(The video above was produced for the Onondaga County Health Department by Syracuse University students.)
SYRACUSE, N.Y. -- Onondaga County has the dubious distinction of having some of the state's highest rates of sexually transmitted disease.
Here's how Onondaga ranks among the state's 62 counties for rates of infection per 100,000 population for the three most common reportable STDS:
Gonorrhea: No 1 in 2014, No. 3 in 2015
Chlamydia: No. 3 in 2015
Syphilis: No. 4 in 2014, No. 11 in 2015.
STD rates for 2015 are the most recent available for Onondaga County.
"It's not something we are proud of," says Dr. Indu Gupta, the county's health commissioner.
She said STDs can be prevented if people use condoms and other safe sex practices.
A hidden epidemic
Syracuse's high concentration of poverty and substantial population of college students are two reasons STD rates here are off the charts, experts say. STDs are often referred to as a "hidden epidemic" because many of the people infected don't know it.
Gonorrhea is most prevalent among young women, particularly African-Americans, in Onondaga County, according to Dr. Elizabeth Asiago-Reddy, medical director of the county Health Department's STD Center. The center provides testing in the basement of the Onondaga County Civic Center.
Most women infected with gonorrhea do not have symptoms, while men almost always do.
"The fact that a lot of young women are not aware they have this is one of the things that propagates the infections," she said.
Syracuse has the nation's highest rate of extreme poverty concentrated among blacks and Hispanics, according to a 2016 study. Many poor young women infected with gonorrhea do not have access to health care or go for regular check-ups, she said.
Selling sex for survival
Poverty can lead to prostitution, which drives the STD rate, said Sandra Lane, a public health professor at Syracuse University and a research professor at Upstate Medical University who used to work for the county health department.
"There is a fair amount of people selling sex for survival, sex for drugs and sex to make money," Lane said.
Public health officials worry in particular about untreatable strains of antibiotic-resistant gonorrhea on the rise worldwide. No antibiotic-resistant cases have been seen yet in Onondaga County.
Gonorrhea, chlamydia and syphilis all can be cured with antibiotics. But if left undiagnosed and untreated, they can have serious health consequences including infertility, life-threatening ectopic pregnancy, stillbirth and increased risk for HIV transmission.
Syracuse teen chlamydia rate exceeds NY rate
Chlamydia is the most prevalent STD here and nationwide. It cuts across all socioeconomic groups and is most prevalent in young women in their teens and early 20s.
"It's exacerbated by a university population that has a lot of unprotected sex," said Asiago-Reddy.
The rate of chlamydia infections among females 10- to 19-years-old in the city of Syracuse was more than double the state rate between 2012 and 2014, according to the state Health Department.
Lane said the county STD Center's hours are not convenient for students who account for a large segment of the population infected with STDs. The latest the center is open is 4:30 p.m. Tuesday. It closes at 3:30 p.m. Mondays and Thursdays, and 11 a.m. Fridays.
"They have to skip school to get treated," she said.
Lane would like to see the center open every day until 5 p.m. or 6 p.m.
When asked if the STD Center's limited hours create access problems for students and if the center has considered staying open later in the day, Gupta issued a response that did not answer the specific questions.
"While members of the community, including students, are always welcome at the Onondaga County Health Department's STD Center, this is one of many local resources available to address sexual health, including their primary healthcare provider or the health clinic on their respective campus," she said.
The center diagnoses 13 to 16 percent of STDs in Onondaga County. The rest are identified by individual doctors and other area clinics that offer STD testing.
Syphilis rate soars
Onondaga County used to see no more than two or three syphilis cases a year. The numbers soared to 29 in 2013, 58 in 2014, then fell slightly to 39 in 2015.
Most of the syphilis cases here and across the state involve men who have sex with men. The increase has been blamed in part on the proliferation of smart phone apps that make it easy for men to quickly find sex partners.
Syphilis is a bacterial infection. The first sign is usually a painless sore. Many people don't show symptoms.
Although it's far less widespread than gonorrhea or chlamydia, syphilis is the most worrisome of the three STDs because it can cause severe health problems, said Asiago-Reddy.
Untreated syphilis can cause heart disease, blindness, hearing loss and dementia. A woman with untreated syphilis can transmit the disease to her unborn child, which can result in death or deformity of the child.
Gupta said people often get STDs because they engage in risky sexual behavior.
"A lot of young people think it's not going to happen to me," she said.
Making STD screening part of routine medical care
During routine physicals, doctors should ask patients about their sexual histories and discuss the risks of unprotected sex, Gupta said.
The county health department recommends that sexually active men and women under 25 be tested annually for gonorrhea and chlamydia.
It also recommends men who have sex with men, and heterosexual men and women with multiple sex partners be tested at least annually for syphilis.
The Centers for Disease Control and Prevention says doctors should make STD screening and treatment a standard part of medical care, especially for pregnant women and men who have sex with men.
In addition to the county STD Center, testing is available at ACR Health at 627 W. Genesee St., Planned Parenthood at 1120 E. Genesee St. and the Syracuse Community Health Center at 819 S. Salina St.
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