Chlamydia is among the sexually transmitted diseases continuing to rise in Alaska, as state officials urge Alaskans to protect themselves from a condition many people carry without symptoms.

Alaska has had the nation’s highest chlamydia rate from 2010 through 2018, according to a bulletin issued last week by the state Department of Health and Social Services.

“While often asymptomatic, untreated [chlamydia] infection can cause miscarriage, pre-term labor, low birth weight; conjunctivitis and pneumonia in [newborns]; pelvic inflammatory disease (PID), ectopic pregnancy, chronic pelvic pain, and infertility in women; and epididymitis and Reiter’s syndrome in men,” state officials wrote. “Moreover, [chlamydia] can facilitate the transmission and acquisition of human immunodeficiency virus (HIV).”

According to DHSS, Alaska saw a 4% increase in statewide chlamydia cases last year, which rose to a total of 6,173 — resulting in a per-capita infection rate of 838 per 100,000 people. Some 76% of cases were in people ages 29 or younger, however — a population that had a per-capita rate of 4,414 cases per 100,000 people.

Nearly two-thirds of last year’s chlamydia cases, 3,975 or 64% of the overall total, were diagnosed in female patients.

The state’s Northern and Southwest areas saw the highest rates by region, followed by the Interior, Anchorage and the Mat-Su, Southeast Alaska and the Gulf Coast.

A regional overview overview of chlamydia infection rates in Alaska during 2017 and 2018. (From DHSS)

“Compared to 2017 data, the greatest increase in [chlamydia] rate occurred in the Interior region (12% increase, from 809 to 907 cases per 100,000 persons),” state officials wrote.

Susan Jones, the HIV/STD program manager for the department’s Section of Epidemiology, said Alaskans’ relatively young average age — 33 to 34 years old — was a major factor in the prevalence of chlamydia.

“Alaska is a young population and the younger a population is, the more sexually active they are and the more sexually active they are with multiple partners,” Jones said.

Rates by race were highest in American Indians and Alaska Natives, Native Hawaiians and Pacific Islanders as well as black people. Jones said those racial disparities have been a continuing issue.

A racial breakdown of Alaska chlamydia infection rates in 2017 and 2018. (From DHSS)

“The rates are highest among the non-white population, and that’s what we’ve seen for a really long time,” Jones said. “Is it because they don’t have access to [health care] service? Is it because of higher disease rates? I don’t know.”

Alaskan minorities’ chlamydia statistics can also be distorted, Jones said, by a statewide population that is roughly two-thirds white — leaving other groups’ rates more susceptible to sudden increases.

“The smaller the population group [is, then] you don’t need a high number of cases in a small population to have a higher rate,” Jones said.

Various factors make chlamydia a particularly difficult STD to diagnose, including its frequent lack of symptoms and its multiple locations of possible infection sites within the body.

“The big thing about chlamydia is that about 85% of the people who have it don’t have any symptoms and don’t know about it,” Jones said. “Chlamydia infection can be in the throat and the rectum, so if you’re performing oral sex or you’re the recipient of rectal sex — if you use those other places for sex and they’re not being tested — chlamydia can be missed.”

Another dilemma health care providers face in fighting chlamydia is that a patient might be treated and cured, but continue to have sex with infected partners who haven’t been diagnosed or cured as well.

“The other, other big thing about chlamydia is you’re going to get it again if all of your partners aren’t treated,” Jones said. “Reinfection with chlamydia occurs three to four months after the initial infection.”

One bright spot in the state’s data, according to Jones, is that just 1% of the women diagnosed with chlamydia last year reported cases of pelvic inflammatory disease — a chlamydia complication which can cause infertility. She credited Alaska physicians for that low rate, saying they have moved quickly to address chlamydia when it is diagnosed.

Alaska’s high chlamydia rate remains a cause for concern, however, because younger women have cervical cells that are more prone to infection — and repeated cases of chlamydia leave a victim more vulnerable to it, rather than building up a resistance as with other diseases.

“You have women having sex with men that are young; you have women with an immature cervical opening; and you have sex in a highly infected population,” Jones said. “And that’s the perfect storm for chlamydia.”

DHSS maintains an HIV/STD program website with links to providers who offer STD testing, as well as a sheet listing contacts statewide.

The department has also created an interactive map, at the request of Alaska Native groups, which displays historical infection rates for both chlamydia and gonorrhea both statewide and within Native health corporations’ service areas. The regional data can then be broken down by various temporal and population factors.

Another resource available to Alaskans are free condoms and other contraceptives, distributed by STD testing advocacy website iknowmine.org, which can be shipped statewide. Jones said two new designs for the condoms’ distinctive wrappers are set to be unveiled ahead of Pride Week in June.

A selection of free Alaska-themed condoms available statewide by mail from advocacy website iknowmine.org. (From iknowmine.org)

“One is a walrus and it says, ‘Cover your oosik,’ and one is a unicorn and it says, ‘Wear it with pride,’” Jones said.

The state’s resources for dealing with chlamydia have been on the decline amid a nationwide increase in STD rates, according to Jones, as DHSS addresses ongoing Alaska outbreaks of both syphilis and gonorrhea. Other STDs, including herpes and human papillomavirus, aren’t formally tracked by the department because they’re not curable.

Steps you can take to protect yourself, according to Jones, include:

•   Maintaining monogamous relationships
•   Using condoms and dental dams
•   Getting yourself — and your sexual partners — tested and treated
•   Talking to your friends about STDs
•   Talking to your health care provider about the type of sexual activity you have
•   Knowing that chlamydia infections are often asymptomatic, but they're 100% curable

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