In January, New Hampshire’s Department of Health and Human Services sounded the alarm about a sudden spike in gonorrhea.
The sexually transmitted disease had reached outbreak levels in New Hampshire, according to the department. Between 2007 and 2013, the disease had stayed level at about 130 cases per year. Then, in 2016, the department got 465 reported cases – a 250 percent increase.
“The amount of increase has certainly been surprising to us,” said State Epidemiologist Dr. Benjamin Chan.
Chan and his office are now conducting research to figure out why more people are contracting the disease, but there are other STD increases to worry about. From 2011 to 2015, cases of chlamydia in the Granite State went up by 22 percent and syphilis rose by 81 percent.
It’s not just New Hampshire; America’s STD rates are at an all-time high, according to the Centers for Disease Control. Doctors and public health officials attribute the increase to a few different factors, including lack of access to health care and screening and a decrease in condom use and people having multiple partners.
At Concord’s Equality Health Center, health care providers have also seen signs of the gonorrhea uptick in their patient population.
Though overall numbers are still low, the bump is “noticeable,” said nurse practitioner Rachel Allen.
“It’s a small state, we’re a small clinic,” Allen said.
Allen said she thinks the reason for the STD rise is not so much that people are more promiscuous than they used to be; rather, the problem is lack of access to health care for people who can’t afford health insurance.
If people are uninsured or don’t realize they can get insurance and preventative care covered, they might not get tested for STDs regularly.
“I don’t think that people’s sexual practices have changed drastically,” she said.
The CDC recommends varying levels of screening and testing depending on a person’s age, gender and sexual orientation.
For instance, younger people or people with multiple or new sex partners should get tested once a year for gonorrhea and chlamydia, especially if they are not using condoms.
Women who are pregnant are encouraged to be screened for STDs early in their pregnancy, so that an unknown disease does not cause birth defects or pregnancy complications.
Higher risk populations, like gay, bisexual and other men who have sex with men are recommended to be screened at least once a year for STDs, while IV drug users are recommended to get tested for HIV at least once a year.
“Anybody can get these infections but there are certainly populations that are higher risk,” Chan said.
However, Chan and Allen say that some screening does not go far enough. While many health care providers ask patients if they are sexually active and practicing safe sex, federal and state guidelines say doctors should err on the side of being more thorough.
Public health officials recommend that health providers ask patients what kind of sex they are having. If it includes having oral and anal sex, doctors may want to test for STDs at those sites as well.
Currently, many providers don’t test everywhere for potential infections, which could be leaving some cases undetected.
“There’s likely a lot of undiagnosed infection out there,” Chan said.
One barrier to a thorough screening is simply that getting specific about sex can be uncomfortable for doctors and patients.
For instance, patients might feel like a doctor is judging them and doctors might not want to give the impression that they’re assuming something about a patient’s sex life.
Providers also may not ask married people about their sexual history or offer testing because they don’t want to make assumptions, but that could make for a missed opportunity for testing if someone needs it.
And when it comes to STDs, public health officials say that more information is better than less.
At the Equality Health Center, Allen gets around the discomfort by asking every patient the same question on an intake form to make sure no one feels singled out.
Allen said she tells each patient, “I care about your health and I ask everyone this. I’m not here to judge anyone.”
Besides screening, the Department of Health and Human Services is trying to prioritize easier access to STD treatment.
The department requested a bill that’s currently making its way through the state legislature that would allow doctors to prescribe the treatment for gonorrhea and chlamydia to an infected person and, by extension, their partner. The bill has been passed by the state Senate and is now in committee in the House.
That way, the patient can give their partner the medication rather than the partner having to wait and pay for a doctor’s appointment themselves.
“We have a hard time tracking down partners and getting them into care,” Chan said. “Many of the people we contact either don’t know or aren’t willing to share the names of their sex partners.”
Allen said that it’s particularly difficult to get sexually active young men to come in for testing and treatment on their own, which made expedited partner therapy a good way to get more people treated.
“That’s a tool that we’ve lost,” she said.
(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter @ella_nilsen.)