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Over the last five years, the United States has seen a steep increase in sexually transmitted diseases - 2.3 million Americans now have some form of STD. One county in Oregon is asking people diagnosed with the more serious forms to identify their partners so they can be contacted and treated. Kristian Foden-Vencil of Oregon Public Broadcasting spent an afternoon driving the foothills of Mt. Hood with two health workers whose job is to find those partners and deliver the tough news.
KRISTIAN FODEN-VENCIL, BYLINE: Mary Horman is a nurse and Liz Baca a disease intervention specialist. Both are with Clackamas County. Most of the work is done over the phone, informing people they've had a partner who's tested positive for gonorrhea or syphilis. It's a difficult conversation, even on the phone. But often, they can't reach the person. And Baca says that's when they have to hunt down the address, drive to the house and deliver the news face to face.
LIZ BACA: It can definitely be scary at times, especially those rural areas where you're really relying on the GPS to get you there. And, sometimes, there are roads that lead you to nowhere, and we have gotten lost.
FODEN-VENCIL: OK. Where are we going?
BACA: We are in Aurora, and we are visiting a resident that was diagnosed with neurological syphilis.
FODEN-VENCIL: A new report from the Centers for Disease Control and Prevention finds that, over the last five years, the number of syphilis cases in the U.S. has increased 76 percent. Gonorrhea cases are up 67 percent. Scientists say there are many reasons for the increases, from antibiotic-resistant bacteria to the ease of finding anonymous sex in an era of cellphone hookup apps. So far this afternoon, Baca and Horman have been challenged by a dog and had to leave a trailer park empty-handed. They were in the right spot but didn't know which door to knock on. And they couldn't just ask around because that would be a breach of medical confidentiality. Their next call is a 64-year-old handyman, who we're just identifying as Larry for those same privacy reasons.
BACA: Hi. Larry?
MARY HORMAN: Hi.
BACA: Yes, it's me. How are you?
FODEN-VENCIL: This call is unusual because, actually, Larry's already seen a doctor and undergone a course of penicillin, so he's expecting this follow-up visit. But Baca wants to know about his partners and understand the extent of his infection. So she shows him a book with graphic pictures of various skin conditions.
BACA: So do you recall any of these symptoms in the last several years? Do you...
LARRY: I do.
BACA: You do. OK.
LARRY: And I would probably say that the - a lesion, I think you called it...
BACA: A lesion, yes.
LARRY: ...I think occurred probably - like I'm saying I think it was probably about 10 years ago.
FODEN-VENCIL: So Larry's been living with syphilis for at least a decade without knowing it. Many sufferers can carry the disease but show no obvious symptoms, and that makes syphilis tougher to fight. Also the fact that the disease was almost eradicated means some younger doctors don't recognize it. Larry says he used to have sex with multiple partners from Craigslist and can't remember names. Baca is crestfallen. Without names and after such a long time, it's too late to find anyone. But David Harvey, the head of the National Coalition of STD Directors, says her time wasn't wasted.
DAVID HARVEY: Almost universally, people appreciate having this information shared in a confidential way...
FODEN-VENCIL: And he says it all but guarantees people get treatment.
HARVEY: ...And it breaks the cycle of infection.
FODEN-VENCIL: And the head of public health in Clackamas County, Dr. Sarah Present, says tracking down partners is important, even if it leads to family strife.
SARAH PRESENT: We do our absolute best to have the initial case talk to their partners for us. We don't want to have to be the bad guys.
FODEN-VENCIL: Baca and Horman climb back in their car, which is pointed away from Larry's just in case they need to make a quick getaway. Baca says she loves the job but follows a few basic rules - be friendly and visible, not fidgety because plenty of people out there have firearms and never enter a home. With that, the two public health workers head off to knock on another door.
For NPR News, I'm Kristian Foden-Vencil in Clackamas County, Ore.
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