Pandemic pushes up already increasing rates of gonorrhea, syphilis in Michigan –

Rates of sexually transmitted infections were on the rise in Michigan before the pandemic.

The march of COVID-19 only advanced the trend as some clinics or providers closed or reduced services and testing supplies, also used for coronavirus testing, were limited, health officials said.

Gonorrhea rates have increased 75% since 2010 but decreased slightly in 2021, according to preliminary information released last week by the Michigan Department of Health and Human Services.

Cases of primary and secondary syphilis are up 25% in 2021 alone and rates have tripled since 2012, the state health department reported and encouraged everyone who is sexually active be routinely tested for STIs, especially after having sex with new partners.

Beyond the pandemic, experts pointed to lacking education, a reluctance to seek care or discuss concerns, stigma, prevailing attitudes about sex, and the opioid crisis research has linked drug abuse to risky sexual behaviors as possible reasons. Positively, some noted better testing practices.

To reverse the course, health officials encourage screenings, discussions and education. Talk, test, treat is a motto, and in Michigan, providers can treat a patients partner even if they do not see or diagnosis the partner for gonorrhea, chlamydia or trichomoniasis, all common STIs.

Prevention is critical; the Macomb County Health Department recently, for the first time, set up a drive-up condom distribution site in Warren, a large, diverse community. District Health Department No. 10, serving 10 counties in northwest and central Michigan, provides condoms, accompanied by information about reduced cost STI testing, at bars, gas stations and party stores in Wexford County, home to Cadillac.

There is so much stigma with sex and sex is normal. Its a part of human life. And we all exist because somebody had sex. So, its not a secret. Keep it healthy. And lets keep young families and babies healthy, said George Davis-Williams, a registered nurse and family planning, STI and HIV coordinator for District Health Department No. 10.

There are three common sexually transmitted infections chlamydia, gonorrhea and syphilis surveilled in Michigan and the United States. Chlamydia and gonorrhea are most prevalent. All are treatable bacterial infections spread during vaginal, anal or oral sex.

In 2020, about 66% of chlamydia cases were diagnosed in patients younger than 25. The most cases of both chlamydia and gonorrhea were diagnosed in people 20 to 24. Syphilis in 2020 was most often seen in people 25 to 29, according to the state health department.

Younger people tend to move in and out of sexual relationships more frequently. They might have multiple sexual partners at once, which increases risk, and be less likely to consistently use condoms, said Dr. Okeoma Mmeje, an obstetrician and gynecologist at Michigan Medicine who researches reproductive infectious disease.

Dr. Dr. Kurt Wharton, chief of womens and childrens clinical care programs at Southfield-based Beaumont Health, noted previous generations were frightened into safe sex by the AIDS/HIV epidemic of the 1980s and 1990s. Until about 1995, such a diagnosis was almost certainly fatal. Young people today just havent had to live through that fear and those experiences.

Per capita by race and gender, Black men are most affected, and of all health department regions, rates are highest in Detroit, the only city in the state with its own health department and where nearly 80% of residents are Black.

This has to do with lack of access and social inequalities, said April Hight, personal health services program supervisor for the Kent County Health Department and responsible for STI, HIV and tuberculosis work there.

We have to think about the social determinants of health as it pertains to economic mobility, transportation, education, attainment, health insurance status. All those things disproportionately, we know, have impact on communities that have been marginalized, Mmeje said.

Health officials, however, noted sexually transmitted infections are not just an issue of one group or class.

It doesnt matter. People who are wealthy, or poor, of all racial groups, of all political ideologies. Again, people have sex. I just cant normalize that enough, Davis-Williams said.

Cant see the chart? Click here.


Chlamydia, also bacterial, brings about a range of symptoms, including abnormal discharge and a burning sensation when urinating. Frequently, though, there are no symptoms, according to the U.S. Centers for Disease Control and Prevention.

Cases of chlamydia per 100,000 people have trended downward in Michigan, decreasing from 520 in 2017 to 449 in 2020, the most recent year complete data is available.

Below is a Michigan map of health department districts. Each district is colored based on cases per 100,000 people in 2020, according to data from the state Department of Health and Human Services. Complete information from 2021 is not yet available. Hover over or click on the map to see details. Scroll down for maps related to gonorrhea and syphilis.

Cant see the map? Click here.

The top five local health department jurisdictions with the highest number of cases per 100,000 people in 2020 were the city of Detroit and Muskegon, Kalamazoo, Genesee and Saginaw counties, according to the state health department.

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Gonorrhea, meanwhile, increased from 129 cases per 100,000 people in 2011 to 234 in 2020.

Gonorrhea can present as painful or burning urination; increased vaginal or white, yellow or green penial discharge; or vaginal bleeding. Often, especially for women, there are no signs. Untreated, gonorrhea can cause serious and permanent health problems, including pelvic inflammatory disease in women and in men, a painful condition in the tubes attached to the testicles, according to the CDC.

The five health jurisdictions with the highest case rates are Detroit and Kalamazoo, Genesee, Saginaw and Muskegon counties, according to the state health department.

Concerning about gonorrhea, treated with antibiotics, is its resistance to medications, Hight and others said. Patients are now receiving double the dose of medication once prescribed, Hight said.

If it gets resistant to what were treating with, hopefully we would come up with another med to treat it, but that would definitely be a problem, she said.

Then we could have treatment failures and gonorrhea is a nasty thing to have go wild in your body. It can eat at your joints and get septic in your blood.

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Syphilis, though less common, is up from 2.8 cases per capita in 2011 to 7.84 in 2020 in Michigan. This includes both primary cases, meaning an initial phase characterized by a single or multiple sores, and secondary cases, which might also present as skin rashes. It can appear when the primary sore is healing or several weeks after, according to the CDC.

Finding primary syphilis is unusual. The lesions are usually painless and people do not typically bring it to professionals attention. The secondary phase is when they have bizarre rashes, unexplained fevers and swelling glands, said Dr. Anthony Ognjan, an infectious disease specialist at McLaren Macomb.

A good physician will ask a lot of questions and determine whether to test, he said.

It is during these initial stages that transmission is most likely to occur. Without treatment, people can continue to have syphilis in their bodies for years. It can lead to the most advanced stage, tertiary, when the disease can damage organs, bones and joints.

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The five local health jurisdictions with the highest case rate per 100,000 people in 2020 are: Detroit and Ingham, Kalamazoo, Macomb and Shiawassee counties.

Overwhelmingly, men, especially men who have sex with other men, are most likely to have syphilis, according to the CDC. However, cases among women have been rising, nationally and in Michigan.

Cant see the chart? Click here.

Macomb County saw an 18% increase in syphilis cases from 2019 to 2020 and a 31% increase from 2020 to 2021, said county Health Officer Andrew Cox, who attributed the rise, at least in part, to the ongoing, but waning pandemic.

The COVID-19 effect

Some providers were not functioning at all or doing in-person visits. And check-ins are easier face-to-face, said Ognjan, who dislikes phone conversations with patients.

Cox said its STI clinics continued their work, but there was a reduction in visits. This was likely because people did not feel safe.

Health departments, faced with a crisis and limited resources, had to shift and reassign employees at times during the pandemic, to help with mass vaccination efforts, contact tracing or other COVID-19-related services.

There were shortages of testing kits because the same manufacturer makes a lot of the COVID testing kits, Hight of Kent County said. We really had to kind of limit who we were testing. Sometimes, we were treating without testing just to get people treated.

The supply issues have since improved.

There are now people coming in for tests who have not been tested in about two years, Hight said.

Patients arrive shifts, she said when asked if the health departments Grand Rapids clinic at 700 Fuller NE is seeing increased demand. Kind of worry about that, that a lot of people arent coming here, she said. Were trying to get the word out that we are open and back.

Problems pre-date the pandemic

There remains a stigma associated with STIs and STI testing, she said.

It is thought to reflect on someones promiscuity. Some people are uncomfortable asking patients and some patients are uncomfortable talking to their doctors about it.

While it would be easy to set up a COVID-19 testing site in an underserved area, for example, it is more difficult to secure permissions for an STI testing site, Hight said.

She suggested more routine testing or screening based on age. For anyone 15 to 24, make that a part of their health care.

Testing is a normal part of our health maintenance to keep ourselves and our partners safe, Dr. Natasha Bagdasarian, MDHHS chief medical executive, said in a statement last week.

People too lack education, critical beginning in adolescence, experts said.

I cant say enough about the importance of healthy sexual behavior education in high school, and even starting in middle school, to have these conversations as a normal part of the development because eventually people will have sex, said Davis-Williams of District Health Department No. 10.

And we would much prefer that they know how to keep themselves safe during sexual activity versus treat them. For a infectious disease that is curable, or sadly, there are some that are incurable and that we have to manage for life time.

It is hard, however, to get comprehensive sex education in schools, Hight said. There is a fear of what parents want, she said.

If more people were open about sexual health, we probably wouldnt be where we are now.

We have to realize what were doing isnt working, she said. So we kind of need to change it up and get a new game plan, but that just requires so many people to come to that realization.

STI testing is available at local health departments and additional testing locations can be found at

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Pandemic pushes up already increasing rates of gonorrhea, syphilis in Michigan -

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