Government to Sex Partner: 'You Have an STD!'

Washington state reports gonorrhea outbreak, fears drug resistance.

Nov. 14, 2013— -- David Miller, a public health worker in Washington state, provides a free and anonymous service to those who have been diagnosed with a sexually transmitted disease: He'll track down their ex-partners and deliver the bad news.

Miller, a 35-year-old registered nurse and the TB/STD coordinator for Yakima Health District, is a sleuth of sorts and a trained diplomat who must guard a patient's confidentiality.

His caseload has jumped from 62 cases last year to more than 109 so far this year, making his job to stop the spread of the high contagious disease even harder.

"There are definitely times when people are pretty upset when I tell them we have received information that they have been exposed to an STD," Miller told "Sometimes they don't even know what that is, and I have to explain it to them."

About 820,000 Americans are diagnosed each year with gonorrhea, according to the Centers for Disease Control and Prevention. An estimated 570,000 of them are between the ages of 15 and 24.

Cases of the STD are up 20 percent in Oregon and up more than 15 percent among men in California, and also up in Idaho, according to a Time magazine story, "Washington Gonorrhea Outbreak: STD Investigators Track Down Patients."

Yakima County, which is predominantly Hispanic, has experienced a gonorrhea outbreak -- a 75 percent increase this year, according to the Washington State Department of Health.

The disease is second only to chlamydia in numbers of annual cases. It can go undetected for some time because there may be few symptoms, but it can cause serious health problems such as pelvic inflammatory disease or infertility

Gonorrhea is usually treated with a single oral dose of antibiotics -- cephalsporins, but health officials are increasingly worried about drug resistance to the bacterium, especially in Europe and Asia.

CDC Warns of "super" gonorrhea.

"Drug resistance has become a major problem with the entire public health effort to halt the spread, and so gonorrhea has achieved new priority," said Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University.

Washington is taking a "very traditional" approach to public health, he said.

"It's very labor intensive, and there is no easy way to do this," said Schaffner. "It's being a disease detective, and you have to do it in an exceedingly diplomatic way."

Schaffner shadowed a STD contact tracer years ago when syphilis was the public scourge. "They were brilliant diplomats trying to gain people's confidence and not alarm others."

Federal and state laws require that each time a patient tests positive for chlamydia or gonorrhea, it must be reported to the CDC, as well as the Washington Department of Health, and the counties get daily reports.

If the doctor indicates the infected patient's sex partners were not treated, it's up to investigators like Miller to find them and either treat them in the field or bring them in to the nearest clinic. He is always sworn to secrecy, never revealing the identity of a patient.

"We make a phone call to the person who was diagnosed and talk to them about any partners they had in the past 60 days prior to treatment and their current sex partners," said Miller.

The questions are thorough and potentially embarrassing: How many partners have you had in the past year and were they men or women or both? Was sex vaginal, anal or oral? Were condoms used? Were drugs used that would put you at risk?

Sometimes Miller gets a full address and phone number, but more often, he has to do some detective work, check social networks to find people, then text them or send letters.

"If they just give us a name and nothing else, we kind of hit a dead end," he said.

Technology seems to be fueling some of the increase in cases, said Miller.

"One of the things that did surprise me when I got started are the [mobile phone] apps that can now track your GPS signal and see how many in the area are looking for hook-ups," he said. "It used to be people went to bath houses. With apps, where people who want to have sex can have it anywhere, it definitely makes things more difficult for us."

Five Washington counties have seen outbreaks in gonorrhea. Spokane County has pioneered the use of social networks in its partner notification program.

"It's very relevant in this day and age, especially the younger population who have no land lines and no white pages," said Kim Papich, a spokeswoman for the Spokane Regional Health District. "We are reaching out through the media that's relevant to them."

Read about five of the worst super bugs.

Lisa Baldoz, who is one of four field investigators for the Washington Department of Health, said special phone apps for men to hook up with one another seem to be fueling the spread of disease. The largest jumps have been among men having sex with men, and in cases of oral and rectal gonorrhea.

One of the problems is diagnosis can be missed in cases of oral or rectal gonorrhea because a urine test can be negative. "That's why the numbers are higher," said Baldoz. Treatment is also more complicated, requiring an injection and then a follow-up of oral medication.

"Just three months ago there were a group of married men who were engaging in high-risk sexual behavior with other married men," told "They were downloading special phone apps specifically for other married men. What was even more interesting was the wives were engaging with the men."

"The difficulty," she said, "is getting men to talk openly about those male sex partners."

Miller faces the same problem trying to get infected patients to reveal their sexual history. Some readily agree to tell their former partners themselves, but others don't disclose. "It's a mixed bag," he said.

"They make up all kinds of reasons why it happened -- that it wasn't sexual," said Miller. "One guy said it was because he didn't brush his teeth and that's how he gave it to his girlfriend. She totally bought it. ... Sometimes people are in denial and will buy whatever they are told."