What federal health officials call "steep and sustained" increases in sexually transmitted diseases across the United States the past four years have frustrated experts battling the trends in Decatur, Springfield and other Illinois communities.
"When the numbers are going higher, that means more people have gotten tested," said Carol Carlton, director of clinical nursing services for the Macon County Health Department. "Eventually, hopefully, (the rates) will slow down."
The U.S. Centers for Disease Control and Prevention said last week that almost 2.3 million cases of chlamydia, gonorrhea and syphilis were diagnosed in the United States in 2017.
That number exceeded the record set in 2016 by more than 200,000 cases and marked the fourth consecutive year of sharp increases in STDs, according to CDC officials.
While curable with antibiotics, most cases of STDs go undiagnosed and untreated for years, leading to problems such as infertility, ectopic pregnancy, stillbirth in infants and increased risk of contracting the AIDS virus. And there are concerns among medical providers nationally that cases of antibiotic-resistant gonorrhea will increase.
The CDC said studies indicate that poverty, stigma, discrimination and drug use can contribute to an increase in STDs.
Macon County had the state's eighth-highest chlamydia rate in 2017, according to the Illinois Department of Public Health. However, the state data shows that total was the lowest number of positive diagnoses that the county has recorded in the past five years. The highest was 900 cases in 2017.
Macon County's 756 diagnosed cases indicated a chlamydia rate of 682.5 per 100,000 population. That rate was exceeded by the counties of Jackson, McDonough, Peoria, Champaign, St. Clair, Cook and Sangamon.
With 364 cases of gonorrhea in 2017, Macon County had third-highest rate in the state with 328.6 per 100,000 population. Only the counties of Peoria and St. Clair had higher rates.
As of June 30, Macon County's year-to-date tally sits at 375 — a 2 percent increase from the first six months of 2017.
Other Central Illinois counties have seen record increases in their STD rates.
In Springfield, 2017 data showed the highest STD levels in at least five years.
"I think that we are having an effect, but it's being drowned out by what is happening," said Joan Stevens Thome, director of health education at the Sangamon County Department of Public Health. "We're chipping away at this mountain that seems to be growing."
Sangamon County had the seventh-highest chlamydia and sixth-highest gonorrhea rate in 2017.
Stevens Thome said the trends in Sangamon County and nationwide are troublesome and probably related to a lack of education, especially among adolescents and young adults.
The Sangamon County Health Department conducts a "reducing the risk" program in area high schools to help the schools comply with a 2013 state law that requires sex education, when it is offered, to be "comprehensive."
But Stevens Thome said state funding cutbacks to local health departments two years ago reduced the ability to offer such programs in schools in Springfield and elsewhere.
"There's so much out there that needs to be done," she said. "We don't have enough resources."
Peoria County's STD rates are at record highs.
The county's gonorrhea rate, 477.8 cases per 100,000 population based on 891 total cases, was the state's highest countywide rate in 2017. And the chlamydia rate — 894.9 per 100,000 — meant almost 0.9 percent of Peoria County residents were diagnosed with chlamydia in 2017. That rate was third-highest among the state's 102 counties.
Persistently high STD rates in Peoria County prompted officials in Peoria, Tazewell and Woodford counties to join forces in promoting comprehensive sex education, according to Monica Hendrickson, administrator of the Peoria City/County Health Department.
Officials from the three counties are trying to reduce STD rates, as well as pre-term births and births to teenagers, in the area.
The cooperative effort, launched in 2016 and involving the Peoria County health department and the Peoria-based Hult Center for Healthy Living, so far has resulted in a push to provide age-appropriate sex education for sixth-, seventh- and eighth-graders in Peoria School District 150.
It's too soon to know whether the effort has affected or will affect STD rates, Hendrickson said. But health-care providers have noticed a positive sign — an increase in adolescents and young adults getting tested for STDs, she said.
When asked why STD rates are high and rising, both Stevens Thome and Hendrickson ticked off factors that include those cited by the CDC.
Hendrickson said health-care disparities in Peoria County based on income or race or both play a role in STDs and many other health-related conditions.
"There's no silver bullet for these trends," she said.
Marisa Hosier, Macon County's director of health promotion and public relations, said she can't speculate what's behind the increase of STD rates in the state, but echoed Carlton's sentiment that the numbers are a sign that more people are being tested for the infections.
"That's an important part of the education piece (of the issue)," Hosier said. "If you have a new partner, routine testing should be a part of how you take care of your health."
Stevens Thome said the reality of sexual activity in the United States — with 30 percent of young people sexually active before they reach high school — conflicts with conservative or squeamish attitudes among adult decision-makers when it comes to promoting safe and enjoyable sex lives as people mature.
As a result, young people may hear talk about sex only when it's lumped in with drugs and alcohol, "like it's a bad thing," she said.
"That stigmatizes condoms," Stevens Thome said. "In America, if you carry condoms, people say you are promiscuous."
Condoms can reduce transmission of STDs, but stigmatizing the use of condoms reduces the likelihood they are used and fuels the increase in STDs, she said.
Without instruction to put sex into proper context, young people are being desensitized to the concept of emotionless sex in the media and through smartphone apps that arrange for sexual hookups, she said.
Hosier agreed that treating reproductive health as a "taboo" subject can be detrimental when it comes to educating people about safe practices.
"It's a part of your overall health," she said. "That's what we like to remind everybody. You know your body best. You know if there's changes and when to take charge. You are taking care of yourself above anything else. No one else will take better care of you than you will."
Stacy Roher, an advanced-practice registered nurse at the Springfield Clinic Center for Women's Health, said she has noticed an increase in STD diagnoses among her patients the past few years among women in their mid 20s and younger. A lack of education may be the culprit, she said.
Even though information is easily available on the internet, Roher said she has been surprised many patients don't realize that STDs can lead to infertility and even cancer.
"I am shocked a lot of the time at the casualness," Roher said. "It doesn't seem like that big of a deal to them."
Melaney Arnold, spokeswoman for the Illinois Department of Public Health, said she didn't know whether the state was seeing record levels of STDs.
Arnold said Illinois is seeing large increases in STD cases.
"From 2013 to 2017, there was an 18 percent increase in chlamydia cases, 45 percent increase in gonorrhea cases, and 54 percent increase in primary and secondary syphilis cases," she said.
Healthcare providers need to make STD testing a standard part of medical care, especially in pregnant women, she said.
The public should talk openly about STDs, get tested regularly and reduce risk by using condoms or practicing mutual monogamy if sexually active, Arnold said. Parents should offer young people safe and effective ways to get information and services, she said.
And the state and local health departments should "continue to direct resources to people hardest hit by the STD epidemic and work with community partners to maximize their impact," she said.
In Macon County, Hosier said the health department has worked with the Decatur School District to introduce a program that targets teenagers and provides information and education on reproductive health issues.
Carlton said that program has been ongoing for three years and has been well-received. "We give them direct answers and are very truthful with them," she said. "... Education in the schools is a big thing."
Outside of the schools, Carlton and Hosier both said Macon County residents can utilize resources such as Planned Parenthood, 3021 N. Oakland Ave., and the health department for STD testing and for educational clinics and materials. Those who are unsure of if their county has an STD clinic can utilize a IDPH database of clinics throughout the state online.
"Our job is to help people," Hosier said. "We serve all residents of Macon County, and I just don't want people to think that they have to be afraid to receive education on STDs. They should be able to protect themselves, their families and their health as best as possible."