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In Montana, Gonorrhea Slowing, Syphilis Skyrocketing

The Lowdown on How to Prevent STDs

Public health officials in Montana are hopeful that a rise in one sexually transmitted disease linked to the Bakken oil boom is starting to go back down.

Cindy Farr is director of the Health Promotion Division at Missoula City/County Health.

"When the big oil boom happened in North Dakota and there was a huge influx of oil workers going there to work, then we started seeing increased cases of gonorrhea working its way across the state from east to west. So, now over the last five years, now we’re starting to see more cases of gonorrhea. It all started with the big oil boom in North Dakota."

In 2013 Montana had about 200 reported cases of gonorrhea. That number doubled the following year, and again, to about 800 cases in 2015. So, public health officials developed a plan.

Judy Neilson is the Montana Health Department’s STD-HIV Prevention Supervisor.
"We issued health alert notices to appeal to physicians to be aware the disease was out there, do testing and routine screening."

The effort is starting to pay off. Growth in the number of reported gonorrhea cases was down substantially last year.

And while Missoula’s rate of gonorrhea infection is slightly ahead of last year, statewide the rate is stabilizing.

According to Neilson, 2017 may wind up with fewer cases than last year.

The Centers for Disease Control and Prevention reports over 2,000,000 new cases of sexually transmitted infections were reported last year in the United States. That’s a new record.

And while Montana has made progress against gonorrhea, the state is facing an uphill battle against syphilis.

“It’s once again reared its ugly head in Montana," Neilson says.

Syphilis was once nearly eliminated in the United States, but it’s back now, and in a big way.

This year an average of one new case is being reported per week in Montana. That compares to a total of 16 last year.

If left untreated syphilis can affect the brain, major organs and lead to death.

One recent syphilis case was congenital, and that, says Neilson, is a disturbing wake-up call.

"Yes, that was very disheartening to us, to have a baby be infected with syphilis."

Edward O'Brien: How challenging is that for the child?

"It can be devastating. It can create bone abnormalities – if they survive. They often do not."

Neilson says that’s first congenital syphilis case reported since the 1960’s.

The disease has been detected in 12 Montana counties, infecting men and women from ages 21 to 64.
But most of the new cases are found in men, specifically those who have sex with other men. Syphilis can produce ulcers or lesions that increase a person’s susceptibility to HIV infection. There’s an average of 20 to 30 new HIV cases in Montana annually. State health officials worry that more syphilis could lead to more HIV.

"In higher incidence areas, a man who has sex with men who develop syphilis has statistically, like, double the chances of developing HIV within six months. That’s a little worrisome," Neilson says.

Sexually Transmitted Infections among Young Americans
Credit CDC
Sexually Transmitted Infections among Young Americans.

Experts recommend condom use and regular health checkups to help stem the tide of STIs. They add we must be willing to talk more about risky sexual behaviors. Neilson say those conversations are still rather taboo.

"It is. There’s still stigma. We need to normalize testing. We need physicians to do the uncomfortable thing and take a sexual risk history and to 'think STD' for sexually active patients."

Dr. Mary Kleschen, the Medical Director of the University of Montana’s Curry Health Center agrees.
"Yes absolutely. I think anything that has to do with sexual activity is more, sometimes, emotionally charged; sometimes are more difficult topics for conversation. And I think that sometimes there’s concern that bringing up the topic will suggest the idea, which research has shown that not to be so," Kleschen says.

In other words, discussing sexual health, she says, will not lead to more sexual activity, especially among young people.
"To use a different metaphor that’s maybe less prickly; we used to be afraid to bring up the topic of suicide because we thought we might give someone an idea. We actually know the opposite to be true; that if people are depressed or contemplating suicide, talking about it and talking about safety planning can be lifesaving. Avoiding the topic isn’t helpful. It’s actually the opposite," says Kleschen.

Syphilis and gonorrhea aren’t the only sexually transmitted infections worrying health officials. Tomorrow we take a closer look at Montana’s most common STI: chlamydia.

Edward O’Brien first landed at Montana Public Radio three decades ago as a news intern while attending the UM School of Journalism. He covers a wide range of stories from around the state.  
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