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St. Louis has retained the dubious distinction of leading the nation in sexually transmitted diseases, ranking first in 2018 among counties and independent cities for the rate of gonorrhea and — after dropping to third place a year ago — regaining the top spot for chlamydia. The city was fourth for its syphilis rate.

Across the U.S., the combined cases of syphilis, gonorrhea and chlamydia reached an all-time high last year, according to the annual report released Tuesday by the Centers for Disease Control and Prevention.

For at least two decades, St. Louis led the way in the rates of sexually transmitted diseases among U.S. counties and independent cities, according to the CDC.

In St. Louis last year, there were 739 cases of gonorrhea per 100,000 people, 1,449 cases of chlamydia and 42.4 cases of syphilis.

The rates in St. Louis are among the highest because St. Louis and Baltimore are the only cities reporting numbers as independent cities rather than as a county, explained Dr. Hilary Reno, assistant professor at Washington University School of Medicine and medical director of the St. Louis County Sexual Health Clinic.

“It is my professional opinion that it’s irrelevant and inaccurate, but it’s what everybody pays attention to,” Reno said.

As a metropolitan area, St. Louis and its surrounding 14 counties ranks 16th for chlamydia, 12th for gonorrhea and 25th for syphilis.

Those numbers are still alarming, Reno said.

She echoes what the CDC says are factors behind the rising rates: Drug use, poverty, stigma and unstable housing, which can reduce access care; decreased condom use among vulnerable groups; and budget cuts that have resulted in clinic closures and poor follow-up care.

“We have come across this problem where people aren’t quite sure where to go for sexual health care,” Reno said. She recently found that 50% of patients treated in emergency rooms at Barnes-Jewish, St. Louis Children’s and Christian hospitals had free testing clinics closer to them.

“Clearly something is not working there,” Reno said. “Is it not advertised enough? Are they somehow not welcoming? Is this a stigma issue?”

Antibiotics can cure syphilis, gonorrhea and chlamydia. Left untreated, however, the diseases can be transmitted to others and produce adverse health outcomes such as infertility, ectopic pregnancy and increased HIV risk.

Congenital syphilis — syphilis passed from a mother to her baby during pregnancy — can lead to miscarriage, stillbirth, newborn death, and severe lifelong physical and neurological problems.

Across the country from 2017 to 2018, congenital syphilis cases increased 40% to more than 1,300 cases, according to the CDC. Seventeen were in Missouri, Reno said.

Reno said nearly 40 organizations across the area, including public health departments and universities, have worked together recently to identify gaps in care, develop new ways to make treatment more accessible and better track data.

“The level of cooperation we have seen in past two years in sexual health has been exponentially growing,” she said. “This is what we have to rely on to really reduce the rates we are seeing.”

Janelle O’Dea of the Post-Dispatch contributed to this report.