GAINESVILLE — How do you solve a problem when nobody wants to talk about it?

That’s the challenge for public health officials who are trying to prevent the spread of sexually transmitted diseases.

"(The discussion) gets into cultural, religious, ethical and philosophical areas," said Dr. David Westfall, medical director of District 2 Public Health in Gainesville. "Monogamy would be ideal, but it is far from the reality in our culture. In public health, we have to deal with the realities, not the ideals."

The sad reality is that STD cases are on the rise nationwide, and Georgia has the dubious honor of ranking No. 1 in the nation for syphilis.

Excluding HIV/AIDS, syphilis is the most serious STD, sometimes causing brain damage or death if left untreated. Fortunately, the disease is rare in the 13-county Northeast Georgia health district. But rates of gonorrhea and chlamydia have gone up in several area counties.

That reflects a national trend. Last week, the Centers for Disease Control and Prevention reported that chlamydia cases in the United States reached a record 1 million in 2006.

One reason for the higher number is that more people are getting tested. But Westfall said there also seems to be an actual increase in the incidence of the disease.

Hall County had 327 reported cases of chlamydia in 2006, compared to 282 in 2005. Across Georgia, incidence of chlamydia increased by almost 20 percent during that one-year period.

Westfall said some people who have the
bacterial infection don’t even know they’re sick. "In some cases there are few or no symptoms," he said. "But we worry about the long-term effects. Untreated infections in the reproductive organs can lead to infertility and other problems later on."

Also, a person who has an STD can pass it along to their partner, even if they think they’re fine.

But sometimes it’s obvious there’s a problem. An STD can cause considerable discomfort, with symptoms that can include genital pain or discharge, sores and itching or burning while urinating.

Yet despite the suffering, some people are reluctant to visit a health care provider. "They may be worried about the stigma attached to these diseases, which affect body systems that are private and personal," Westfall said.

But District 2 is trying to convince the public that there’s no shame in seeking help. Using about $17,000 from a CDC grant, the district is launching an STD awareness campaign, with special emphasis on Hall, Hart, Franklin, and Stephens counties.

"Historically, those counties have had a higher rate (of STDs)," Westfall said.

District 2 spokesman Dave Palmer said they hired a marketing firm to create a TV commercial that has been running on the Toccoa-based WNEG station.

"We’re also going to run spots on Spanish-language radio stations, because we felt that (radio) is the best way to reach that population," he said.

In addition, the agency has printed posters, in both English and Spanish, that depict a pair of dice and say, "Do you know your odds? ... 1 in 4 people will have a sexually transmitted disease."

"We tried to be as attention-getting as we could without being graphic or offensive," Palmer said. "We’re supplying the posters to schools and other places where young people gather."

Westfall said in one recent study, about 98 percent of gonorrhea and chlamydia cases occurred in people ages 18 to 25.

"Older, monogamous couples are not at high risk," he said. "Teens may be experimenting with multiple sexual partners and also not practicing safe sex."

But anyone who has sex even once needs to be educated about STDs, he said. "The message we’re trying to get across is that anyone who has been exposed needs to be concerned."

And there’s a new reason to be concerned. Drug-resistant strains of gonorrhea have emerged that do not respond to many antibiotics, including Cipro.

"It’s happening more in larger metro areas, not so much here," Westfall said. "But it’s become common enough that the recommended treatment protocols (from the CDC) have changed."

Doctors are also worried about the rise in cases of congenital syphilis, which is passed from mother to baby before birth, sometimes resulting in fetal deformities or death.

"That’s something you would hope we would have eradicated," Westfall said. "An STD workup is part of standard care for pregnant women. It could be that we’re seeing congenital syphilis because some women are getting little or no prenatal care."

As a public health official, Westfall’s chief concern is preventing the spread of infection. So it’s not enough to just treat the person who’s been diagnosed with an STD. That person’s sexual partners all need to be tested, too. And that can require some delicate negotiations.

Westfall said patients are counseled about the importance of sharing the names of their partners. Then the staff’s epidemiologists, acting almost as detectives, do what they can to track those people down.

Amy Greene, a nurse who runs the STD clinic at the Hall County Health Department, said it helps that the process is anonymous. The person contacted is not told who gave the department their name; they are only told that they may have been exposed to an STD and need to come in for testing.

"If you come in as a contact (of someone who’s already been diagnosed), the testing and the treatment are free," she said.

For people who just come in and ask to be tested, a total price of $45 covers screening for a wide spectrum of STDs. "That’s a bargain if you compare what it would cost at a private doctor’s office," Greene said.

The testing is confidential, and patients specify how they would like to be contacted. (A teen, for example, might not want the health department to call their parent’s house.) Patients are told they need to make a follow-up visit to discuss their results in person.

"We have a really good return rate," Greene said. "Most patients do come in to get counseling and treatment."

Though it is rarely necessary, Georgia law does allow officials to force an STD patient into treatment if medical professionals believe the person is a threat to public health.

In many cases, a single, short course of antibiotics knocks out the infection, but patients are encouraged to get retested after the treatment to make sure.

The clinic also tries to educate people on how to keep from getting another infection.

"We offer condoms, and we talk extensively about how to reduce their risk," Greene said.