What’s going on with gonorrhea?
The sexually transmitted disease is not only on the rise in Oregon and around the globe, but its ability to shape-shift has the World Health Organization warning of an antibiotic-resistant strain of super gonorrhea on the horizon.
Gonorrhea has nearly tripled in Oregon since 2012. In 2016, Multnomah County led the way with 250 cases per 100,000 residents. Morrow and Umatilla counties followed with the second and third highest rates of 160 and 110. The state averaged 107. In actual numbers of cases, Multnomah had 760 and Umatilla reported 88. Morrow, the least populated of the three, had 19 cases.
Despite the dubious distinction of having the third highest rate in the state, the tide is actually turning in Umatilla County. Riann Roggiero, communicable disease nurse for Umatilla County public health, said the 2016 year-end ranking could have been worse.
“In 2016, I was notified by the state that Umatilla County was rated number one in Oregon,” Roggiero said. “This time last year, we were projected to hit 120 cases.”
The county decided to push back. Roggiero teamed with state disease intervention specialist Patrick Dinwiddie to make field visits to partners of patients diagnosed with gonorrhea. These were folks who hadn’t responded to Roggiero’s phone calls. The pair visited about 35 people in three days spread out over a few months. As one might imagine, the topic of gonorrhea wasn’t a great icebreaker. The health workers eased into the subject and worked to make each person understand that he or she was at risk.
“They realized we weren’t there to hunt them down and make them feel ashamed,” Roggiero said.
Many times, Roggiero, who is a registered nurse, tested for gonorrhea and gave the necessary combination of antibiotics on the spot, sometimes to two people at the same residence. She administered an intramuscular injection of ceftriaxone and another drug, azithromycin, by mouth inside the privacy of the home, except for once. On that occasion, the patient insisted the health workers stay outside and ushered Roggiero to the side of the house. The nurse instructed the woman to lower the waistband of her pants in order to bare the injection site. As Roggiero gave the shot, a neighbor called out in concern. Roggiero, bound by federal Health Insurance Portability and Accountability (HIPAA) privacy rules, couldn’t explain. It was an awkward moment.
Umatilla County Public Health Administrator Jim Setzer said the aggressive response actually increased the county’s gonorrhea numbers for a time, because cases that might have gone unreported were detected and treated. Setzer wasn’t bothered by the uptick.
“I’d rather know that we’re aggressively pursuing gonorrhea, that we’re identifying and treating cases,” Setzer said.
In the long run, the disease started to wane. Instead of the projected 120 cases, the county had 88. So far in 2017, there are 33 cases.
Gonorrhea spreads through sexual activity and is most prevalent in men and women in their twenties and thirties. Many experience no symptoms at all. Undetected and untreated gonorrhea can lead to infertility, ectopic pregnancies and chronic pelvic pain in women and sterility in men.
Dr. Sean Schafer, a physician with the HIV/STD and tuberculosis section of the Oregon Public Health Division, lauded Umatilla County’s proactive response.
“They’ve done a good job with the resources they have,” Schafer said.
Schafer said gonorrhea numbers are on the rise both nationally and internationally. Oregon, once only about a third per capita of the rest of the country’s rate, has caught up in recent years.
“Since 2010 or so, we’ve increased substantially — about fourfold,” he said. “We’ve essentially gone from about 30 cases per 100,000 to over 100 cases per 100,000.”
He said the rest of the country increased more slowly and the two eventually converged.
Also worrisome is the bacteria’s ability to evolve and adapt to the point where treatment is ineffective. So far, only a small number of cases of treatment failures are documented, he said, none in the United States, but the possibility lurks.
Oregon, as other states, regularly sends samples for testing by ARSI (Antibiotic Resistance Solutions Initiative) funded by Congress in 2016 to improve detection and containment of resistant infections. ARSI could be weakened if Trump’s 2018 budget request to cut ARSI by roughly $23 million goes through.
Schafer said one odd reason for the increase in gonorrhea cases is that people with HIV don’t worry as much about unsafe sex anymore.
“Ironically, drugs used to treat HIV are very effective and if taken regularly eliminate the chance of infecting someone else,” he said. “National statistics have documented the decline in condom use. People are less concerned about catching a lethal disease” and perceive gonorrhea and syphilis to be much less dangerous.
Another reason for the upswing in gonorrhea could be an increase in methamphetamine use.
“Meth is an upper,” he said. “It reduces judgment and leads to riskier sex.”
Schafer encouraged physicians to screen patients for gonorrhea.
“This is an epidemic,” he said. “Doctors should be asking questions. They can help control the spread.”
Roggiero and Setzer urged people who test positive for gonorrhea to be honest with their partners. If not, an STD can become an endless loop of being treated and getting reinfected. Once a partner knows the truth, he or she needs to act.
“Telling a partner is a scary, hard step, but it doesn’t solve the problem,” Setzer said. “The partner needs to get tested.”
Contact Kathy Aney at firstname.lastname@example.org or call 541-966-0810.