An outbreak of gonorrhea across portions of the state of Alaska, that began in 2009, has continued throughout 2010 statistics show. Alaskan state health officials say they are examining new ways to try to control this STD and curb its spread.
Between 2008 and 2009, the number of gonorrhea cases in Alaska rose an alarming 69 percent, according to a new U.S. Centers for Disease Control and Prevention (CDC) report.
State health officials began calling attention to a spike in gonorrhea cases in Southwest Alaska more than a year ago and highlighted the statewide rise in March, according to a report in the Anchorage Daily News (ADN).
The new CDC report shows that Alaska ranks ninth in the nation for its rate of gonorrhea, compared with its ranking in recent years in the mid-20s. Alaska also is second in the nation for its high rate of chlamydia, another sexually transmitted disease (STD) that often is transmitted along with gonorrhea.
Symptoms can be mild, which may delay people coming in for testing and treatment, allowing them to continue to spread the disease, health officials say. The health consequences for untreated gonorrhea can be severe: People can become infertile, a result more common for women than for men, says a report [PDF] released by Alaska's Department of Health and Social Services (HSS).
"I am surprised the numbers haven't declined," said Susan Jones, the state's HIV/STD program manager. "It's this continuing rise in numbers that we haven't been able to get under control."
Alaska's rate is about 144 reported cases per 100,000 people, compared with a national average of 99 cases per 100,000. Between 2000 and 2008, Alaska had an average rate of 85 cases per 100,000 people.
The disease is being found across the state but is especially prevalent in northern and western Alaska and in Southcentral, Jones said in the HHS press release [PDF].
Alaska Natives have higher rates than other groups, health officials say. For Alaska Native women, the rate was 656 per 100,000. Women are far more likely to be tested, and treated, because they may go to the doctor for an annual exam to get birth control.
Even when someone has been treated, they can become reinfected if they again have sex with someone carrying the bacteria.
"What goes around, comes back around," Jones said.
People with multiple sexual partners are at a greater risk of getting a sexually transmitted disease. Some patients don't know the name of the person they had sex with, which makes it hard for health officials to track them down and curb the disease's spread, according to Jones.
Treatment is a single dose of an antibiotic, said state health officials and they are trying to make testing and treatment more available, through practices such as "expedited partner therapy."
In the CDC-backed approach of "expedited partner therapy", a doctor can write a prescription or provide the antibiotic for partners of a patient with an STD, without ever seeing the partner, Jones said. The Alaska State Medical Board recently changed its rules to specifically allow that therapy. The CDC discusses the limitations and legal status, state by state, of this practice on their website.
The patient could give the partner the medicine, with or without their knowledge, or it could be made available at a pharmacy. In Juneau, the Native health corporation and the public health system have joined together in a version of that approach, Jones said.
CDC officials came to Alaska last summer to help the state determine whether health providers and patients statewide generally supported the therapy and how best to offer it.
Doctors accepted the idea, though some were concerned about patients having an adverse reaction to the antibiotic. If patients had to pick up the medicine at a pharmacy, the pharmacist could ask about any previous problems, Jones said.
Some patients said they would be comfortable giving the medicine directly to a partner they knew well but not one they didn't know well.
Even with the increased attention and effort, Alaska's gonorrhea numbers continue to climb.
The final count for 2009 was 1,006 cases -- which was even higher than what was reported to the CDC.
Already the number for 2010 has topped that, Jones said.
But while Alaska cases go up, the national rate dropped from 2006 to 2009, according to the CDC.
The state Health and Social Services department is encouraging Alaskan residents to find a place in their community to get tested. They are instructing people to call the local public health nursing center, family planning or Planned Parenthood Center. Residents have been notified they may also call the Alaska Native Regional Health Corporation in each regional area for more information.