Gonorrhea cases increase in Michigan, causing alarm

By: - November 30, 2020 3:37 pm

The Department of Health and Human Services, Lansing | Susan J. Demas

The Michigan Department of Health and Human Services (DHHS) is raising alarms about a 22% increase in gonorrhea cases. 

In 2019, Michigan reported 18,264 gonorrhea infections. This annual number has already been surpassed as of Oct. 31, pointing to a 22% increase in reported gonorrhea infections for 2020, the department said in a press release

Despite the marked increase and the alarm bells, health officials warn the state is facing a shortage in necessary testing equipment to definitely identify the bacterial infection. That shortage is the result of production for swabs shifting to COVID-19-related production.

“Because laboratory testing is challenging at this time, it is imperative that medical providers continue to clinically diagnose and treat suspected cases of gonorrhea to slow the spread in our state,” said Dr. Joneigh Khaldun, chief medical executive and chief deputy for health for DHHS. 

This increase, the department release noted is likely an undercount. According to statistics from the Kalamazoo County Health Department, testing there dropped off by about 73% in April and May 2020. In June the agency saw a drop of about 50%, in July about 40% and in August a 43% drop. 

Ingham County Health Officer Linda Vail released her agency’s year to date numbers showing a 69 percent increase in reported cases of 2019 — 780 confirmed cases so far in 2020 compared to 540 cases in 2019. Chlamydia cases, which Vail said goes ‘hand in hand’ with gonorrhea, are down. 

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“I don’t know if that’s because chlamydia is often asymptomatic,” she said, noting that the antibiotics prescribed to treat gonorrhea also treats chlamydia. 

Both infections, if untreated, can lead to serious health complications including sterilization of the carrier from scarring of the reproductive system. Gonorrhea often presents in men with a burning sensation while urinating. Both men and women may notice a green or yellow discharge coming from the infected area. 

“By race and sex, increases are similar in magnitude among men and women as well as among black and white patients,” DHHS spokeswoman Lynn Sutfin wrote in an email responding to demographics being most impacted by the increase. “By age, increases are the greatest among those ages 30-44 and 45+ years old.”

Sutfin said the state does not collect data such as sexual orientation or risk activity related to gonorrhea cases. That means it’s difficult to determine if increased use of Pre-Exposure Prophylaxis (PrEP) — a daily medication taken to prevent HIV infection — played a role in the increase of reported cases. 

“We do not have comprehensive surveillance data connecting PrEP appointments with STI case data,” Sutfin wrote. “It is unlikely PrEP is driving the increases as they are seen across a wide demographic and geographic area.”

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PrEP prescription protocols require regular screening not only for HIV, but all sexually transmitted infections (STIs). Studies have shown that an active sexually transmitted infection such as syphilis, gonorrhea or chlamydia can increase the likelihood of contracting HIV during sex. 

PrEP is up to 99% effective in preventing a person from contracting HIV and the state has ramped up efforts to increase uptake of the intervention, particularly among younger Black men who have sex with men who continue to account for nearly two-thirds of all new HIV infections in the state and across the U.S. 

Vail said testing numbers are down in her county because of the pandemic. Many of the staff that had been involved in partner notification were shifted to do contact tracing for coronavirus cases leaving the county struggling to continue STI operations. STI screening is not the only place she has seen a drop off in numbers. 

She said the county’s blood lead testing program is also slowed down. 

The reason? Those tests are conducted during face to face meetings with Women Infants and Children (WIC) program recipients. Since the COVID-19 pandemic hit, face-to-face meetings have ceased. 

The good news, Vail said, is that gonorrhea should be fairly straightforward for a physician to presumptively diagnose during a telehealth visit. 

“I don’t know what it’s like to have gonorrhea, but I have had urinary tract infections, and believe me, that’s not something you wait on,” she said. “It’s obvious. I suspect gonorrhea is the same way in terms of discomfort, so it should be easy to address through telehealth.”

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Todd A. Heywood
Todd A. Heywood

Todd Heywood is an award-winning journalist with over 30 years of experience. He's worked in print, online, radio and television. His reporting has been cited by the U.S. House of Representatives as well as in the United Nations reports on HIV. He's an avid vintage Star Wars collector and lives in Lansing with his three dogs.

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