WORTHINGTON - While the birth rate among Minnesota teens has been on a downward trend over the past three decades, the same can’t be said for sexually transmitted infections (STIs), which have risen to epidemic levels across the state.

The first story in this series on teen sexual health, published in Saturday’s edition of The Globe, noted that Nobles County ranked third in the state in birth rates among youths ages 15 to 19 in 2017. This story addresses the county’s rankings in sexually transmitted infections.

In 2017, Nobles County ranked seventh in the state in the number of gonorrhea cases among teens ages 15 to 19, and ninth in chlamydia cases. It is the only county in southwest Minnesota to be ranked in the top 10 in any of the three categories.

While rankings are not done for syphilis cases, Donna Erbes, health services director for Southwest Minnesota Opportunity Council’s Family Planning program, said those numbers are also on the rise locally, as well as statewide and nationally.

The rise in sexually transmitted infections among teens throughout the state has led to an effort to increase awareness and testing among Minnesota’s youths. During National STD Awareness Month in April 2016, Community Restoring Urban Youth Sexual Health (CRUSH) led the first statewide STI Testing Day, with clinics providing no- or low-cost STI screening for teens.

“There’s discussion at the state level about having an STI Testing Week in 2019,” Erbes said. “They’re trying to increase awareness and testing.”

Increasing awareness and providing testing for STIs are both duties of SMOC Family Planning in Worthington, where Erbes has been the director for the past 10 years.

The rates of STIs are predominantly high among teens ages 15 to 19 in Nobles County, with 1,677 cases of chlamydia and 335 cases of gonorrhea per 100,000 population reported in 2017, according to the University of Minnesota Prevention Research Center (PRC).

PRC states adolescents and young adults experience a higher incidence of STIs compared to other age groups. That’s likely related to lack of access to STI prevention services, socioeconomic status, concerns about confidentiality and discomfort with facilities designed for adults.

At SMOC Family Planning, Erbes said their programs are open to all people. They provide testing for STIs in house, education on sexually transmitted infections, and free condoms to help protect individuals.

“With STIs, you can come in and be tested without an exam, unless you’re having symptoms,” Erbes said. “If you’re sexually active and you don’t have a monogamous partner, you should be tested once a year or when you change partners. If you have more than one partner, you should be using condoms routinely.”

Erbes said STIs are prevalent among teens and young adults ages 15 to 24.

“Today’s society is more accepting of multiple partners,” she added.

What teens don’t understand - or perhaps know - is that having STIs continuously or repeatedly without getting diagnosed and treated could lead to infertility, Erbes said.

In her role, Erbes does a lot of education about STIs when she speaks in high schools, colleges, community groups and health fairs.

“We talk about STIs and really, the only thing to prevent an STI is abstinence or use a condom,” she said. “We talk about not just sexual intercourse, but different kinds of sex - vaginal-penile sex is not the only way to get a sexually transmitted infection. All different types of activity can lead to an STI.”

STI testing at SMOC Family Planning is individualized according to the type of sexual activity an individual is having. Erbes said since chlamydia and gonorrhea are the two most prevalent locally, they are generally tested for, along with HIV.

“You should at least be tested once yearly for HIV,” she said.

Individuals who test positive for chlamydia receive a one-time antibiotic treatment that is long-acting over the course of a week, Erbes said. Gonorrhea cases receive the same treatment plus a one-time injection. Retesting is then done in three months to ensure the individual’s partners aren’t passing it back and forth, she added.

SMOC Family Planning also tests for syphilis and can begin initial treatment for an individual, though eventually they are referred on for treatment.

“It’s curable, but it can be debilitating and cause death if not treated appropriately,” Erbes said. “The other part of that is the partner treatment.”

Erbes said that while STI rates are on the rise, local screening efforts have improved with the addition of rather personal questions about sexual health.

“If you have oral sex, rectal sex, vaginal sex, it all leads into possible different testing,” Erbes said.

As SMOC Family Planning continues its quest to increase awareness of STIs and unwanted pregnancies, provide birth control options and testing, Erbes said the local office will add a new service to its offerings in 2019.

“We’ll start giving the Gardasil injection, the cancer-preventing HPV vaccine,” she said. “In the past, it’s kind of been looked on as a sexually active HPV vaccine, and now it’s taking on a cancer prevention vaccination.”

The agency will also continue to build its collaborative efforts with others in hopes of spreading the word about the dangers of STIs.

“We collaborate with different agencies so they know more about our process and referrals,” said Liz Bunjer, assistant director of SMOC Family Planning, based in Marshall.

“We’re really interested in not being seen as the little, quiet clinic,” Erbes said. “We want to partner with parents and other community organizations and the clinics in town. This is a real problem not just in Nobles County or Minnesota, but across the nation.

“Even though we’re making steps in the right direction, there’s still a lot of work to be done,” she added. “We’re here with good information. We want to be a great access to people and to the medical community.”