Free STD Testing in Maryland

Many reasons are responsible for the sustained rise in STD cases. The most prominent ones include lack of awareness about protective measures to avoid sexually transmitted infections (STIs) that later convert into STDs and delayed testing.

Why Testing Matters?

STDs and STIs come at a high cost for all vulnerable sections of the population, especially women and babies. In Maryland, there were 29 newborn babies diagnosed with syphilis in 2018, while the state's infection rate for infants is the 9th highest in the US. These are tragic figures, but the pandemic doesn't impact infants only.

There were a record number of cases reported in all main STDs in Maryland, while the rate of congenital syphilis was highest in newborns. CDC states that an improvement in the nation's overall health and addressing issues like infertility, congenital disabilities, infant deaths, and HIV rely on curbing STDs.

STIs are chronic infections that often lead to lifelong health conditions, such as inflammation and scarring of the reproductive organs, infertility, pelvic inflammatory disease, and complicated pregnancy, to name a few. Timely screening and treatment, particularly in women of childbearing age, is important.

In Maryland, congenital syphilis is among the most concerning issues because undiagnosed and untreated pregnant females are at a higher risk of stillbirth and miscarriage. Similarly, for untreated newborns, congenital syphilis can cause detrimental health concerns. It can affect their skin, eyes, bones, ears, brain, and heart, and can cause developmental problems and even death soon after birth. Maryland was featured in the top seven US states for the highest rates of congenital syphilis between 2012 and 2017, which makes timely testing for pregnant women even more crucial.

Compared to older adults, young people, especially young females, are more vulnerable to chlamydial infections in Maryland. Nevertheless, all sexually active individuals are at risk of contracting chlamydia. Therefore, CDC recommends annual testing and screening of chlamydia in sexually active individuals aged 25 or above. Those who have multiple sex partners, men who have sex with men, and those who already have an STI should get tested at least once a year.

State Initiatives to Curb STDs

Maryland comprises 24 jurisdictions, including Baltimore City and 23 counties, each having an independent local health department. The state has introduced several initiatives to address the rising rate of STDs in Maryland. For instance, the Baltimore City Health Department's HIV/STD Prevention Program was launched to focus on activities and efforts to prevent the spread of STDs across Baltimore City.

Two categorical STD clinics are operated under this program. The clinics offer testing, diagnosis, and treatment services for commonly occurring STDs, family planning services, hepatitis B immunization via the Vaccine for Children's program, and Ryan White primary care services for HIV patients. Through this program, over 30,000 patients are treated annually. The program also supports health education services to community groups and schools, but this service is strictly offered upon request.

The Center for STI Prevention (CSTIP) is responsible for performing STI surveillance in Maryland. The CSTIP monitors disease trends and early detection of outbreaks. It also implements evidence-based practices to manage resources effectively and identify common risk factors and disparities among the impacted communities. Moreover, CSTIP offers technical, epidemiological, and programmatic consultation services to local health care providers, health departments, and organizations across the state to increase public awareness and reduce transmission of STIs. It also monitors reported chlamydia, syphilis, and gonorrhea cases.

Reinfection is very common in people who have been diagnosed or treated for chlamydia and gonorrhea. In Maryland, HIV and syphilis cases are given comprehensive follow-up services, also called Partner Services. This includes additional testing and treatment and notifying partners of the individuals regarding the risk of exposure and the need for testing. However, the follow-up service isn't offered for gonorrhea and chlamydia cases because the number of cases is too high to provide partner services.

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STD Statistics in Maryland

The total number of STDs (chlamydia, gonorrhea, and P&S syphilis) cases reported in Maryland showed a 53% increase from 2009 to 2018, according to the Maryland Department of Health's Center for STI Prevention's annual report. The P&S syphilis infection rate increased from 5.5 cases/100,000 people in 2009 to 12.2 cases/100,000 people in 2018, recording a 222% increase overall.

According to the CDC's 2018 STDs surveillance report, the prevalence of the three main STDs described above has increased drastically in Maryland. The most impacted area is the Baltimore metropolitan area. InnerBody reported that Baltimore had 2,004 STD cases per 100,000 people in 2018, 207 HIV cases, 7,636 chlamydia diagnoses, 4,231 gonorrhea cases, and 210 syphilis cases in 2018. Furthermore, the state's congenital syphilis cases increased at a rate of 39.7/100,000 people, which was the 9th highest in the US as per 2018-2019 estimations.

In 2018, the rate of syphilis' most infectious stages rose significantly among adults in Maryland. Reportedly, the number of cases increased to 737 at the rate of 12.3/100,000 people. It was the country's 12th worst rate. The number of chlamydia cases in Maryland also increased considerably in comparison to 2017. The state recorded 35,483 total cases of chlamydia in 2018, at a rate of 586 cases/100,000 residents. It was the 12th worst rate countrywide. Gonorrhea rate dropped to 10,300 cases in 2018, at a rate of 170 cases/100,000 Marylanders. It was the nation's 24th highest rate.

Baltimore metro area is the worst affected zone in Maryland. In 2018, there were over 17,400 cases of STDs in Baltimore, Columbia, and Towson combined. Out of these, 1,392 were syphilis and 5,998 gonorrhea cases. Statewide, there were 2,536 cases of STDs in 2018, while in 2017, 2,059 cases were diagnosed. Overall, the number of gonorrhea cases went down in Maryland during 2018, with around 10,305 cases. Comparatively, in 2017, the state reported 10,970 cases.

Age, Gender, and Ethnic Disparities

Maryland ranked 12th in chlamydia cases, which means the state reported over 586 cases per 100,000 residents. Women aged 35 or above were disproportionately affected by chlamydia, whereas males above 35-years reported a higher number of chlamydia cases. The highest number of chlamydial infection was reported among females aged 20 to 24, with 4,525 cases/100,000 population.

Females aged between 15 and 24 accounted for the highest number of gonorrheal infections, with 44% of all reported cases. In comparison to males, females below 20 years of age had higher infection rates, while males had higher rates for the rest of the age groups. Males aged 20-24 were the most at-risk group among males as they reported 727 gonorrhea cases/100,000 people in 2018.

Between 2014 and 2015, the rate of chlamydia increased for nearly all racial groups in Maryland. African-Americans are the worst affected population group in Maryland. The black population continually reported higher chlamydia and gonorrhea infection rates with 858 cases and 361.1 cases/100,000 residents.

Syphilis is the most common STI in Maryland that is diagnosed with HIV. Around 40% of diagnoses in 2018 were co-infected with HIV. Gonorrhea and chlamydia's co-infection with HIV is relatively less common. Older adults were affected the most, as around 20% of co-infections were diagnosed in people aged 40-45. Fewer than 5% of females aged between 20-24 years were diagnosed with gonorrhea co-infected with HIV. Around 23% of chlamydia infections among men who have sex with men were chlamydia reinfections, 19% of cases among African-Americans, and 20% of cases reported in other racial groups were also chlamydia reinfections.

References

• Barclay, T. and Rodriguez, E., 2020. These U.S. Cities Have The Highest STD Rates (Updated 2020). [online] Innerbody. Available at: https://www.innerbody.com/std-...
• Cdc.gov. 2019. Sexually Transmitted Disease Surveillance 2018. [online] Available at: https://www.cdc.gov/std/stats1...
• Cdc.gov. 2018. 2017 Sexually Transmitted Diseases Surveillance. [online] Available at: https://www.cdc.gov/std/stats1...
• Cdc.gov. 2018. 2018 STD Surveillance Report: State Ranking Tables. [online] Available at: https://www.cdc.gov/std/stats1...
• Cohn, M., 2019. Baltimore Sun - We Are Currently Unavailable In Your Region. [online] Baltimoresun.com. Available at: https://www.baltimoresun.com/h...
• Maryland Department of Health (, 2019. Sexually Transmitted Infections 2018 Annual Report. [online] Phpa.health.maryland.gov. Available at: https://phpa.health.maryland.g...
• Phpa.health.maryland.gov. 2018. Maryland’S Integrated HIV Plan 2018-2022: A Comprehensive, Coordinated Response To HIV For Baltimore And Maryland. [online] Available at: https://phpa.health.maryland.g...