By Matt Leingang
Enquirer staff writer

For the first time in five years, Cincinnati is not expected to have Ohio's highest gonorrhea infection rate.

The city's 2004 chlamydia rate is also dropping but is still projected to remain the worst in the state, according to preliminary data from the Ohio Department of Health.

Chlamydia and gonorrhea are the two most common sexually transmitted diseases in Ohio and the rest of the country. An estimated 2.8 million Americans are infected with chlamydia each year, along with more than 700,000 new gonorrheal infections.

THE DATA

Gonorrhea in select Ohio cities/counties Disease rate* 2002 2003 2004 Dayton 915.4 933.8 762.3 Cleveland 893.7 835.7 738.7 Cincinnati 1,063.6 1,011.8 648.4 Canton 772.2 675.7 626.8 Lima 617.3 693.3 539.0 Youngstown 382.4 493.6 449.9 Akron 444.6 386.3 377.0 Columbus 423.6 368.0 330.4 Toledo 509.2 360.1 318.3 Hamilton County 421.6 397.1 253.3 Brown County 41.1 34.5 27.6 Butler County 82.2 130.1 110.4 Clermont County 26.7 29.5 195.2 Warren County 11.4 25.7 18.3 Cuyahoga County 376.7 350.7 306.6 Franklin County 305.2 267.0 240.3 *Per 100,000 population. 2004 rates are based on an annualized projection as of March 31, 2004. Chlamydia in select Ohio cities/counties Disease rate 2002 2003 2004 Cincinnati 1,395.9 1,326.7 1,254.8 Dayton 1,062.3 1,176.6 1,209.8 Cleveland 1,081.3 1,161.5 1,208.9 Lima 923.6 894.2 754.5 Toledo 833.4 675.5 749.3 Youngstown 751.0 726.0 744.8 Canton 965.3 834.9 636.8 Akron 588.3 628.4 604.6 Columbus 653.4 566.0 583.5 Hamilton County 557.9 527.2 500.9 Brown County 172.6 151.8 110.4 Butler County 221.7 306.6 223.2 Clermont County 171.8 144.0 98.2 Warren County 52.5 73.1 109.6 Cuyahoga County 494.9 517.3 537.5 Franklin County 504.9 435.4 441.7 Northern Kentucky 2003 Chlamydia Gonorrhea Boone County 150.0 32.6 Campbell County 235.8 75.6 Grant County 138.5 53.6 Kenton County 222.5 130.1 State 216.6 93.3 --- Are STDs increasing or decreasing in the U.S.? Doctors know of more than 20 sexually transmitted diseases. The latest scientific data suggests that chlamydia, which infects 3 million Americans a year, is declining in areas with screening and treatment programs, but remains at high levels. Syphilis, which infects 20,000 Americans a year, and gonorrhea, which infects 700,000 Americans annually, are declining and have reached all-time lows. Hepatitis B is declining, as is trichomoniasis and chancroid. Herpes is believed to be increasing, with dramatic increases documented through the early 1990s. Human papillomavirus (HPV) and bacterial vaginosis are both extremely widespread, but researchers are unsure if they are increasing. AIDS - after declining for a decade - could make a comeback in this country. Last year, 42,136 new AIDS cases were diagnosed in the United States, up 2.2 percent from the previous year. Source: U.S. Centers for Disease Control and Prevention

The overall declines in Cincinnati are encouraging but difficult to explain, public health officials say.

It could be that more people - particularly teenagers - are using condoms or postponing their first sexual experience, driving down incidence rates.

Or it could be that fewer people in Cincinnati are getting tested, which would actually be a setback for disease surveillance and containment.

"I'm pretty leery of projections because there are so many variables here," said Dr. Judith Daniels, medical director at the Cincinnati Health Department. "The data is worth mentioning, but let's see where we are at the end of the year."

In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and African-Americans. The same is true in Ohio, where young people ages 15-24 account for 74 percent of chlamydia cases and 60 percent of gonorrhea cases.

If left untreated with antibiotics, chlamydia can cause reproductive damage and infertility in women and urethral infections in men. Gonorrhea can cause pelvic inflammatory disease in women and sterility in men.

Since 1999, Cincinnati has ranked first in gonorrhea and chlamydia infection rates among all age groups. But it's not just a city problem. Hamilton County shares the same dubious distinction.

In Northern Kentucky, however, STD rates are generally below statewide averages.

New rankings

Dayton and Cleveland are projected to finish 2004 with the highest gonorrhea rates in Ohio, according to preliminary data from the state Health Department.

Cincinnati will fall to third place with 648 gonorrhea cases per 100,000 residents, down from a rate of 1,011 per 100,000 residents in 2003.

Chlamydia's drop is less dramatic - the city is projected to see 1,254 cases per 100,000 residents in 2004, down from 1,326 last year. But that will again lead the state.

The projections are based on STD cases reported through March 31. The data wasn't released until now because of the amount of time that it takes to compile and analyze the data, state officials said.

But the statistics are not definitive. For example, there may be testing gaps among Ohio cities.

"This is anecdotal, but it would be fair to assume that more chlamydia tests are done in Cincinnati than any other city in Ohio," said Tim Bahns, the state's STD program administrator.

Cincinnati is alone in having six city-funded neighborhood health centers, which primarily serve low-income patients. Physicians there often make it a mission to test young people for STDs.

It's possible that STD rates in other cities have long been underreported.

Problems with system

The magnitude of the problem is probably also underreported among middle- and upper-class whites in the suburbs.

"A lot of people who go to private doctors aren't necessarily screening patients or reporting what they find in a timely manner," said Bernard Young, AIDS coordinator for the Cincinnati Health Department.

STDs are difficult to track, Young said. People are diagnosed only when they seek treatment for symptoms or are offered screening by a doctor or public health worker.

And because chlamydia and gonorrhea often don't have symptoms, many people do not know they are infected, increasing the likelihood that they will pass it along to a partner.

A standing debate in health care is whether young people should be routinely screened.

"Teens with chlamydia say that it is one of the worst things that can happen to them, in part because they trusted their partner, and the partner was probably unaware that they were infected," said Dr. Frank Biro, professor of pediatrics and director of education at the Teen Health Center at Cincinnati Children's Hospital Medical Center.

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E-mail mleingang@enquirer.com