What’s going on with gonorrhea?

The sexually transmitted disease, known colloquially as “the clap,” is surging in Oregon and around the nation. Umatilla County reported 71 new cases of gonorrhea last year and 88 cases in 2016 — up from just four in 2012.

Two other STDs, syphilis and chlamydia, are also on the rise in the United States.

Ruth Helsley, of the Oregon Health Authority, manages the state’s HIV/STD prevention program.

“STDs are having a big-time comeback,” Helsley said. “Oregon is not unique — it’s happening all over the country.”

From 1975 to 1997, gonorrhea rates plummeted, stayed steady for a decade, then began rising again. Syphilis had an even more dramatic rise from the ashes.

“In the ’90s, we thought syphilis was gone,” Helsley said.

Now both STDs are back — in spades.

Helsey offered an explanation. People are taking more sexual risks because they are less afraid of contracting HIV.

“At this point in history, the fear of HIV as a lethal diagnosis is going away,” she said. “Now, it is treatable.”

She said people are more relaxed about engaging in risky sexual behavior. But just because HIV treatments provide a better prognosis and even protect partners, she said, doesn’t mean they combat gonorrhea, syphilis or chlamydia.

With the threat of fatal HIV lifted, “obviously what’s causing a rise in STDs is unprotected sexual activity.”

The Umatilla County Public Health Department is dealing with the gonorrhea epidemic by frank discussions with clients and messaging to the public about the importance of protected sex. A poster greets those entering the Pendleton clinic.

“Half of all sexually active young people will get an STD before the age of 25,” it says in block print.

Jim Setzer, the county’s public health administrator, isn’t shy about the subject of STDs or how people get them.

“People don’t get gonorrhea by someone sneezing in line at Safeway,” Setzer said. “They don’t get this by themselves.”

That’s why tracking down sexual partners is so important. He understands the hesitancy of those asked to divulge names, but it’s necessary.

“You know the old adage,” Setzer said. “You’re not just sleeping with that person. You’re sleeping with every person they’ve slept with.”

“If partners aren’t treated, you have exponential transmission with one person exposing others and those people exposing other people,” Helsley said.

To those working to stop the epidemic, it seems like the public health version of Whack-a-Mole.

The last time state gonorrhea rankings came out (in 2017), Umatilla County had the dubious distinction of having the third highest rate in the state.

The county made inroads by sending a communicable disease nurse and a disease intervention specialist into the field for several months to make home visits to partners of patients diagnosed with gonorrhea. Often the nurse, Riann Roggiero, tested for gonorrhea on the spot. If positive, she administered an intramuscular injection of ceftriaxone and another drug, azithromycin, by mouth.

Gonorrhea symptoms usually appear within two weeks, but sometimes symptoms aren’t immediately noticeable. Men might notice pain urinating, along with swelling, discharge and sore throat. Women may experience similar, but milder symptoms.

But, Setzer said, “Many people are asymptomatic.”

Untreated infections can lead to scarring, infertility, arthritis, heart valve damage or inflammation in the lining of the brain.

Most at risk are men who have sex with other men, illicit drug users and people with multiple sexual partners.

Helsley said the plan of attack involves diagnosing as early as possible and treating. Some cities have launched public awareness campaigns to jar people into getting tested for STDs. In Portland, an organization call Syph Aware posted signs on TriMet buses and MAX trains.

The message is to get tested, Helsley said.

“People in high-risk categories should get tested every six months,” she said. “Don’t relax.”

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