Many, from politicians to media reports, have noted the link between shale drilling and fracking in Texas, North Dakota, and Pennsylvania — three distinct regions — and increasing rates of sexually transmitted diseases. Most have assumed that, because both things are happening at the same time, that the two are inherently linked. However, new information about these regions indicates that the full picture might be more complex.

Ohio’s shale country has been the center of many of these discussions — there are over 1,000 new shale wells, and the two most commonly transmitted STDs, chlamydia and gonorrhea, have been popping up more frequently in the eastern shale counties — but not the rest of the state.

The Ohio Department of Heath, however, says that this doesn’t necessarily mean that an influx of oil and gas workers led to an increased exchange of STDs. Improved testing, as well as the rising popularity of heroin, could also be contributing factors.

“I don’t think all of the increase that we’ve seen is due entirely to the industry that’s here now,” said Carroll County Health Commissioner Nicholas Cascarelli in an interview with Canton Rep. “…I’d be naive to say it isn’t accounting for some of it, but some of this increase occurred even before a lot of the activity started to get here.”

Health Commision Dr. James Hubert notes that, while rates of STDs in the counties might, overall, outpace state rates, that hasn’t been consistent in every year that the drills have been in operation. Additionally, he notes that an increase in hepatitis C cases likely indicates that heroin — which often becomes tied to prostitution, and is, in many counties, the “drug of choice” according to Hubert — is a large contributing factor.

Debbie Merz, ODH’s manager for STD surveillance, also points to improved testing being behind some of the on-paper increases. Often times, an infected person will not display any symptoms, but as test prices have come down over the last 10 years, many people have been tested just as a matter of due course.

“It’s probably likely that the same behavior has been occurring, we just know about it now,” theorizes Merz.

Whether or not symptoms appear, testing is important since some diseases, like chlamydia, can lead to infertility in women, which can become a very emotional — and costly — problem down the line. Those interested in receiving a test can visit their regular physician, or they can visit an urgent care center. Urgent cares take walk-ins and can conduct a wide range of STD testing.