‘Alarming’ rate for this sexually transmitted disease in Fresno County, public health warns

While California continues to hammer at COVID and its test positivity rate, there is a growing concern among state and Fresno County public health officials over a trend that seemingly runs contrary to a year of shelter in place orders, quarantines and shuttered bars, restaurants and college campuses.

A health alert is in effect for an “alarming” amount of cases of sexually transmitted disseminated gonorrheal infections across the state and including Fresno County, where data are distinct.

The number of cases of chlamydia in the county were down by nearly half in the third quarter of 2020 (41.5%) and the number of HIV cases (31%) and syphilis cases (16%) also were down. But the number of cases of gonorrhea were the same in the third quarter of 2020 as they were in the third quarter of 2019.

“There is a match, which is really interesting,” said Jena Adams, supervising communicable disease specialist for Fresno County. “You look at chlamydia and there was a huge decrease for the same time frame and even syphilis cases were down.”

In the third quarter of 2020, the number of confirmed positive coronavirus tests were rising rapidly — county public health officials reported the seven-day average of new cases to be 324 on July 1, up from 88 on June 1. The seven-day average on new cases was in the 400s toward the end of July before easing in the middle of August, preceding a winter surge that started in November and peaked in mid-December.

Still, there were 636 reported gonococcal infections from July 1 to the end of September 2020, as there were in 2019 when there were no coronavirus-related stay at home orders or restrictions.

That could play into the data — an infected person might have had difficulty finding STD screening or simply decided to put it off in fear of putting themselves at extra risk of contracting the coronavirus. It is possible the increase in cases reflects a decrease of STD screening due to the impact of the COVID-19 pandemic as opposed to a more virulent strain of gonorrhea, according to the alert.

But the increase in cases led the CDPH and FCDPH to issue the health alert, requesting health care providers in the state increase screening for disseminated gonorreahal infections.

Health alert calls for increased screening

That included a social history including sexual activity and drug use as well as housing status, for patients reporting joint pain, and if there is a suspicion of a disseminated gonorrheal infection the collection of testing of culture specimens from sites of infection.

Disseminated gonorrheal infections occur when the sexually transmitted pathogen invades the bloodstream and spreads in the body, and can lead to septic arthritis, skin lesions, bacteremia (the presence of bacteria in the bloodstream) or on rare occasions endocarditis (a life-threatening inflammation of the inner lining of the heart’s chambers) or meningitis.

The majority of cases fall within the 15 to 19, 20 to 24 and 25 to 29 age groups and patients often presented with joint pain attributed to another cause, which later was determined to be due to a disseminated gonorrheal infection.

Gonorrhea is treatable with antibiotics, but while medication will stop the infection it will not repair any permanent damage done by the disease, according to the Centers for Disease Control and Prevention.

The STD data from the third quarter of 2020 is the most recent available to county public health officials. By June it is expected to have a finalized case count for all STDs, but in Fresno County from 2014 through 2018 the number of cases of gonorrhea increased every year from 1,508 to 2,250, the 10th highest in the state.

“It will be interesting to see our 2020 numbers for all STDs — were they under-reported because people didn’t seek screening?” Adams said. “And then, what happens in 2021? Do we see cases go up? The next couple of years will be interesting to see what the total number looks like.”

This story was originally published May 6, 2021 at 5:00 AM.