STD Investigators: Solving Mysteries, Saving Lives

LAURA: If you’re between the ages of 15 and 24 and sexually active, your chance of getting an STD is 1 in 2. Young people are at greater risk of getting infected than any other age group.

Many of you, like many older adults, are scared to get tested, scared to tell anyone if you do get tested and, if you’re infected, scared to get treated. So you don’t.

Which is where our guests come into the picture. I’m Laura Sessions Stepp. And today on Sex.Really we’re going to hear from Melissa Wong and Teri Lopez, who are STD investigators.

Melissa and Teri work for San Mateo County, in Northern California. Think of them as health care detectives – who solve mysteries and save lives. Women and men all over the country now do this kind of work.

We first met Melissa and Teri on a panel at Sex Tech 2010, a conference in San Francisco.

Terry: Welcome everybody. My name is Terry Lopez, and I have been with San Mateo County health system for five years now. And then Melissa…

Melissa: My name is Melissa Wong. I was on the prevention and education side of things until just recently. Unfortunately, our health department lost their STD and HIV education program, but I was fortunate enough to remain there and am now an STD investigator, which is similar work.

Terry: Yeah, I never thought that this job even existed, that people actually go out and follow people with STDs. And so, we have our little cartoon here: Not everything you did in Vegas stays in Vegas.

Melissa: And if it didn’t stay in Vegas, we’re gonna find ya.

LAURA: Teri says that her job starts with the untreated.

Terry: In California, Chlamydia, Gonorrhea and Syphilis are reported to the health department by a health care provider and by the laboratory. So, once we receive a lab report and a doctor report, if the doctor states that this patient has not been treated, or they can’t find them, that’s when we step in and we try to contact them and provide them with treatment.

LAURA: Sometimes, the person they’re seeking has given a false phone number or wrong address. He or she might not return to the doctor for test results. This evasion can last a long time – it took one young man, for example, 18 months to seek help. Melissa told this story to our reporter, Evan Roberts.

Evan: My understanding is that there have been instances, where people—where there is something keeping them from responding to you…?

Melissa: Sure. We had an eighteen month-long case that began when we saw a couple of young men come into the clinic and test positive for HIV. Similar stories—they had been meeting people online, hooking up at somebody’s house, anonymous sex. What was interesting is that they both named the same person. They had very limiting identifying information— first name, screen name, and maybe age and ethnicity. We of course tried contacting this person, got multiple hang-ups, doors slammed in the face. Sent letters. And this person was eventually named, over the course of the next few months, five more times for multiple STDs, including HIV. And so it was beginning to become quite a health issue. Long story short, after almost eighteen months of not being able to get a hold of this guy, we tried contacting him through a MSM hook-up sight and he responded, which was amazing. He ended up going into a San Francisco clinic, bringing his partner, they both tested positive for HIV and Gonorrhea. So, we don’t know if this individual has changed his behavior in any way, but we do know that he knows his status now and that he is linked to care.

Evan: Now this story just enrages me, this person. I’m not trained to be an STD investigator at all, so this may not be the appropriate response, but, how do you deal with all these emotions surrounding this?

Melissa: This was a really tough thing that all of the people in the health department involved in this case went through. We went through the whole gamut of emotions, from being pissed—like, why is this guy out there doing this? Probably knows his status, probably knowingly infecting who knows how many young men with HIV among other things. Then we went through the emotions of feeling sorry for him. The health department actually got to the point where they started looking at this as a community problem. And they wanted to go the avenue of having a health department-ordered HIV test. We didn’t want to go that way, because we as the investigators are thinking, if we go this way of kind of policing him, it’s going to shut all doors. So we avoided that, and it all turned out well. We didn’t have to go that route because he went in on his own, after a year and a half. To this day—knock on wood—we haven’t had him named or come up again, so far.

LAURA: Some might say it turned out well. Except he may have infected people during those 18 months of denial. Then again, if investigators had pushed him harder, he might not have responded at all. One small victory: He did take “HIV Negative” off his online profile. Not all cases are this difficult.

Melissa: For example, I had a case of a young woman who was positive for Chlamydia. She had just been released from jail. I tracked her down, found her at her house. She had no idea she was positive for Chlamydia. Here she is, four or five months pregnant. She wasn’t linked into prenatal care. So I treated her, treated partner, and got her to prenatal care, all in one little field visit.

Evan: I guess in comparison to the eight-month ordeals, that can feel pretty good.

Melissa: Yeah. And those are the days that you think: “This is why I do this.” Those are the days that feel good.

LAURA: One of the first outbreaks of a sexually transmitted disease occurred among French soldiers in the 15th century. We now call that disease syphilis. 500 years later, STDs have increased in kind and number and can be found among residents of crack houses, farmhouses, dormitories and well-tended suburban homes.

A lot has changed, though, since the days of what we used to call “venereal disease.” Many STDS today can be cured or rendered harmless, if diagnosed and treated early. Melissa and Teri say that’s what keeps them going, even when someone hangs up on them for the third - or 13th - time.

Melissa: Well, I think it’s really important to stop the spread of these diseases when we can, as much as possible. But I’ve always just been really drawn to being able to talk to people about sex and reproductive health in a real way, because oftentimes people don’t have a person like us to talk to. And so I really enjoy that human aspect of it.

Teri: Same here. I love having that one-on-one time with the patients. We get patients that keep on calling back. Even after we’ve already worked with them, they call back. And it’s like: I have a question, or I have a new boyfriend now what should I do? And it’s great.

LAURA: Melissa and Teri suspect that young people call, in part, because they don’t have anyone else to talk to about sex. In particular, safe sex.

Teri: Besides STDs and HIV, I think what’s really important and that needs to be discussed more with young adults are the feelings that lead up to this.

Melissa: Teri is exactly right. I feel like in sex-ed classes, and even on TV, sex has become this very scientific and clinical thing, like: You have sex, you can have babies; you have sex, you can have STDs. But there is really none of the emotional part that’s ever talked about, and that’s what’s so important. And what we’re seeing, especially with our young people who are coming up with STDs is they didn’t use a condom because they didn’t feel like they could say anything, or they thought that their partner would leave them. It’s so deeply rooted in their self-esteem and skills building and negotiation techniques.

LAURA: Melissa and Teri go to work once someone has been tested. In the coming months, Americans are going to hear a lot about young people who haven’t been tested but should be – namely, anyone who’s been sexually active.

MTV, the Kaiser Family foundation, the Centers for Disease Control and others, are reviving the campaign called GYT – as in: Get Yourself Tested.

It’s a worthy cause. If young people know they’re not alone, and that many STDs are treatable, they may be more likely to set aside their fear and show up at the doctor’s door.

I’m Laura Sessions Stepp and this is Sex. Really. Join us for a new episode in two weeks.