SALT LAKE CITY — A skyrocketing rise in gonorrhea cases in Utah — particularly among groups that have historically been considered low-risk when it comes to sexually transmitted diseases — has public health officials alarmed and scrambling for answers.

Over five years, the incidence of gonorrhea in Utah has quadrupled, according to the Utah Department of Health, jumping from 310 in 2010 to a preliminary figure of 1,564 in 2015.

"It’s been huge. We haven't seen this for quite a while, so we're still trying to wrap our mind around it," said Erin Fratto, a communicable disease prevention coordinator at the Utah Department of Health who specializes in STDs.

Experts have been surprised by the communities most affected by the increase.

Gonorrhea and other STDs have historically been much more prevalent among youth, men who have sex with men, and Hispanic and black communities.

But experts said the increase in gonorrhea cases in Utah has been driven largely by white females who are in their mid-20s or older. During the past 10 years, the rise in the gonorrhea rate among women ages 40-44 has been an alarming 1,555 percent, according to Fratto.

She said experts are also seeing rising rates among incarcerated people and drug users.

Screening rates haven't gone up, nor have any significant changes been made to funding or resources, she said. The outbreak has public health officials scrambling to find explanations and increase education efforts.

Lynn Beltran, the STD and HIV epidemiology supervisor at the Salt Lake County Health Department, said the county has been “in a serious gonorrhea outbreak for the last three, going on four years now.”

"We're having to redirect resources to try to address this, because once it surpasses a certain threshold it's really hard to get back under control," Beltran said.

Disease shift

Researchers at the local and state health departments are conducting investigations into the gonorrhea outbreak. That involves interviewing patients to find common factors and following up with their partners to get everybody tested and treated.

In Salt Lake County, which has the majority of gonorrhea cases, epidemiologists are seeing the burden of disease shift to white adults in their mid-20s or 30s, she said.

In preliminary interviews with patients, Beltran said it’s clear that attitudes about sex have changed. She also said dating apps like Tinder have facilitated casual hook-ups to a greater degree than ever before.

"It's much more socially acceptable now to have casual sex and have multiple sexual partners outside of a relationship," Beltran said. "But what never happened as those attitudes shifted is effective education around sexual health."

"We're just kind of brewing this perfect storm," she said.

Beltran and Fratto said they’re battling old stigmas and lack of education among youth, who still make up the majority of STD cases.

In 2014, adolescents 15-24 years of age made up 16 percent of the state's population but accounted for 63 percent of reported chlamydia cases and 38 percent of gonorrhea cases.

Barbara Kuehl, director of academic services at the Salt Lake City School District, said educators are limited when it comes to what they’re allowed to teach students in sex education classes.

According to Utah law, teachers are allowed to discuss contraception, but they cannot tell students where to get it or how to use it, and the emphasis is on abstinence.

“It’s a very clinical perspective that kids get,” Kuehl said. “They do get some information, very moderate information.”

Kuehl worries that an abstinence-only education does not prepare students for the confusing and significant decisions ahead of them — or that they are already facing.

“It kind of denies both the reality and it rejects kids that are sexually active,” Kuehl said. “There’s such an implied judgment.”

“The reality is we have a lot of kids that are involved or have been at some point in that, and if you want to help them get out of that really risky zone, you’ve got to say, ‘OK, this is where you are — how can we move forward?’” she said.

One-size-fits-all sex education also doesn't take into account significant disparities when it comes to race, income and family support, Kuehl said.

After-school program

The school district, which is about 52 percent minority students, tries to provide that education at an after-school program for students who get parental permission to attend.

The program, which is sponsored by Planned Parenthood Association of Utah but developed by a different company, focuses not only on sex education but also on self-esteem, healthy relationships and community service.

The program’s funding is at risk as a result of Gov. Gary Herbert's directive to cut off state funding to Planned Parenthood Association of Utah. His order is currently being challenged in court by the association.

The questions that students ask range "from the ridiculous to the sublime,” according to Kuehl. But she said it’s in this environment where some of the most telling questions are revealed.

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Annabel Sheinberg, the education director at Planned Parenthood Association of Utah who helps run the program, said students are often curious — and confused — about STDs and protection.

Teens often ask about how STDs are transmitted, where they can get tested and whether doctors will tell their parents, Sheinberg said. They also often have questions about how to tell partners if they have STDs and how to tell partners that they don’t want to have sex.

Other common questions: Can you get an STD from oral sex? (The answer is yes.) Do I have to be 18 to buy a condom? (You don't, but there's a wide misperception among teens that you do.)

And Sheinberg noted that teens often ask about the definition of abstinence — whether oral sex or other behaviors "count."

“Most high schoolers take health in either ninth or 10th grade, so in their entire high school career, they probably have one class that addresses STDs,” Sheinberg said. “That’s a tall order.”

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Committee rejects comprehensive sex education bill

A committee of lawmakers overwhelmingly voted down a bill that would have implemented a comprehensive sex education program in Utah schools.

Attempts to make Utah’s sex education classes more comprehensive has run into opposition in the Legislature.

Rep. Brian King, D-Salt Lake City, sponsored a bill this year that would allow parents to opt-in to a comprehensive sex education class and cited rising STD rates in Utah as evidence that it was needed.

That bill was defeated in a House committee along party lines after opponents said that comprehensive sex education promotes sex and that sex education should take place in the home, not in school.

"Unfortunately, too many of our youth are introduced to sexuality prematurely, (leading to) significantly greater curiosity that often leads to age-inappropriate and escalating behaviors," Jeremy Boberg, CEO of Utah Addiction Centers, said during the committee hearing last month. "Inappropriate sexual-related behaviors come from this."

Utah numbers lower

Despite the rise in gonorrhea, Utah still has better numbers when compared to the rest of the country.

Utah's gonorrhea rate is usually one-fifth that of the U.S. average and Utah's chlamydia rate is a little over half that of the U.S. rate.

But Utahns shouldn’t rely on that fact to assume that they’re safe, Beltran said.

Gonorrhea is spread through unprotected sex. Untreated, it can lead to serious complications like pelvic inflammatory disease, infertility and ectopic pregnancy.

Susceptibility to other infections like HIV also increases when infected with other STDs.

"Right now we are on the last drug that we have to treat gonorrhea because it's mutated several times," Beltran said. "Everyone's watching to make sure it doesn't become resistant to this last drug. … We don't even have a new one on the horizon that it might respond to."

That means it's more important than ever for people to protect themselves from STDs, Beltran said.

"I don't care who you are, you should be getting tested regularly for a panel of STDs," said Beltran. "Your doctor should be willing to do that regardless of your situation."

All four STDs that the health department tracks — chlamydia, syphilis, HIV and gonorrhea — have been on the rise.

The incidence of chlamydia, which remains the most common STD in Utah and nationwide, has increased 49 percent during the past 10 years.

Sheinberg advised parents to be aware of all the ways their children can be at risk, including sexual assault and sexual violence.

"It's good to talk broadly about the different situations that can come up to take some of the shame and stigma away," Sheinberg said. "Open up the dialogue and make it very clear that this is a health issue like any other."

Email: dchen@deseretnews.comTwitter: DaphneChen_

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