State health officials recently released a health advisory because of a rise in sexually transmitted diseases, particularly syphilis.
And the Missouri Department of Health and Senior Services warns while the initial increases were first observed in major metropolitan areas - Kansas City and St. Louis - the uptick is now happening in rural communities, such as Jefferson City.
Syphilis used to be rare in Central Missouri, Cole County Health Department Director Kristi Campbell said. However, in January alone, the county identified two new cases.
In 2018, there were 76 cases in Cole County. All data for 2018 is still considered provisional.
"It's not just Cole County," Campbell said. "It's the whole state."
DHSS data shows confirmed cases of sexually transmitted diseases in Cole County have increased exponentially since 2016. There were nine confirmed cases of syphilis in the county in 2016, 18 in 2007 and 76 in 2018.
Those numbers outpace Boone County, whose population is nearly 2.5 times that of Cole County. In Boone County, there were 10 cases in 2016, 16 in 2017, and 37 in 2018.
Smaller counties, such as Callaway, have also seen increases in confirmed cases of syphilis.
In the DHSS health advisory, the department said observations indicate a "sustained increase in the number of syphilis cases reported in the state." Overall, the number of cases in the state rose 38 percent from 2016-17 and has increased 218 percent since 2012.
The DHSS website has data showing reports of sexually transmitted diseases going back to 2000 at health.mo.gov/data/hivstdaids/data.php.
That data shows in 2012, Cole County only had one confirmed case of syphilis.
The Centers for Disease Control and Prevention website shows the disease is a sexually transmitted bacterial infection. It is categorized by four stages - primary, secondary, latent and tertiary. Each stage has different symptoms. People with primary syphilis generally have sores at the origin site of the infection. Secondary syphilis symptoms include a skin rash, swollen lymph nodes and fever. These two stages have relatively mild symptoms.
Latent stage syphilis has no symptoms. Tertiary syphilis is associated with severe medical problems that can affect the heart, brain or other organs, according to the CDC.
The only certain way to avoid getting syphilis is to not have sex, according to the CDC website. Using latex condoms correctly can prevent transmission of the disease. However, sometimes sores associated with syphilis occur in areas not covered by condoms. Contact with these sores can still transmit syphilis.
Missouri's increase in syphilis was initially found in men who have sex with other men. Recently, the disease has shown up in all groups, particularly heterosexual women. And there has been an increase of syphilis being found in newborns.
That has happened in Cole County, said Mary Telthorst, the county director for clinical services.
"Depending on what state of pregnancy (the mother is) in, they can develop birth defects. But, once they're born, they're treated with penicillin and that should take care of it," Telthorst said.
Campbell pointed out Jefferson City is a college town, containing Lincoln University, which is an "open admissions" university, meaning a person need only have the equivalent of a high school diploma to be admitted. The university, like all such institutions, hosts some non-permanent young residents, which may play a role in county health numbers.
The fastest-growing age group for sexually transmitted diseases is the group that contains 15- to 24-year-olds.
"We're getting into a younger age group now," Telthorst said. "What is in (the data) goes into why we're seeing an increase. It's just the fact that people are having sex at an earlier age."
Social media - particularly "hook-up" apps - may play a role in the increased numbers of people with sexually transmitted diseases, she said, although there are no clinical studies that can verify the concern.
Hook-up apps are intended to help people find others with whom they will date or have casual sex.
"With the social media apps, where there is a lot of hooking up with anonymous partners, you can understand why you would have an increase in STDs," Telthorst said. "People like us (in community health) who try to contact patients' partners and get them treated - if the person doesn't know the name of the partners or how to get ahold of them - then we can't get them treated."
It's really challenging, the county public health educator Bethany Tillmann said, because they oftentimes don't know their sexual partners' names.
"When people come in and we ask for partner information, we're getting names like Sizzle or Big D. They say they only know their social media log-in," Tillmann said. "So, they will message these people right in front of us, using the apps on their phones to contact them."
Missouri's disease intervention specialist and Judy Opperman, the Cole County STD program coordinator, are working through a number of cases, Opperman said.
When the county health department receives clients with STDs, they discuss what the diseases are and what risk factors the clients have. The county health department may have a little more time with the clients than their doctors have, she said.
"They haven't thought through the risks," Opperman said. "You can see when that light bulb comes on - it doesn't matter if they're 15 or 50."
Cole County is somewhat "old school," in that it meets with and talks to clients personally, she said. It can be dicey because the county worker is a stranger. They talk about who the sexual partners were and try to gather contact information so the county can reach out to partners and offer treatment.
Oftentimes, the illness is passing around in small groups of people, she said.
"We also take phone calls from people. You don't even have to identify who you are if you have concerns about STDs or have questions about testing," Opperman said. "Any of our nurses can answer those questions. Sometimes people are really scared."
People wishing to call and ask questions about STDs need only call the Cole County Health Department at 573-636-2181 and ask for a nurse who can answer questions about the diseases or testing.
As Cole County's public health educator, Tillmann goes into schools to teach children about the dangers of STDs and other issues affecting them. She gives sixth-graders presentations on cyberbullying, sexting, sexual harassment, revenge porn and social media awareness. For seventh-grade students, she presents information about healthy relationships, social media, cyberbullying and STDs.
Eighth-grade students receive information about public health, social media, cyberbullying and STDs.
And high school students receive more advanced information about healthy relationships, cyberbullying, social media and STDs.