PUBLIC HEALTH

Gonorrhea on the rise

By Sam Pfeifle

Yes, it’s true. The Maine Bureau of Health has declared an official gonorrhea outbreak, with 70 cases diagnosed since January 1 of this year, as compared to only 41 cases during the same period last year. Somehow, that eminently preventable sexually transmitted disease is making a comeback, and it portends an increase in risky behaviors.

“The first I heard about it was back in April,” says Jerry Cayer, director of the Portland Department of Health and Human Services. “The numbers were suggesting that we had a problem.” Cayer notes that, despite the fact that roughly one third of the cases have been reported in Cumberland County, the outbreak is statewide. Only three of Maine’s 16 counties (Franklin, Hancock, and Oxford) reported no diagnosed cases.

Despite the fact that gonorrhea is treatable with one-time doses of either ciprosloxacin, orally, or an injection of ceftriaxone, certain aspects of the outbreak are particularly troubling. Of the 30 male cases, 22 were men who had sex with men; four of those were co-infected with HIV. That’s scary for Gloria Clark, the program manager at the Portland STD Clinic at 108 India Street, part of Portland’s public health division.

“STDs travel together,” says Clark, “they really do. Unfortunately, they make it easier for someone to get the other ones. We call them a doorway, or a portal, for other STDs. Say you have a sore in the urethra, on the penis, or in the vagina, all the white blood cells go there as the body’s defense for the infection. Unfortunately, if HIV comes along, that’s where it likes to go, you’ve got HIV’s favorite types of cells.”

Also problematic are the 11 cases reported among females between the ages of 15 and 19; 28 percent of the 40 female cases reported.

“It speaks to the fact that teenagers are engaging in sex and they’re engaging in unprotected sex,” says Cayer, “so they’re at risk.” Asked how the problem could be addressed, Cayer is matter of fact. “The first line of defense is abstinence,” he says, “and then you have to talk about the use of latex condoms.” It is a good sign that the school board recently agreed to dispense contraceptives through the Portland schools, but there are plenty of other Maine schools that haven’t followed suit.

“Young people are harboring a lot of the infection right now,” warns Clark. “For 15 to 19 group, AIDS has been around. They weren’t really hit by the huge media push about prevention. They kind of missed that. That might be part of it, too. They haven’t been so ingrained to protect themselves.”

In the end, it is the utter preventability of gonorrhea (and other STDs, like chlamydia, which is also on the rise) that has health officials frustrated.

“At the end of the day,” says Cayer, “it comes down to unprotected sex.”

“Definitely, HIV doesn’t have the heightened awareness around it that it used to,” says Clark. “That heightened awareness people had to protect themselves. After 20 years, some people are tired of it. But it’s still just as important. We still know how to prevent it. I tell people here at the clinic, ‘It’s 100 percent preventable. This is something that you for sure cannot get if you don’t want to.’ But this is still happening. People get complacent, people forget.”

As gonorrhea can often go long periods of time without symptoms (particularly in women), and can still be transmitted in that time, people who’ve engaged in risky sexual behavior lately (including oral sex) are urged to have themselves checked out. People in Portland can visit the India Street STD clinic on Tuesdays and Thursdays from 3 to 6 p.m. Call (207) 874-8446 with questions.