Doctors May Have Difficulty Controlling NH Gonorrhea Outbreak

New Hampshire is currently experiencing a serious gonorrhea outbreak that may be difficult to contain for a number of reasons.

Despite having one of the lowest incidences of gonorrhea cases in the country in 2015, the state of New Hampshire now appears to be in the midst of a serious gonorrhea outbreak that may be difficult to contain. According to the New Hampshire Division of Public Health Services (NHDPHS), doctors reported 465 new cases of gonorrhea in 2016, a number that is about 250% higher than the average number of cases reported between 2007 and 2013, and 90% higher than the number of cases reported in the state in 2015.

Benjamin Chan, MD, the state epidemiologist, said that the state is “actively working to identify individuals who may have been exposed” so that those cases can be treated. Health officials are also working on notifying others who may have been exposed through these individuals. Dr. Chan added that New Hampshire’s Division of Public Health Services (DPHS) has requested that both healthcare providers and patients connect all sexual partners with medical care so that they can be evaluated and treated, if necessary.

At this point in time, officials do not have any suspicions regarding the cause of the outbreak public. However, a look at the New Hampshire 2015 State Health Profile may provide some insight. According to that report, New Hampshire ranked 50th among the 50 states for infections of chlamydia and gonorrhea, which were evaluated together in the report, and there were only 9.2 gonorrheal infections per 100,000 people in the state that year. However, those infections occurred almost entirely among women ages 15 to 29. Given that women tend to experience few or no symptoms when infected, the possibility of those infections spreading unchecked over the course of 2016 coupled with rising drug resistance and foundering public health services, could have placed the state in a susceptible position for the infection’s spread in the following year.

As evidence of an outbreak grew, the DPHS warned that more than one in every four (28%) gonorrhea cases reported were not treated correctly with a dual therapy of ceftriaxone and azithromycin to counter potentially drug-resistant strains. They also noted that infections were largely concentrated in four counties: Merrimack, Rockingham, Strafford, and Hillsborough. “Those most impacted by gonorrhea have been males under 40 years of age, and those residing in Hillsborough County,” a NHDPHS spokesperson said in a public health alert.

Gonorrhea is one of the most common sexually transmitted diseases reported in the United States today, with about 800,000 infections occurring in the country each year, according to Centers for Disease Control and Prevention (CDC) estimates. However, CDC research indicates that fewer than half of these cases are diagnosed because most individuals do not experience enough problematic symptoms to visit a doctor for treatment. The most commonly reported symptoms are a “burning sensation when urinating, or a green or whitish discharge.”

Due to the fact that so many cases are left entirely untreated, the infection is able to easily spread. However, there are other factors likely in play in the New Hampshire outbreak. Jonathan Mermin, MD, MPH, the director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, warned in late 2016 in the CDC’s annual STD Surveillance Report that “many of the country’s [public health] systems for preventing STDs have eroded.” That report indicated that 395,216 gonorrhea cases were reported in 2015, with “young people and gay and bisexual men continu[ing] to face the greatest risk.” Given that men who have sex with men may also face higher rates of antibiotic-resistant cases of gonorrhea, outbreaks of drug-resistant strains of the illness could become more common in the future, although none have, as yet, been confirmed in the United States.

Brian Katowitz, a CDC spokesman for the National Center for HIV/AIDS, Viral Hepatitis, STD and TB prevention, told Contagion®, “It is important to note that while rates of gonorrhea have increased sharply in recent years, the current antibiotic regimen is still effective.” However, he went on to say, “If resistance continues to increase and spread, current treatment will ultimately fail.” This failure, Katowitz warned, would “cripple our ability to control the spread of gonorrhea.” He emphasized that medical practitioners must adhere to CDC treatment guidelines that specify the dual ceftriaxone/azithromycin treatments to cure the infection and prevent transmission, and that physicians who suspect treatment failure should report it immediately to their local health department.