As cases of sexually transmitted diseases continue to rise across the state, Alaska public health officials are calling attention to the need for testing and prevention.
Alaska has consistently placed in the top tier of national rankings for chlamydia and gonorrhea, and recent outbreaks are likely to put both in the first- or second-place spots, Susan Jones, an Alaska public health nurse and manager of the state HIV/STD program, said.
An outbreak means that an unusually high number of cases for a certain disease are being reported at a given time, Jones said.
In 2017, there were more than 2,000 cases of gonorrhea in Alaska, according to preliminary numbers, up from 1,454 confirmed cases in 2016, Jones said. A 31 percent increase in the number of gonorrhea infections from 2015 to 2016 triggered a gonorrhea outbreak public health advisory in October.
The second most-reported notifiable disease in the U.S., gonorrhea can cause pelvic inflammation, pregnancy complication and infertility, as well as facilitate the transmission of HIV infection, according to the Centers for Disease Control and Prevention.
Although gonorrhea has been on the rise across the state, prevalence of infections in the Gulf Coast region, which includes in the Kenai Peninsula, have remained near zero, according to a July 2017 State of Alaska Section of Epidemiology Bulletin.
Since 2000, Alaska has ranked either first or second for chlamydia rates in the nation, according to a July 2017 Alaska Department of Public Health and Social Services Section of Epidemiology bulletin.
In 2016, 5,698 cases of chlamydia were reported, according to the bulletin. In 2017, that number will likely be around 6,000, Jones said. Untreated chlamydia can cause a host of health problems, including pregnancy complications, infertility, pelvic inflammation and facilitate the spread of HIV, according to the CDC.
Particularly worrisome to public health officials is the increase in syphilis infections.
“The syphilis outbreak is more concerning, because syphilis can end up causing all sorts of problems down the road,” Jones said.
Syphilis can trigger a series of health issues, including neurological problems, tumors, dementia, blindness, hearing loss and death, Jones said.
Even if treated, syphilis can having lasting effects on the health, depending on how much damage was done before treatment.
In March, the Alaska Department of Health and Social Services Section of Epidemiology released a public health advisory to raise awareness about the number of syphilis cases reported in the first quarter of 2018.
With 20 confirmed cases and another two probable cases of infection reported, the number of syphilis cases reported in first three months of 2018 roughly matched the number of cases reported each year from 2015 to 2017, according to the health advisory. In 2015 and 2016, 20 annual cases of syphilis were reported. In 2017, 21 cases were reported for the whole year.
Getting an outbreak under control
Many people who are infected with a sexually transmitted disease don’t know they have it, making testing crucial to stop the spread of the infection, Jones said.
“That’s the way you control an outbreak,” she said. “You try to find everybody that’s been exposed, depending on disease, you test them and treat them.”
The Kenai Public Health Center offers gonorrhea and chlamydia testing for clients 29 and younger, and nurses work closely with the State of Alaska Epidemiology program, Kenai public health nurse Tami Marsters said. All services are confidential, including services for teens. Because chlamydia, gonorrhea and syphilis are public health reportable infections, anyone that tests lab positive for one of these infections will receive a follow up call from a public health nurse or the Alaska State Epidemiology program, Marsters said.
For those who test positive for a reportable infection, the clinic offers expedited partner therapy — which allows nurses to provide treatment to partners who cannot or are not wiling to come to the clinic.
“Public health nurses provide education and medication to the original client to give their partners. Because chlamydia and gonorrhea so easily transmitted, and often have no symptoms, if all partners are not treated the infection continues to be passed around and reinfection occurs,” Marsters said.
On a state level, the HIV/STD program is tasked with notifying a patient’s current or past sexual partners — in person or via phone — to alert them that they might be infected. A team of about five travels around the state, make phone calls or in some cases contacts local public health officials, to reach out to those potentially infected, Jones said.
“For priority cases like HIV and syphilis … one of our public health people are going to talk to you,” Jones said. “What they want to do is to make sure that all the people that either exposed you, or you have exposed, to syphilis are found and we treat them all.”
While health care providers notify state public health officials about the incidence of reportable diseases like chlamydia, gonorrhea, syphilis and HIV, the state HIV/STD program prioritizes HIV and syphilis cases. Because the number of positive tests for chlamydia and gonorrhea reach into the thousands, state public health reach out only to high-risk cases, Jones said.
Jones encouraged people to be proactive about their health by getting tested, using safe sex practices and having frank discussions with providers.
“In today’s world in Alaska, public health alone cannot control these outbreaks,” Jones said. “So we need to have patients help us out by letting partners know and by talking to providers, openly and frankly, so everything can be tested.”
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