A multi-faceted approach for addressing STIs in urban settings: The City of Milwaukee experience and strategic response

Unmitigated sexually transmitted infections (STI) incidence in many cities is often referred to as a “silent epidemic”. While rates of syphilis have declined, reported cases of Chlamydia (CT) and Gonorrhea (GC) have increased. The City of Milwaukee was recently ranked number #1 and #3 for CT and GC respectively in the 2007 National Association of City and County Health Officials' (NACCHO) Big Cities Report. To combat this trend, the City of Milwaukee Health Department (MHD) developed and implemented an array of initiatives in both clinical and community settings designed to reduce STI incidence. The initiatives were designed to capitalize on existing resources and increase the number of clients identified and treated. They included developing a Dual Protection initiative that promotes emergency contraception (EC) and condom distribution as well as identification of and referral to a “family planning medical home”; implementing a clinical express service model to more efficiently triage patients; providing community organizations with standardized testing, treatment and counseling protocols, and deploying field-delivered therapy. STIs represent a significant burden of communicable diseases in cities, yet control of STIs has become complex, resource intensive and fiscally challenging. Solutions must entail creative, multifaceted and simultaneously implemented strategies involving partnerships and leveraging existing community and private healthcare resources. Local Public Health Agencies (LPHAs) must develop approaches that transcend simple education and treatment of persons who self-identify and actively seek healthcare assistance. Current trends, especially in urban settings, suggest the need for new and improved models for cost-effective control and prevention by LPHAs.