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Leg Day

 

Pain Management: Maintaining Intimacy

Chronic pain can lead to sexual problems. When you are in pain, the last thing you probably want to do is be intimate with your partner. But it is important to remain close to your loved one. A healthy, intimate relationship can positively affect all aspects of your life.

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Many people living with pain often have fears about sexuality, including:

Fear of rejection by a partner: It is common for people with chronic pain to feel that a partner is no longer interested. You may wonder if a partner is less attracted to you because you are in pain. Share your feelings and fears with your partner and listen to your partner's concerns.

Fear of pain associated with sex: It is natural to worry that sexual intercourse will cause you more physical pain. You can address this concern by experimenting with different positions that are more comfortable.

Fear of failure to perform: Pain, depression, alcohol and medications all can affect sexual performance or the ability to get aroused or have an orgasm. Sometimes, failure to perform is caused by stress and anxiety. In many cases, patience and understanding can help in overcoming performance problems. Many medications can reduce your sexual ability and/or cause impotence. If you suspect a medication may be affecting your sexual performance, don't stop taking the drug without first consulting your health care provider.

If intercourse is undesirable, there are other ways to be aroused, including:

·         Touching: Explore your partner's body through touch. This may include cuddling, fondling, stroking, massaging and kissing. Touch increases feelings of intimacy.

·         Self-stimulation: Masturbation is a normal and healthy way to fulfill your sexual needs.

·         Oral sex: This form of contact may be an alternative or supplement to traditional intercourse.

 

·         You may also want to experiment with having sex at different times of the day or in different positions. If you have more pain in the evening, having sex earlier in the day might help. Try different positions -- some may feel better than others. You may also want to use lubricants when there is a lack of natural lubrication. Lubricants can ease or prevent pain associated with sexual contact.

Intimacy Without Sex

Sexuality is only one form of intimacy. Non-sexual ways you can be intimate with your partner include:

·         Sharing feelings: Discuss your feelings with your partner. Talking and listening can help you both better understand each other and may bring you closer.

·         Participating in common interests: Couples that play together often stay together, so the saying goes. Hobbies, sporting activities, or volunteer activities can bring couples closer together when they share interests.

·         Making time to be alone together: Try taking a bath together, sharing a candlelight dinner, taking a walk, or just holding each other in bed.

·         There are many additional ways of creating non-sexual intimacy. Explore various things that you and your partner can do together to bring you closer.

Intimacy Is Possible

You can have a healthy and satisfying relationship in spite of chronic pain. Remember that intimacy begins with honest communication. You and your partner should talk about your feelings -- what you miss and what you want or need from your relationship. In any relationship, an effort must be made to maintain what is good and change what needs improvement. In your efforts to become more intimate, you may discover something about your partner that you did not know before. Your relationship may become stronger than it was before you faced the issue of chronic pain.

 

If sexual problems continue to be an issue, consider speaking with a counselor or sex therapist.

Foods to Help Improve Your Circulation

 Foods to Help Improve Your Circulation

Circulation Is Key

Blood is like your body’s superhighway. It carries nutrients and oxygen to everything from your heart and brain to your muscles and skin.

A healthy diet is one way to optimize your circulation, or blood flow. Combined with exercise, hydration, weight management, and not smoking, some foods can help improve circulation. Next time you head to the grocery store, consider including these items in your shopping cart.

FITNESS AT ANY AGE

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ISBN-13 : 978-1515067214

#fitness #health   #weightloss 

#arthritisrelief#arthritistreatment #nutrition

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Arthritis Help for Veterans

 Arthritis Help for Veterans

Veterans can learn effective, drug-free ways to ease arthritis pain and improve their quality of life with physical activity programs and self-management education workshops.

Over one in three veterans (or 35%) have arthritis, making it a common condition among those who served in the US military.

Arthritis is more common among veterans than nonveterans overall, and is a leading cause of work and physical disability. Though arthritis affects veterans more, about 1 in 4 (or 23.7%) of all US adults has arthritis.

Among veterans, arthritis is more widespread in older adults, men, and those who are significantly overweight.

Traumatic and overuse injuries, which commonly occur during active duty, are reasons veterans may develop arthritis. Fortunately, there are low-cost or free physical activity programs and educational workshops that can help veterans feel better.

Lifestyle Management Programs

There are several proven programs to help veterans and other adults with arthritis be healthier and live with less pain. Some of these programs offer at-home and self-directed options in addition to their regularly scheduled in-person classes.

Veterans can:

Participate in physical activity classes that can teach them how to feel their best. These classes have been shown to safely reduce pain and disability related to arthritis and improve movement and mood.

Join self-management education workshops designed to teach people with arthritis and other chronic conditions how to control their symptoms and to develop more confidence in managing health problems that affect their lives. Classes are led by people who have experience living with arthritis or other chronic conditions.

Why is physical activity important for people with arthritis?

If you have arthritis, participating in joint-friendly physical activity can improve your arthritis pain, function, mood, and quality of life. Joint-friendly physical activities are low-impact, which means they put less stress on the body, reducing the risk of injury. Examples of joint-friendly activities include walking, biking and swimming. Being physically active can also delay the onset of arthritis-related disability and help people with arthritis manage other chronic conditions such as diabetes, heart disease, and obesity.

How much activity do I need?

Stay as active as your health allows, and change your activity level depending on your arthritis symptoms. Some physical activity is better than none.

How do I exercise safely with arthritis?

Walking eases arthritis pain. Older man and woman walking outside. 

Learn how you can safely exercise and enjoy the benefits of increased physical activity with these S.M.A.R.T. tips.

Start low, go slow.

Modify activity when arthritis symptoms increase, try to stay active.

Activities should be “joint friendly.”

Recognize safe places and ways to be active.

Talk to a health professional or certified exercise specialist.

Start low, and go slow

When starting or increasing physical activity, start slow and pay attention to how your body tolerates it. People with arthritis may take more time for their body to adjust to a new level of activity. If you are not active, start with a small amount of activity, for example, 3 to 5 minutes 2 times a day. Add activity a little at a time (such as 10 minutes at a time) and allow enough time for your body to adjust to the new level before adding more activity.

Modify activity when arthritis symptoms increase, try to stay active.

Your arthritis symptoms, such as pain, stiffness, and fatigue, may come and go and you may have good days and bad days. Try to modify your activity to stay as active as possible without making your symptoms worse.

Activities should be “joint friendly.”

Choose activities that are easy on the joints like walking, bicycling, water aerobics, or dancing. These activities have a low risk of injury and do not twist or “pound” the joints too much.

Recognize safe places and ways to be active.

Safety is important for starting and maintaining an activity plan. If you are currently inactive or you are not sure how to start your own physical activity program, an exercise class may be a good option. If you plan and direct your own activity, find safe places to be active. For example, walk in an area where the sidewalks or pathways are level and free of obstructions, are well-lighted, and are separated from heavy traffic.

What types of activities should I do?

How hard are you working?

Measure the relative intensity of your activity with the talk test. In general, if you’re doing moderate activity you can talk, but not sing, during the activity. If you are doing vigorous activity, you will not be able to say more than a few words without pausing for a breath. Learn more about measuring physical activity intensity.

Low-impact aerobic activities do not put stress on the joints and include brisk walking, cycling, swimming, water aerobics, light gardening, group exercise classes, and dancing.

For major health benefits, do at least:

150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, like cycling at less than 10 miles per hour, or

75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity, like cycling at 10 mph or faster, each week. Another option is to do a combination of both. A rule of thumb is that 1 minute of vigorous-intensity activity is about the same as 2 minutes of moderate-intensity activity.

In addition to aerobic activity, you should also do muscle-strengthening activities that involve all major muscle groups two or more days a week.

Muscle-strengthening exercises include lifting weights, working with resistance bands, and yoga. These can be done at home, in an exercise class, or at a fitness center.

Flexibility exercises like stretching and yoga are also important for people with arthritis. Many people with arthritis have joint stiffness that makes daily tasks difficult. Doing daily flexibility exercises helps maintain range of motion so you can keep doing everyday things like household tasks, hobbies, and visiting with friends and family.

Balance exercises like walking backwards, standing on one foot, and tai chi are important for those who are at a risk of falling or have trouble walking. Do balance exercises 3 days per week if you are at risk of falling. Balance exercises are included in many group exercise classes.

What do I do if I have pain during or after exercise?

It’s normal to have some pain, stiffness, and swelling after starting a new physical activity program. It may take 6 to 8 weeks for your joints to get used to your new activity level, but sticking with your activity program will result in long-term pain relief.

Here are some tips to help you manage pain during and after physical activity so you can keep exercising:

Until your pain improves, modify your physical activity program by exercising less frequently (fewer days per week) or for shorter periods of time (less time each session).

Try a different type of exercise that puts less pressure on the joints—for example, switch from walking to water aerobics.

Do proper warm-up and cool-down before and after exercise. You can find warm-up and cool-down exercises on the Arthritis Foundation’s Walk With Ease Exercise Videos webpage.

Exercise at a comfortable pace—you should be able to carry on a conversation while exercising.

Make sure you have good fitting, comfortable shoes.

Intimacy Without Sex

 

Intimacy Without Sex

 

SUPER SEX AFTER 60

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My book is available on AMAZON.

 

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ISBN-13 : 978-1545347348

 

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Sexuality is only one form of intimacy. Non-sexual ways you can be intimate with your partner include:

 

·         Sharing feelings: Discuss your feelings with your partner. Talking and listening can help you both better understand each other and may bring you closer.

·         Participating in common interests: Couples that play together often stay together, so the saying goes. Hobbies, sporting activities, or volunteer activities can bring couples closer together when they share interests.

·         Making time to be alone together: Try taking a bath together, sharing a candlelight dinner, taking a walk, or just holding each other in bed.

There are many additional ways of creating non-sexual intimacy. Explore various things that you and your partner can do together to bring you closer.

Tips to Lower Your Cholesterol

 

Tips to Lower Your Cholesterol

 

Aging Well

 

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ISBN-13 ‏ : ‎ 978-1659483161

 

#fitness #health   #weightloss #wellness #healthy eating #nutrition #healthy  #exercise #workout

 

Simple Steps Add Up

Has your doctor said you have high cholesterol? Then you know you need to change your diet and lifestyle to lower cholesterol and your chance of getting heart disease. Even if you get a prescription for a cholesterol drug to help, you'll still need to change your diet and become more active for heart health. Start with these steps.

 

Know Good and Bad

Your body needs a small amount of cholesterol. But many people have too much, especially the “bad” kind, or LDL cholesterol. That can happen if you eat too much saturated fat, found mainly in foods from animals. If your LDL level is too high, plaque can build up in your heart's arteries and lead to heart disease. The “good” cholesterol, HDL, helps clear LDL from your blood.

 

Use Your Hands

It’s easy to eat too much, especially when you eat out and the portions are huge. That can lead to weight gain and higher cholesterol. What’s a true portion? There’s a “handy” way to tell. One serving of meat or fish is about what fits in your palm. One serving of fresh fruit is about the size of your fist. And a snack of nuts or serving of cooked vegetables, rice, or pasta should fit in your cupped hand.

 

Think Delicious and Nutritious

Load your plate with fruits and vegetables -- aim for five to nine servings each day -- to bring down your LDL level. Antioxidants in these foods may provide the benefit, along with fiber. And you may eat less fatty food if you fill up on produce. Bonus: You'll also help lower blood pressure and keep your weight in check.

 

Boost Your Omega-3s

You can eat fish twice a week. It’s a great source of protein and omega-3s, which are a type of fat your body needs. Omega-3s help lower levels of triglycerides, a type of fat in the blood. They may also cut down on cholesterol, slowing the growth of plaque in arteries. Go for fatty fish, such as salmon, tuna, trout, and sardines. Grill, roast, bake, or broil, but don’t fry them.

 

Start Your Day With Whole Grains

A bowl of oatmeal is a smart choice. It fills you up, making it easier not to overeat at lunch. The fiber also curbs LDL cholesterol. Whole grains aren’t just for breakfast. You’ve got plenty of options to try later in the day, such as brown or wild rice, popcorn, and barley.

 

Go Nuts

Need a snack? A handful of almonds, pecans, pistachios, walnuts, or other nuts is a tasty treat. They are high in monounsaturated fat, which lowers LDL "bad" cholesterol but leaves HDL "good" cholesterol alone. Studies show that people who eat about an ounce of nuts a day are less likely to get heart disease. Keep the portion small, so you limit fat and calories. And avoid those covered in sugar, chocolate, or a lot of salt.

 

Make It Unsaturated

You need some fat in your diet, but probably less than you think. Plus, the type of fat matters. Unsaturated fats -- like those found in canola, olive, and safflower oils -- lower LDL "bad" cholesterol levels and may help raise HDL "good" cholesterol. Saturated fats -- like those found in meat, full-fat dairy, butter, and palm oil -- raise LDL cholesterol. Remember, good fats have just as many calories, so use just a bit.

 

Pick the Best Carbs

Beans and whole grains such as brown rice, quinoa, and whole wheat have more fiber and don’t spike your blood sugar. They will lower cholesterol and make you feel full longer. Other carbs, like those found in white bread, white potatoes, white rice, and pastries, boost blood sugar levels more quickly so you feel hungry sooner, which can lead you to overeat.

 

Go for 30

Just half an hour of physical activity 5 days a week can lower your bad and raise your good cholesterol levels. More exercise is even better. Being active also helps you reach and keep a healthy weight, which cuts your chance of developing clogged arteries. You don't have to exercise for 30 minutes straight. You can break it up into 10-minute sessions. Or go for 20 minutes of harder exercise, like running, three times a week.

 

Walk It Off

It's simple, convenient, and all you need is a good pair of shoes. Aerobic exercise ("cardio") such as brisk walking lowers the chance of stroke and heart disease, helps you lose weight, keeps bones strong, and is great for your mood and stress management. If you're not active now, start with a 10-minute walk and build up from there.

 

Go Beyond the Gym

You can be active anywhere. Garden, play with your kids, hike, dance, walk your dog -- if you’re moving, it’s good! Even housework goes on the list if it gets your heart rate up. Do as much as possible, as often as you can, wherever your day takes you.

 

Be Smart When You Eat Out

Restaurant food can be loaded with saturated fat, calories, and sodium. Even “healthy” choices may come in supersize portions. To stay on track:

 

Choose broiled, baked, steamed, and grilled foods -- not fried.

Get sauces on the side.

Ask for half of your meal to be boxed up before you get it.

 

 Check the Label

What’s the serving size? The nutrition info may look good, but does the package contain two servings instead of one?

 

If it says "whole grain," read the ingredients. Whole wheat or whole grain should be the first one.

 

Note the saturated fat, sodium, calories, and cholesterol. Are they OK for your daily plan? If not, what will you choose to change?

 

Stay Chill

Over time, out-of-control stress becomes a problem. It raises your blood pressure, and for some people, it might mean higher cholesterol levels. Make it a priority to relax. It can be as simple as taking some slow, deep breaths. You can also meditate, pray, socialize with people you enjoy, and exercise. And if some of the things that stress you out are things you can change, go for it!

 

Check Your Weight

Extra pounds make you more likely to get high cholesterol, high blood pressure, and type 2 diabetes. These all affect the lining of your arteries, making them more likely to collect plaque from cholesterol. Losing weight, especially belly fat, raises your good and lowers your bad cholesterol.

 

Keep Tabs

Celebrate your progress! Remember that you’re in charge of your health and that you can turn your cholesterol around. See your doctor regularly so you know how it’s going. Working together, you'll keep your heart going strong.

 

 

 

Ease Inflammation

 

Ease Inflammation

 

 Aging Well

 

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Too Much of a Sometimes-Good Thing

 

Your body needs some inflammation to fight infection and speed healing. But too much for too long can push your immune system to attack healthy organs and tissues. This can lead to heart disease, diabetes, cancer, arthritis, and irritable bowel diseases. Luckily, there are ways to keep the flames at bay.

 

Catch Enough ZZZs

 

When you don’t get the sleep you need, your body may kick inflammation up a notch. Your goal should be 7-9 hours every night. Aim for both quality and quantity. Go to bed and wake up at the same time every night and day, put your screens away well before you lie down, and sleep in a cool, dark, and quiet room.

 

Go for a Stroll

 

It takes as little as 20 minutes of moderate exercise, such as a brisk walk with your dog or a friend, to head off an anti-inflammatory response in your body. Health guidelines call for 30 minutes of physical activity a day, 5 days a week. If you currently don’t work out at all, 20 minutes is a great place to start.

 

Spice It Up

 

Studies on turmeric, rosemary, cinnamon, cumin, and ginger show they may slow down processes in your body that lead to inflammation. Dial up the flavors in your dishes and give your health a boost by trying out some of these spices.

 

Try Fasting

 

Research shows intermittent fasting may be more than just a fad. Eating only during a fixed window of time each day can have anti-inflammatory effects. Long-lasting inflammation can raise your risk for conditions including heart disease, cancer, and diabetes. There are many ways to follow this eating plan. A common method involves only eating between 10 a.m. and 6 p.m. daily.

 

Get Your Greens

 

Stock up on salad fixings. Greens such as collards, broccoli, kale, and spinach have antioxidants and other compounds that can help reduce inflammation and keep day-to-day damage to your cells to a minimum. The U.S. Department of Agriculture recommends that women eat at least a cup and a half of dark green vegetables every week. Men ought to eat two.

 

Try Yoga

 

This ancient Indian practice focuses on breathing. It also helps lower levels of the stress-related hormone cortisol. When yoga is a regular part of your routine, you may also feel less depressed, less anxious, and have fewer symptoms of inflammation, such as high cholesterol and unstable blood sugar levels.

 

Easy on the Alcohol

 

A glass of wine with dinner isn’t going to do much harm. But too much alcohol can raise toxin levels in your body. This turns on inflammation, which can damage tissues and organs. If you drink at all, do so in moderation. What does that mean? According to the CDC, it’s no more than one drink a day for women and two for men.

 

Upgrade Your Diet

 

Refined carbohydrates, red meats, and fried foods raise inflammation in your body. Swap out unhealthy foods for inflammation-fighting fruits, vegetables, nuts, beans, and fish. Plan your menu around foods such as tomatoes, blueberries, almonds, walnuts, lentils, and salmon.

 

Shed Extra Weight

 

If you’ve got a few pounds to lose, getting rid of them could ease inflammation. Excess weight, on the other hand, can make it worse. That’s part of the reason obesity and overweight are risk factors for so many health conditions. Talk to your doctor about how you can get into a weight range that’s healthy for you.

 

Go for Green Tea

 

If a cup of joe is your morning habit, try green tea instead. It’s packed with compounds known as polyphenols that fight off free radicals. These molecules can promote inflammation in your body. You don’t have to kick your coffee habit altogether. Consider swapping out one cup a week for the green stuff.

 

Stop Smoking

 

Smoking comes with a laundry list of harmful effects. Higher levels of inflammation is one of them. Decide to quit and pick a day to do it. You don’t have to go it alone, though. Your doctor can come up with a plan so you can kick the habit for good.

 

 

A sexually transmitted disease is killing Texas babies

 A sexually transmitted disease is killing Texas babies

FITNESS AT ANY AGE

 

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I would appreciate your support. It’s only $25.95

 

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#fitness #health   #weightloss #wellness #healthyeating #nutrition 

In April, health officials in Houston issued an urgent notice about rising cases of congenital syphilis, imploring pregnant women to get tested and treated for a condition that can kill or debilitate infants. New county data showed it had caused at least 14 fetal deaths in 2020, marking a 250% increase over the year before.

Congenital syphilis, which occurs when the sexually transmitted disease is passed from woman to fetus and is avoidable if caught and treated in time, had been steadily ticking upward in the city, tracking rising syphilis infections among women. More babies are born with the condition in the Houston area than anywhere else in Texas, which has the nation’s highest rate of congenital syphilis.

“Nobody’s making a big enough deal about this,” said Dr. Irene Stafford, an OB-GYN and maternal-fetal medicine specialist in Houston. “What will it take? Where is the funding, where are the big media campaigns? …We have babies dying from something 100% preventable, so where is the big response?”

Statewide, 528 cases of congenital syphilis were reported to the Texas Department of State Health Services in 2019 — the latest data available — up from 367 in 2018, when Texas accounted for more than a quarter of cases nationwide. The state’s congenital syphilis rate — the number of cases per 100,000 live births — ranked worst in the country for two years running and is far above the national average. More than 80% of Texas cases have been reported in Houston, Dallas, San Antonio and surrounding areas.

Data provided to Public Health Watch via an open-records request show that between 2016 and 2019, most Texas babies with congenital syphilis were born to Black and Hispanic women, including almost nine of every 10 cases in 2018. In the Houston area, every baby who died from congenital syphilis in the last two years was either Black or Hispanic.

In emails, the state health department said it was addressing the problem by educating physicians and patients and improving data reporting and collection. It pointed to enhanced surveillance and better capacity to identify congenital syphilis as reasons for Texas’ worst-in-the-nation ranking. But the agency’s own 2021 report said the state is experiencing “true increases in both syphilis and congenital syphilis cases.”

Many factors are likely colliding to drive up syphilis among Texas women – and, in turn, congenital syphilis, experts say. Among them are inadequate sexual health education, rising addiction, lack of access to family planning services and chronically underfunded STD prevention programs. The condition’s early detection and treatment also hinge on larger inequities, such as who has health insurance and timely access to care. (Texas has the country’s worst uninsured rate, and the latest data show about one in four Texas women of reproductive age have no health coverage.)

On top of all this, COVID-19 forced local health departments to reassign STD investigators to pandemic control. The specialists find people who may have been exposed and ultimately break chains of disease transmission.

More babies born with syphilis also reflect gaps in the state’s safety net and missed opportunities in clinical settings. In a study published last year, researchers at the Centers for Disease Control and Prevention examined about 1,300 cases of congenital syphilis reported nationwide in 2018. More than half of the cases came from the South, including Texas. The most commonly missed opportunities in the region were lack of timely prenatal care and failure to provide proper treatment for women diagnosed with syphilis during pregnancy.

Stafford, an OB-GYN with McGovern Medical School at UT Health Houston who practices in high-risk hospitals, said she sees a pregnant patient with syphilis at least once every couple of weeks, and about two or three babies born with congenital syphilis each month.

“For every baby born with syphilis, there’s probably three more women who had it who were treated,” she said. “That’s what’s so frustrating — this is completely treatable.”

Stafford suspects future data will confirm the pandemic worsened the problem.

About 40% of babies born to women with untreated syphilis are stillborn or die as newborns, according to the CDC. Babies with the disease can also experience bone and liver problems, severe anemia and vision and hearing loss. Stafford said research on long-term impacts of treated and untreated congenital syphilis is sparse and unclear. But the real-world effects she sees are unmistakable.

She told the story of one patient, a woman dealing with drug addiction and homelessness, who had given birth to two babies with congenital syphilis. Each time, she left the hospital before doctors could treat her, Stafford said. The older child, now 2, is in therapy for developmental delays. The younger one, born earlier this month, required treatment in a neonatal intensive care unit.

“The toll it’s taken on her family,” Stafford said. “That’s the stuff we have to think about, too — the impact this disease has on babies who do survive and their caregivers.”

Most pregnant women do seek care, she said, but still face obstacles to follow-up testing and treatment regimens.

“Many patients can’t find transportation or child care, or can’t afford to pay to park (at a hospital),” Stafford said. “We can’t just sit here and blame patients — they need our help.”

STD Rates Worsened by COVID-19

Texas ranks worst for congenital syphilis, but national rates aren’t going in the right direction, either. In an article published in September in the New England Journal of Medicine, CDC researchers reported 2,022 cases of congenital syphilis as of July 29, 2021, surpassing the total number of cases for 2019 and reaching the highest case count since 1994.

Virginia-Bowen-e1635433292370-300x372.png

Virginia Bowen

Virginia Bowen, an epidemiologist in the CDC’s division of STD prevention, said Texas sits at the intersection of two regional trends. One is in the West, where research finds significant overlap between syphilis among women and methamphetamine use. The other is in the Southeast, where Bowen said syphilis has been historically endemic, so any sexually active person has a greater chance of contracting it, as they would gonorrhea or chlamydia, the rates of which are also soaring nationwide. “There’s a good chance that maybe Texas is experiencing a blending of these two stories,” she said. “But you’ve got to follow the local data.”

Syphilis is a reportable disease, and local public health workers are supposed to follow up with each newly diagnosed patient, Bowen said. But COVID-19 caused big disruptions to those kinds of follow-up services and the fieldwork of finding people possibly exposed to syphilis, as STD interventionists were redeployed en masse to emergency pandemic containment.

In Fort Worth, Tarrant County Public Health has made a number of changes in response to higher STD rates, including rising congenital syphilis, said Dr. Kenton Murthy, assistant medical director and deputy local health authority. Pre-pandemic, the agency switched from an appointment-only model at its STD clinics to a mix of appointments and walk-ins, increasing the number of patients who could be seen by up to 30%. It also reinforced lines of communication between its disease intervention specialists and one of the city’s main emergency rooms, where many syphilis cases are first diagnosed. Between 2016 and 2019, 68 cases of congenital syphilis were reported in Tarrant County, according to data obtained by Public Health Watch.

Vinny-Taneja-e1635457308170.jpeg

Jill Johnson

Vinny Taneja

Vinny Taneja, the county’s public health director, said funding for STD prevention has been relatively stagnant despite rising costs and needs. More money will help, Taneja said, but it will go only so far without parallel work to reduce barriers to the health care system.

“COVID-19 really shed a light on that part of the problem — that certain groups had worse COVID-19 outcomes compared to others due to gaps in our health care system,” Murthy said. “But STDs were already reflecting that.”

According to the National Coalition of STD Directors, the spending power of STD programs decreased by more than 40% between 2003 and 2019. At the same time, STDs have been surging, with U.S. cases of congenital syphilis nearly quadrupling between 2015 and 2019, according to CDC data. Jennifer Mahn, director of clinical and sexual health at the coalition, said STD prevention is poised to get an infusion of money — $1.13 billion in American Rescue Plan funds to hire thousands more disease intervention specialists at the local level.

“It’s just starting to get into people’s hands and implementation needs time,” Mahn said of the new funds. “I think it’s going to be a rough next year or so, but maybe in the next two or three years, we can start to move the needle on this.”

Texas lawmakers did take up rising congenital syphilis rates in 2019, passing legislation requiring physicians to test pregnant women for syphilis three times: at the first prenatal visit, during the third trimester and at delivery. But it’s unlikely all physicians are following the rules or are even aware of them, said Dr. Judy Levison, an OB-GYN in Houston and a professor at Baylor College of Medicine.

Levison co-leads a fetal and infant morbidity review board in Houston that reviews local cases of perinatal HIV and congenital syphilis to look for new trends and ways to intervene. The Houston board was launched as a pilot in 2015; similar boards were created in Dallas and San Antonio over the next few years.

Case reviews have revealed gaps in physician knowledge regarding syphilis testing and treatment during pregnancy, Levison said. In response, she said, the board hopes to persuade state Medicaid insurers to educate their providers.

“Probably the biggest thing we’ve learned,” said fellow OB-GYN Stafford, a member of the Houston review board, “is that nobody is immune to syphilis.”

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Dr. Kim Onufrak

In Nueces County, congenital syphilis was already rising pre-pandemic, and COVID-19 made it worse by further restricting access to care, said Dr. Kim Onufrak, clinical director for the Corpus Christi-Nueces County Public Health District. The agency had to close its own STD clinic, which provided free or low-cost syphilis testing, to in-person visits in spring 2020 following a redeployment of staff, though it maintained tracing and treatment services. The clinic is scheduled to reopen next month.

In 2020, Nueces County reported 50 congenital syphilis cases; as of this month, the 2021 caseload was at 49. Onufrak said a majority of congenital syphilis cases in her jurisdiction occur among women without access to prenatal care or who received care very late in their pregnancies. Most low-income pregnant women are eligible for Texas Medicaid, but even then, many physicians don’t take Medicaid insurance, Onufrak said.

In South Texas, Bexar County has the state’s second-highest number of congenital syphilis cases. Preliminary data show four stillbirths related to the condition in 2020 and five so far in 2021, said Dr. Anita Kurian, assistant director at the San Antonio Metro Health District. Despite the state’s screening law, she said, about half of the county’s congenital syphilis cases are among women who do get prenatal care but don’t get treated or tested for syphilis in a timely manner.

Kurian said the health district’s community-based STD and HIV screenings are back after being suspended because of COVID-19, with multiple testing events each week, many at high-risk sites such as homeless shelters and methadone clinics. The events are picking up on more cases of syphilis among women, she said, and the data is being used to identify future testing locations.

“Rising rates of congenital syphilis are extremely disconcerting,” Kurian said. “Even asymptomatic children at birth can develop symptoms later in life.”

Last year, facing spikes in congenital syphilis and related stillbirths, the Houston Health Department announced My Prenatal Promise, an effort to educate local women about the importance of syphilis screening during pregnancy.

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Lupita Thornton

Lupita Thornton, a public health investigator and manager in the department’s Bureau of HIV/STD and Viral Hepatitis, said it’s the agency’s first major STD- prevention marketing campaign.

Thornton said the department depends solely on state and CDC funds for its STD and HIV work, getting none from the city. The new federal relief funds tapped for hiring disease intervention specialists could be a game-changer, she said. But it’s also just one piece of the solution, as a baby born with syphilis is often the result of systemic breakdowns and other health and social ills.

“We need to pour money into things like mental health and drug abuse,” she said.

Several months ago, Thornton received a report about a 17-year-old girl who tested positive for syphilis. She went searching to offer her treatment, starting with family members, who said she struggled with mental health issues and ran away a lot. (“Or maybe they kicked her out because they were unable to manage her mental health issues,” Thornton said.)

Thornton found a phone number for a potential contact, who eventually gave her the best street corner and time of day to find the girl. She and her team lingered across the street, looking for someone matching her description.

They found her sitting under a bush surrounded by men, one of whom noticed the caseworkers and approached them aggressively. There was no way to safely get the girl out in that moment, and Thornton and her team were forced to retreat, losing her to follow-up.

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