Guilford County officials always seek ways for the county to be a leader in the state – but no one wanted the county to be the leader in new gonorrhea cases.
Guilford County is number one among major counties in the spread of the sexually transmitted disease. However, that does come with a silver lining: The STD is paying off in a big way because now Guilford County has been selected as one of only nine cities and counties across the country to receive a large new grant to study the disease and explore best-practices for fighting its spread.
The study is being funded by the Centers for Disease Control and Prevention (CDC), the arm of the federal government set up to promote health and improve disease response preparedness in the United States. The CDC is now focused on studying and battling increasingly prevalent new resistant strains of the STD that can’t be cured with medicines traditionally used to fight it. In that effort, the CDC has approved the new grant as part of its Antimicrobial Resistant Gonorrhea Study, which could mean nearly $2 million in federal money for Guilford County.
The Guilford County Division of Public Health is working with Wake Forest University to implement the study and develop response strategies with the help of the grant money. The CDC is now in the second year of the five-year study and, for fiscal 2017-2018, Guilford County is getting $430,000. Area health officials expect the county will be part of the study for at least three years after 2017-2018 – though the grant must be renewed by the CDC each year.
Guilford County Health Director Merle Green said she was extremely pleased with the CDC’s selection of Guilford County as a test site and she added that hopefully the study will help local governments across the country address the growing problem of resistant gonorrhea.
“It is very big news,” Green said. “Only a small handful of cites and counties were picked. It’s very impressive.”
Green said one reason Guilford County registers so high in gonorrhea cases is due to the county’s large college student population.
“Epidemiologist will tell you that there is a greater prevalence in college towns,” Green said.
According to a report from the North Carolina Department of Health and Human Services (DHHS), in calendar year 2015, the most recent complete report available, there were 320 newly diagnosed cases of gonorrhea in Guilford County per 100,000 residents – a rate that puts Guilford County at number one among the large counties, and means the county ranks fifth overall in the state. By comparison, Mecklenburg County had 249 cases per 100,000 and Wake County had 142. Forsyth County came in high with a rate of 283 new gonorrhea cases, while Alamance County was at 202. Anson County, which is just southeast of Charlotte, had the highest rate of any county in the state – 373 new cases per 100,000.
According to Green, the high number of new cases in Guilford County may be a little deceiving because Guilford County has a very aggressive investigation unit that is constantly looking for cases of the STD. She said some other counties in North Carolina make much less of an effort to do so, and therefore, she said, those counties may not register as high on the gonorrhea prevalence chart even though there may be more cases, albeit unreported, in that area.
Green said Guilford County has a very good working relationship with Wake Forest University since the county’s chief medical officer, Dr. Laura Bachmann, is contracted from that school. Also, the county’s laboratory and the university’s labs frequently work together on projects.
Green said one reason Guilford County was chosen as a test site is because of its history when it comes to this type of study.
“We’ve done other research projects that were a success,” she said.
She also said Guilford County has a lot of clients at the 1100 E. Wendover Ave. clinic and much of the study data will come from patients who go there for diagnosis and treatment.
There are more than 100 diseases or medical complaints that health departments must record and report, and, according to statistics from the CDC, gonorrhea is the second most commonly reported “notifiable” disease in the United States. There are roughly 400,000 cases reported each year and the CDC estimates that most cases go unreported. According to the CDC, there are about 820,000 new infections each year nationally.
In the past, gonorrhea has been considered less serious than other STD’s such as syphilis, since gonorrhea isn’t life threatening like syphilis and HIV, and because, until recent years, there have been multiple effective treatments. A decade ago, the CDC had five recommended treatment options for gonorrhea – now, due to increasing resistance among new forms of the disease, there’s only one option remaining.
Four years ago, the CDC released information about the threats posed by antibiotic resistance to human health. That report listed antibiotic-resistant gonorrhea as one of the top three most urgent threats of this type. Two years ago, the federal government formed a “National Strategy to Combat Antibiotic-Resistant Bacteria” (CARB) and Guilford County is now on board. The nine grants are just one part of that effort. With the increasing use of antibiotics, and increasing resistance as a result, now 30 percent of new gonorrhea infections each year are resistant to at least one drug.
Guilford County Epidemiologist Mark Smith said the funds are being provided out of the concern for the growing problem of resistance, and it’s similar to what’s happened over the years with syphilis.
“It started out and penicillin was very effective,” Smith said.
With more and more use, however, the effectiveness of that drug has declined.
“The same thing has happened with gonorrhea,” Smith said. “Different antibiotics, one by one, have become less effective, and we’ve gotten to the point where there are just a couple.”
He also said resistant gonorrhea is currently found mostly overseas in places like Japan, as well as on the West Coast of the United States and in the New York area, but he added one focus of the study is to see how smaller health departments, such as Guilford County’s, can battle the problem.
According to Smith, even though Guilford County has only seen “very, very few cases” of the newer, resistant strains of gonorrhea so far, those are expected to increase and there are plenty of new cases of regular gonorrhea in Guilford County. He said that even the cases that aren’t resistant can be used to study disease containment strategies.
“We have enough cases of gonorrhea each year to make it worthwhile and our lab is one of the best in the state,” Smith said.
He added that the purpose is to develop the capacity to be able to respond to what is expected to be a growing problem.
The study will include money for extensive culture tests, field investigations and follow-up work with people who are infected and their sexual partners.
Smith said that, across North Carolina, gonorrhea typically tracks higher in urban areas than rural ones.
According to the latest report from the NC DHHS, in calendar year 2015, there were 17,047 new gonorrhea infections reported in North Carolina. The state’s gonorrhea rate – 146 for every 100,000 residents – is higher than the national rate of 111 per 100,000. According to state statistics, North Carolina gonorrhea stats are similar to those in many other states in the Southeast.
Green said that, in recent years, Guilford County has been trying to prevent the spread of STD’s in some “very creative ways.”
She said, for instance, the county works with area barber shops and beauty shops to distribute free condoms there and the county does the same with some area nightclubs.