The 12-story building between Powell Symphony Hall and the Third Baptist Church in midtown seemed like an odd place to house the city's main clinic for treating sexually transmitted diseases. Yet, for a long time, some city residents wishing to get help, counseling or advice for an STD had few options bsides visiting the public clinic on the second floor of the building at 634 North Grand.

Some city officials now concede that it was perhaps unwise to use the North Grand site because the high-traffic location probably discouraged some people from seeking help out of concern about their privacy.

"You walked into the building after 9/11, and security would ask you where you were going. If you said second floor, they knew what you had," says city Health Commissioner Melba Moore (right). "We wanted to make things better by doing a better job. So, we felt we'd be better off putting the services in the community."

The decisions to shift STD clinical services to community settings and focus on evidence-based approaches are among reasons city health officials say they are making headway in reducing STD rates that have been among the nation's highest.

The first proof came with the latest numbers from the Centers for Disease Control and Prevention. For a decade, the city has routinely placed near the top in gonorrhea and chlamydia infections. But the new data, released Tuesday, show that St. Louis had lower rates for gonorrhea and syphilis in 2009 than in 2008, and saw an easing in the rise of chlamydia infections as well. The city still ranked second in chlamydia, but the rate hadn't risen as fast as it did in previous years.

Pamela Rice Walker (right), the city's interim health director, said in a statement Tuesday that the drop showed that "parents and the community of health providers have made it a priority to reduce the number of STDs among our youth. This report shows that the things we are doing are working, but we must remain vigilant."

Working with Teens

Walker was referring to a range of city, county and nongovernmental programs that have increased testing and treatment for STDs and helped to reduce infection rates. There also have been new approaches to addressing STD rates.

One successful approach is called SPOT -- Supporting Positive Opportunities with Teens. Its headquarters are at 4169 Laclede Ave., a site that's a far cry from the building on North Grand. SPOT is a friendly, youth-focused place where young people can drop in for numerous services that have nothing to do with STDs.

Those make it a more inviting site for youngsters to congregate and seek help, says Dr. Katie Plax (right), medical director of SPOT.

"We have youths staffing our front desk. It makes people feel comfortable when they walk in. They're being greeted by someone in their age group. It lets them know 'You can trust the services because I do.' "

Like Moore, Plax says new approaches like SPOT have helped the city lure more young people into seeking help. Plax says that's important because young people, mainly between the ages of 15 and 19, have been leading the way in the rise in infection rates for gonorrhea and chlamydia.

"We know a lot of barriers got in the way," Plax says. "There were costs and insurance or lack thereof, transportation to get to where services were and the services might not all be together. It meant going one place to see a doctor, another to get lab tests, still another to pick up medications for treatment. And there was the worry among a lot of young people about the confidentiality of their health information."

She says, "We were trying to work against those barriers by making services free and having all the things in one place. Now you can see your doctor, get your testing done and get treatment all under one roof."

In addition, epidemiologist Kelly Zara says, treatment options have helped to reduce infection rates.

"People are now able to get one-dose treatment for gonorrhea," Zara says. "In the past, if someone got medication to be taken over 10 days, not everyone would take all the medicine. They might take it for two days and stop. But if they don't have to be compliant for 10 days, hopefully now, they're not going to be infectious to other people."

Although everyone agrees that the city needs to do more, Zara (right) says the city seems headed in the right direciton.

"I'm encouraged because, although chlamydia is still a problem, it's a problem nationally. It's not just something we're dealing with here. Everybody's dealing with it, and we've kept the increase small," she said.

"The gonorrhea rate is encouraging, too. We've been dropping since 2006. In terms of syphilis, we're doing pretty well. We've had a drop in cases since 2008 while nationally the rate for the number of syphilis cases has gone up. So that's good. We're not following the trends of going up," added Zara.

Places like SPOT make diagnosis and treatment easier, she says, "because it's a place where they're comfortable. They are around other people their own age. They don't have to worry about someone from their neighborhood walking in the door and seeing them at a clinic and learn what they are doing."

SPOT offers a lot more. Youngsters can drop in for a free snack, take a shower, do their laundry, work on a computer, watch TV and get lots of free health services, including STD and HIV testing, pregnancy testing, contraception, pap smears and referrals for other health needs.

Yet still more is needed

Still, Plax and others don't deny the holes in the city's safety net. One problem, she says, is funding. It's a factor cited by others who note the city's public health budget has been declining.

In some other cities, Plax notes, "there are lots of folks going out to let partners know they should be tested and treated for an exposure to an STD. If you don't have money to hire those people, that can make a difference."

In addition, she says, there is more "need for free comprehensive sex education in schools to reach people and let them know the facts."

With SPOT, she says the city has a model that allows it to have youths "working in partnership with us to tell us what it is they need. Also having free services and having people who love to work with young people make a difference."

Many health providers agree that one reason the city probably saw a spike in its STD rates was because it made a commitment to expand testing.

"As we see more access to testing and more people treated, we should also see the numbers come down," Plax says.

That apparently is what's happening with the city's rates. She notes that a lot more testing also is being done by others, including Planned Parenthood and health clinics in St. Louis and St. Louis County. SPOT's funding comes from several sources, including the city, the Missouri Foundation for Health, BJC Healthcare, St. Louis Children's Hospital Foundation and Washington University. St. Louis also has its own set of youth-focused programs to address STDs.

"I think one thing we shouldn't forget is that we should ask youths directly for their help and ideas about what solutions they see to the problems," Plax says. "Chances are they will give us great advice. I don't think we can do it without them."