje. Dr. Goje is an obstetrician and gynecologist who specializes in infectious diseases, including sexually transmitted infections, which is what we're going to be discussing today. Thank you very much for being here. Listeners, please remember that this is for informational purposes only and is not intended to replace your own physician's advice. Dr. Goje, I saw this report from the Centers for Disease Control and Prevention that was talking about a called attention to this uptick in the cases of sexually transmitted infections. It was saying they are at an all-time high.

Deanna Pogorelc:  Can you talk a little bit about what some of the factors that are contributing to why this is happening right now.

Dr. Tosin Goje:  Thank you for having me. Yes. For the fifth year, sexually transmitted infections have persistently increased for the fifth year.

Deanna Pogorelc:  Fifth year.

Dr. Tosin Goje:  Yeah. We're talking about gonorrhea, chlamydia and syphilis. There are a few contributing factors. I think one of them is the shortage of funding for the free clinics. Many of the young people actually go to this free clinics and the free clinics screen these patients and also give like direct treatment. Chlamydia can be treated immediately using azithromycin as a one-time medication. Gonorrhea can be treated immediately as a one-time medication of intramuscular subtracts and oral azithromycin. Their partners can also be brought to the free clinic and be treated at the same time.

Deanna Pogorelc:  Are those the antibiotics?

Dr. Tosin Goje:  Those are antibiotics. By having those free clinics treating the patients, screening the patients, treating their partners, we're preventing and decreasing the spread of sexually transmitted infection. Decrease in funding is one of the reasons that there's a persistent increase. Also, we need more education. More people, especially with the increase in opiates intake, the opioid epidemic, having more high risk behaviors, more higher risk sexual activities, use of less condoms, that exposes patients and partners to STIs.

Deanna Pogorelc:  Right. Just to be clear, are STDs and STIs the same thing?

Dr. Tosin Goje:  Yes. STD means sexually transmitted diseases. STI is sexually transmitted infections. We prefer to use sexually transmitted infections.

Deanna Pogorelc:  Okay.

Dr. Tosin Goje:  They're infections.

Deanna Pogorelc:  Okay. You specifically mentioned three STIs. Can we go through kind of one of each of those individually and talk a little bit about what they are, maybe what some of the symptoms might be, and then why they're particularly concerning, and why the rise in that is troublesome?

Dr. Tosin Goje:  Absolutely. Let's start with chlamydia. Chlamydia is one of the most common sexually transmitted infections. It is caused by a bacteria called chlamydia trachomatis and many times it's asymptomatic. We tend to pick up chlamydia infections when patients are screened. CDC recommends that young women and young men less than age 25 should be screened yearly. Those older than 25 who have any risk factors or who feel they've been exposed should also be screened. That is one of the best ways to actually pick up this asymptomatic infection. The second one is gonorrhea. Gonorrhea is caused by Neisseria gonorrhoeae, and it's also a bacterial infection.

Dr. Tosin Goje:  CDC recommends that young adults less than the age of 25 should also be screened and those who are at high risk or who feel they've been exposed to the infection should be screened. With gonorrhea in men, some people might have some burning with urination. Some women may have some irritation or burning, but many times it's asymptomatic. Screening is one of the best tools or if a patient or a young adult feels they've been exposed to a person with gonorrhea. The third is syphilis. Syphilis is cost by spirochete. I remember when I was in med school, there was this picture of a teeny tiny worm-like, jelly-like thing called T pallidum, Treponema pallidum. It causes syphilis. Syphilis could be primary syphilis, it could be secondary syphilis, or it could be tertiary syphilis.

Dr. Tosin Goje:  Sometimes think with syphilis there will always be a lesion or a sore, but it's not always the case. In women, they might have what we call latent syphilis whereby they have no signs, no symptoms, no complaints. But when we screen them in pregnancy, the test comes back positive. Syphilis is very, very important in obstetrics because there has been an increase in newborns with syphilis, and there has been an increase in death in utero, meaning death in the womb, due to a mother having syphilis, not knowing, getting pregnant and then the baby in the uterus gets infected. One of the good things that CDC recommends, which we do, is all pregnant patients with their first visit to the obstetrician or healthcare provider get a screen for syphilis.

Dr. Tosin Goje:  Then if they're at a high risk or live in a population or area that is at high risk for syphilis, they get a second screen in the late second trimester or early third trimester and even get a third screen if it's needed. This are steps to make sure that babies are not exposed to syphilis. Because babies could be born with congenital deformities if their mother had syphilis and was not treated. These are the three major sexually transmitted infections that we are campaigning about educating people about because they've been rising despite all the good measures that we've put in place. We'll keep working to decrease them hopefully in the coming year.

Deanna Pogorelc:  Yeah. You mentioned the importance of screening because some of these won't produce symptoms. Can you talk a little bit about the screening and what that entails and who should be screened?

Dr. Tosin Goje:  As we earlier talked about, for gonorrhea and chlamydia, all young adults less than age 25, so age 15 to 24 or before your 25th birthday, depending on how you want to word it. I always say less than 25, sexually active, even if you're not, up to age 15, you should be screened for gonorrhea and chlamydia. There are many noninvasive ways that you can screen for gonorrhea and chlamydia. You don't need a pap test or a pelvic exam to be screened for gonorrhea and chlamydia. You could be screened from a urine for gonorrhea and chlamydia. There is the self-collected vaginal swab. I read of a big research that was conducted in the United Kingdom where women were asked to collect their vaginal swab and the doctor collected a swab. They compared the results, and it was comparable.

Dr. Tosin Goje:  Both the doctor collected swab and the patient collected swab did very well. That takes away that barrier of a young lady not wanting her privacy to be invaded. It could be urine. It could be a self-collected vaginal swab. It could be a provider vaginal swab collection without a speculum, and it could be a speculum vaginal or cervical collected swab. There are many ways that we can collect the swab. The NAATs, which is called the nucleic acid amplification test, is the best test and that is what is mostly used in the country now. It's very sensitive and that helps us to pick up most of these infections, gonorrhea and chlamydia. For syphilis, it's usually a blood test because as I said, most people don't have lesions. Universally we don't screen everyone for syphilis.

Dr. Tosin Goje:  But if a patient feels they've been exposed, they should speak up and get screened. But in pregnancy, all pregnant patients at their first obstetric visit, she'll be screened for syphilis.

Deanna Pogorelc:   Okay. For gonorrhea and chlamydia, is that something women can ask for when they go in for say their annual exam or is that something that should be being offered to them when they go?

Dr. Tosin Goje:  It should be offered yearly to all women. If the patient thinks she's been exposed or she's at a high risk, she can request for a screen even if she was screened recently.

Deanna Pogorelc:  What does high risk mean?

Dr. Tosin Goje:  Having sexual intercourse with someone who has been exposed, having sexual intercourse without use of condoms, and someone who might have been exposed previously in the past 30 to 60 days. Many of the times I hear my patients call to say, "I want to be screened because my partner was in a relationship I just got to know about." That also falls on the high risk.

Deanna Pogorelc:   I know you kind of were focusing on young people when you were talking. Is this increase in cases mostly happening in younger people or can older people get STIs too?

Dr. Tosin Goje:  Oh, older people can have STIs, but we're just talking about the guidelines for screening.

Deanna Pogorelc:  Okay. Yeah.

Dr. Tosin Goje:  There's a difference between screening and requesting for a test. The guidelines for screening is for the younger people less than 25 yearly screening, but anyone can request a screen. Any patient can request for a screen if they feel they've been exposed to an STI.

Deanna Pogorelc:   Sure. Are all of these treatable by antibiotics or are they all treatable in some way?

Dr. Tosin Goje:  Yes, the three sexually transmitted infections we've talked about are all treated by antibiotics. Most of the antibiotics are readily available. For chlamydia, the recommended antibiotic is called azithromycin and is a one-time medication. That helps with what we call compliance. You take it one time and that is done, but it's very important that all sex partners have the patient be treated also to prevent reinfection. There are also other alternative medications if the patient has an allergy. They can speak with their provider about that. For gonorrhea, it's also antibiotics, but it's two antibiotics for gonorrhea. One of them is an injection called ceftriaxone and the second one is a pill, which could be the azithromycin or the doxycycline.

Dr. Tosin Goje:  Once again, because this a sexually transmitted infection, all sex partners should be treated or encouraged to seek care also. For syphilis, it's also an antibiotic. It's penicillin.

Deanna Pogorelc:   I've heard a lot of talk about antibiotic resistant just in the world of infectious diseases. Is there any concern about resistance to antibiotics with these infections?

Dr. Tosin Goje:  Yes, especially for gonorrhea. In the past, we could treat gonorrhea with what we call the fluoroquinolones, but now we have resistance to fluoroquinolones, so we don't use fluoroquinolones for treatment of gonorrhea. Then we moved to a group called cephalosporins and that's where the ceftriaxone comes under. Now we're noticing that we need a higher dose of the cephalosporin called ceftriaxone to treat gonorrhea. We don't use just one medication. We use two medications, ceftriaxone, which is a cephalosporin, and the azithromycin to treat gonorrhea. That's what happens when there is resistance. It's important that the providers are aware about resistance and they use the CDC recommended medication. I know that CDC is aware of resistance. They have a five year plan.

Dr. Tosin Goje:  They are looking for new antibiotics and looking for ways to combat this resistance issue.

Deanna Pogorelc:   Okay. I want to backtrack one second when we were talking about screening. I've heard about at-home testing kits and I think you were talking a little bit about patients who can swab their own sample. Are those effective? Something that someone could buy in like a drug store or online. Are those testing kits effective or should they really see a doctor?

Dr. Tosin Goje:  From research, they are effective and they're comparable to a doctor collected swab, but I don't think there's any FDA approved home kits in the United States. But science wise, they're comparable, meaning collecting the swab up by a patient is as good as a doctor collecting it. But there will be more steps before we can make it mainstream. Who knows? Maybe in the next few years that will happen. But I think when we talk about STIs, it's not just about a home kit. There are other things that are involved with sexually transmitted infections, things like abuse, violence. Sometimes patients still need to see a provider if there are other things they need to discuss, especially if it has to do with abuse or violence or if they have other complaints because a patient can also misdiagnose themselves.

Deanna Pogorelc:   Yeah, good point. Okay. Kind of wrapping up, is there anything else we can tell our listeners about protecting themselves, screening themselves? What's the take home message?

Dr. Tosin Goje:  Prevention, prevention, prevention. Patients should always be on the safe side of prevention. Gonorrhea, chlamydia and syphilis are transmittable infections, but they're preventable by using safe methods, safe sex, decreasing our high risk behaviors for sexual activities, making sure that all sex partners are treated when we have infection so that we don't get re-infected, taking the appropriate antibiotics and completing the regimen. Those are things that patients can do. The other thing is patients should speak up. If you think you have been exposed to an infection, a patient should speak up. I will say for our practice, I'm very proud of the young ladies who come in and say, "I want to be screened." That is a good thing to do.

Dr. Tosin Goje:  If you think you've been exposed, you should be able to go to your healthcare provider and request a screen to protect yourself.

Deanna Pogorelc:   Great. Well, thank you so much for being here. That was super helpful information and very interesting. If you'd like to schedule an appointment with the Cleveland Clinics' OBGYN and Women's Health Institute, please visit clevelandclinic.org/obgyn or call 216-444-6601. To listen to more of our Health Essentials Podcast, visit clevelandclinic.org/hepodcast and subscribe wherever you get your podcasts. For more health tips, news and information, follow us @ClevelandClinic, one word, on Facebook, Twitter and Instagram. Thanks for joining us.