October 15, 2013 in Features, Health

Gonorrhea cases on the rise in Inland Northwest

Rise in cases especially dangerous for women since infection carries only mild symptoms during early stages
By The Spokesman-Review
 
Staff illustration photo

Rising numbers of people have been diagnosed with gonorrhea in Spokane.
(Full-size photo)

Treatment and testing

 Testing for gonorrhea is easy and non-invasive, said Anna Halloran, who works in the Spokane Regional Health District’s STD program.

 Men and women can be tested through urine specimens, although some providers use swabs to test for the sexually transmitted infection.

 Any provider – family practice doctors, urgent care providers, OB-GYNs, community and family planning clinics – can test for gonorrhea, Halloran said.

 Some clinics offer reduced-cost tests for people who don’t have insurance. Planned Parenthood charges patients on a sliding scale, spokeswoman Christine Johnson said, to help uninsured and low-income people get tested.

 While no antibiotic-resistant strains of the bacteria have been found in Washington or North Idaho, gonorrhea has grown resistant to penicillin and most other antibiotics used to treat it, leaving only one class of antibiotics to wipe out a case.

 The Centers for Disease Control and Prevention now recommends an injectable antibiotic be used to treat gonorrhea in combination with one of two oral antibiotics.

The gonorrhea warning call can be hard to make and hard to receive.

But phone calls to sex partners of people diagnosed with the sexually transmitted infection are part of regional health districts’ efforts to stem its spread. After telling residents they may have been exposed to gonorrhea, health officials help them get testing and antibiotics.

As health officials in Spokane County and North Idaho report gonorrhea outbreaks, it’s a call more residents could be receiving. Reactions vary, said Anna Halloran, who works in the Spokane Regional Health District’s STD program, “from being understandably upset, to just wanting to get the antibiotics and just getting it taken care of. Some people suspected it to begin with.”

The number of reported cases of gonorrhea, aka the clap, has more than tripled in North Idaho since this time last year. They’re up 44 percent in Spokane County. The actual number of cases is still relatively low – many more people are diagnosed with chlamydia, the most commonly diagnosed sexually transmitted disease – but health officials are warning residents about the bacterial infection’s spread and medical fallout.

It’s a warning that applies broadly, they say: Anyone who has unprotected sex can get gonorrhea. But it may apply especially to teenagers and young adults, who get gonorrhea most often, and especially to women ages 15 to 24, who historically have suffered the highest rates of infection and who stand to suffer the most serious medical problems. Women are more likely to live with the infection longer without knowing it, leading to serious reproductive complications.

The main complication is pelvic inflammatory disease, or infection of the uterus, fallopian tubes and other reproductive organs, said Lisa Hylsky, coordinator of the Panhandle Health District’s STD program.

“Women likely don’t even find out they even have this infection until it’s already reached this stage,” Hylsky said. “And the problem with pelvic inflammatory disease is it increases the risk of other serious health problems.”

That’s because, especially in women, the symptoms are nonexistent or vague. For men, on the other hand, symptoms can be dramatic.

“They’re peeing razor blades,” said Jeff Lee, an epidemiologist with the Panhandle Health District. Men also experience a penile discharge that’s “hard to miss,” Hylsky said.

When infected women do experience symptoms, they’re mild – a burning sensation when they urinate, irregular bleeding, some discharge – and often mistaken for other problems.

So by the time many women learn they’re infected through testing, the organism that causes it has spread. Effects include ectopic pregnancy, a life-threatening pregnancy that occurs outside the uterus; chronic pain; and scarring that can lead to infertility.

Sharp rise in cases

In North Idaho, health officials reported a spike in the number of reported infections on pace to match the region’s all-time high. Forty-five cases were reported in the Panhandle in 2007, prompting health officials to launch a public education campaign, posting fliers in bars about the disease and working to spread the word through media. The number fell in 2008 and continued to decline each year, until this year, when 27 cases have been reported so far.

In Spokane County, 181 cases had been reported by the end of August, an increase of 44 percent from the same period last year. Gonorrhea cases are up 34 percent over 2012 for Washington overall, with 2,756 cases reported by the end of August.

For comparison, reported cases of chlamydia, the STD that affects the most people throughout the U.S., were up 9 percent so far this year in Spokane County, with 1,371 cases. In Washington, cases are up 1 percent, with 16,589 cases reported by the end of August.

Lee, the Panhandle Health District epidemiologist, said sexual behaviors that led to the 2007 spike in North Idaho have continued.

“Basically, people were hooking up at bars,” he said. “It’s the same old story – multiple partners and not using protection. We have a very mobile society, and people can bring something with them: gonorrhea, syphilis, whatever.”

In Spokane County, it’s difficult to say why more people are getting infected, said Halloran, a specialist in the Spokane Regional Health District’s STD program.

Gonorrhea – once believed to be mostly conquered – has gained attention recently as it’s grown resistant to most antibiotics. The Centers for Disease Control and Prevention issued new treatment guidelines in 2012 to try to preserve the effectiveness of the last remaining class of antibiotics effective against it.

But no antibiotic-resistant strains have been identified in Washington or North Idaho.

“We do not believe that treatment failure is the cause of this increase,” Halloran said. “There are probably several factors, but really the message we want to put to people is to get tested.”

Education, application

A higher risk of infection often comes down to the fact that gonorrhea can be spread around without causing any obvious symptoms along with a couple of behavioral factors, said Hylsky, of the Panhandle Health District’s STD program: unprotected sex and sex with multiple partners.

“And we know that young people tend to have frequent changes in partners and unprotected partners,” she said.

Hylsky travels to health classes in North Idaho high schools, armed with a PowerPoint presentation, to talk about STD prevention and the symptoms, or lack of symptoms, of sexually transmitted infections. She said she pushes abstinence as the best prevention but also tells the students about condoms and other protection.

Hylsky emphasizes that anybody who has sex can get an STD, she said, “but I think a lot of times kids just think it’s not going to happen to them.”

Young women, she said, may be put at risk when their partners refuse to use condoms.

“Some girls feel the pressure to just give in and not use protection,” Hylsky said. “Or sometimes they’re just blindly trusting and not weighing the risks.”

Health workers at Planned Parenthood strive to educate all their patients about safe sex practices, said Dr. Denise Bayuszik, medical director for the organization’s Greater Washington and North Idaho chapter.

They try to make sure patients know they can get gonorrhea from vaginal, anal or oral sex, for example, and that they need condoms to protect themselves against STDs no matter what they’re using for contraception.

Having that knowledge and applying that knowledge are two different things, Bayuszik noted.

Among young people at risk of contracting gonorrhea or another sexually transmitted infection, “they hear it but they don’t,” Bayuszik said. “Young people seem to need to hear things over and over again.”

Meanwhile, Planned Parenthood – along with the Spokane County and Panhandle health districts – keeps providing the tools people can use to protect themselves.

“We can’t give away enough condoms,” Bayuszik said.

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