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by KEVIN TAYLOR & r & & r & & lt;span class= & quot;dropcap & quot; & R & lt;/span & eported cases of gonorrhea (or "the clap") in Eastern Washington and North Idaho are shooting up and no one seems to know why -- beyond the duh factor, that is.





"One thing we do know with certainty when we see an increase in reported gonorrhea rates is people are having unprotected sex," says Stacy Wenzl, a sexually transmitted disease epidemiologist with the Spokane Regional Health District.


Lax condom use aside, there appears to be little evidence to explain why reported cases of gonorrhea -- a bacteria-caused sexually transmitted infection -- are up 300 percent in North Idaho and up 77 percent in Spokane County.


"We essentially share the same population," Wenzl says of the rise in Spokane and North Idaho. "We are following it closely and trying to determine what the cause is."





It's the same in North Idaho. "We really don't know what's causing it," Donna Marshall-Holden, STD/HIV coordinator with the Panhandle Health District in Coeur d'Alene, says. "We have not identified, as of yet, any social network. It has spanned homosexuals, heterosexuals, young people, people in their 30s. There's not really anything that at this time says, 'This is where it's coming from.' We're still investigating."





& lt;span class= & quot;dropcap & quot; & A & lt;/span & 300 percent increase in reported gonorrhea seems terrifying, but the real numbers are easier to take. Panhandle Health has been seeing an average of 9 cases per year for the past several years. The health district, which covers Idaho's five northern counties, is up to 29 reported cases of gonorrhea and counting through last week, Marshall-Holden says. The Spokane Regional Health District, which serves a far larger populace, has seen 108 reported cases of gonorrhea through August, up from 61 in all of 2006.


Most gonorrhea is discovered in people who are coming in for regular exams, or exams scheduled for other reasons, which indicates there could be a lot more out there. When you're infected, there is rarely a giant arrow aimed at your crotch and a loud buzzing sound.





"Most people don't know they have it. The best way to know is to get tested," Marshall-Holden says. The test is painless now, she says. For men, a urine test has replaced the sometimes painful swab from inside the urethra.


Gonorrhea in women is often detected during annual exams. "The CDC recommends women 24 and under get an annual screen for chlamydia. We can combine that to test for gonorrhea, too," Marshall-Holden says.





Gonorrhea tends to be more detectable in men, who may have a discharge of snot-colored pus from the penis. Other symptoms may be as vague as a fever or sore joints.





Gonorrhea is unlikely to kill anybody but, Wenzl and Marshall-Holden point out, it does not go away by itself and can cause serious health problems. In women, untreated gonorrhea can cause pelvic inflammatory disease, tubal pregnancies, infertility and infection during childbirth; in men, testicle damage, greater odds for bladder cancer, and infertility.





& lt;span class= & quot;dropcap & quot; & P & lt;/span & anhandle Health is aggressively investigating reasons behind the tripling of reported gonorrhea. Staffers are conducting interviews with infected patients to track down sexual histories and partners. The district has posted flyers in bars, clubs and other nightspots as well as alerting North Idaho College about the outbreak.





"This is not restricted to people who go to bars, or people you think are promiscuous," Wenzl says. "Our job is to educate providers and the community that this infection is treatable and to try and remove the stigma associated with it."





Both nurses recommend condoms, abstinence or monogamous relationships. Or at least coming in for a test. While gonorrhea is easily treatable most of the time, some strains are resistant to antibiotics.
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