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Alaska fighting uphill battle to reduce gonorrhea rate

Lisa DemerAlaska Dispatch News

An outbreak of gonorrhea across Alaska that began in 2009 is continuing this year, and health officials say they are trying new ways to curb it.

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 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.

The new 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 that often is transmitted along with gonorrhea.

"Hopefully, the high numbers now are more of a success story in that people are coming in and getting tested. Though 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."

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.

Back in the 1970s, a man with a gonorrhea infection would have experienced such painful burning and heavy discharge that he would have likely gone to the doctor within a week. Now, with the current, milder strain, he might not seek help for months.

The health consequences for untreated gonorrhea can be severe: People can become infertile, a result more common for women than for men, Jones said.

Health officials will contact sexual partners of infected people and urge them to get tested and treated, without saying how they may have been exposed.

"I like to say, 'Care enough to get your partners identified and treated,'" Jones said.

TREATMENT: ONE PILL

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. 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, and people who don't know their partners well, are at greater risk of getting a sexually transmitted disease, she said. 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, she said.

Condoms protect against STDs, but people must use them correctly, every time. Testing can be done with a simple urine test or swab test that women can do themselves. Treatment is a single dose of an antibiotic, Jones said.

NEW WAYS TO FIGHT BACK

Health officials are trying to make testing and treatment more available -- and to prevent people from getting infected to begin with.

For instance, teens can order free condoms or ask questions about STDs on a website run by the Alaska Native Tribal Health Consortium. The site is www.iknowmine.org, which refers to an individual's knowing his or her STD infection status.

"We're getting at least two or three orders a week," said Connie Jessen, STD program manager for the consortium.

A teen in a village might be reluctant to get tested at the local clinic where his or her aunt works. But soon, they should be able to order STD home testing kits for gonorrhea and chlamydia off the website through an effort being run with Johns Hopkins University, Jessen said.

In September, the consortium hosted a tribal task force meeting with the goal of getting health organizations to increase STD testing. Since then, health aides have been seeking resource materials and going to schools to talk to teens, Jessen said.

The consortium also soon should be launching a media campaign with radio and television public service announcements. It also is using Twitter and Facebook to try to spread the word about STD testing and treatment.

"I feel we're gaining some momentum," Jessen said.

Health officials call another promising new line of attack "expedited partner therapy."

In that CDC-backed approach, 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 patient could give the partner the medicine, 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.

NUMBERS STILL HIGH

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.

Health officials urge people who suspect they've been infected to get tested at their doctor's office, local public health clinic, Alaska Native regional health corporation clinic or Planned Parenthood clinic.

Find Lisa Demer online at adn.com/contact/ldemer or call 257-4390.


By LISA DEMER
ldemer@adn.com
Contact Lisa Demer at LDemer@adn.com or on