Marion County has the fourth highest gonorrhea infection rate in the state, according to the Public Health Accountability Metrics report released by the Oregon Health Authority in March.
Gonorrhea infections in Oregon have tripled since 2012, and Oregon has also seen increases in the sexually transmitted infections chlamydia and syphilis, matching a national trend. Infection rates for all three STIs have increased each year for the past three years in the U.S., according to Marion County Health Officer Dr. Karen Landers.
"Chlamydia rates have been high for many years, but are increasing, while rates of gonorrhea and syphilis are showing recent but significant increases," Landers said.
Landers said that Marion County is overrepresented in regard to STIs due to three reasons: the high number of correctional institutions in Marion County, the association between substance use and STIs and Marion County's relatively young population — chlamydia and gonorrhea are typically seen in under 25-year-olds.
Gonorrhea and chlamydia are bacterial infections, and many people who contract them do not experience symptoms, according to the Centers for Disease Control and Prevention. Both diseases can cause pelvic inflammatory disease and infertility if untreated.
Syphilis is a bacterial infection that progresses through four stages of infection, each producing different symptoms. Left untreated, syphilis can damage the brain and nervous system and cause blindness, according to the CDC.
All three STIs can be treated and cured with antibiotics. However, antibiotic resistant strains of gonorrhea, chlamydia and syphilis are a growing threat to disease prevention and treatment. Out of the estimated 820,000 cases of new gonorrhea infections in the United States each year, an estimated 246,000 are resistant to at least one antibiotic, according to the CDC.
According to the Marion County Reportable Diseases and Conditions report from 2016, the most common reportable disease in Marion County was chlamydia, with 1,740 cases that year. Gonorrhea was fourth on the list with 347 cases in 2016, an increase from only about 60 cases in 2013. Syphilis increased from an average of six cases per year in 2012 to 50 cases per year in 2016.
Woodburn and northern Marion County have lower rates of gonorrhea and syphilis infection, but higher rates of chlamydia. The difference is likely because the population is younger on average, Landers said.
"Syphilis shows the highest concentration in the Salem area, probably a combination of age ranges and population density; syphilis is typically seen in the 30-50 year range," she explained. "Gonorrhea shows the highest concentration in Salem and south of Salem, which may be a function of correctional institution concentration."
A major factor in the increase in STIs is the improvement in treatments for HIV, Landers said. Condom and barrier-based safe sex practices have become less common as people's fear of HIV declines, resulting in an increase in other STIs.
Proper use of condoms and other barrier methods remains the most effective practice for sexually active individuals to prevent STIs, according to the CDC.
Landers said that internet hookups pose a particularly difficult challenge for health care providers identifying and treating STIs.
"One of the most significant factors in the increase of STIs are the ways in which people are connecting with sexual partners, through anonymous online venues or apps," Landers said.
Public health officials are often unable to investigate STIs because cases may not be able to give a name or address of exposed partners, and the number of partners people may have has increased.
"A reduced ability to identify, test and treat exposed people means they may be unaware of their infection and could be spreading it to others," Landers said.
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