A gonorrhea epidemic has hit Oregon amid public health concerns that the disease is becoming immune to standard treatment.

Since 2012, cases have nearly tripled statewide, affecting just about every part of Oregon, including rural counties where infections have been traditionally low.

Officials in some counties have become so concerned that they've launched public awareness campaigns, with ads on dating sites, Facebook and Google. In others, specialists have gone door-to-door, trying to track down infected people and their partners to get them treated.

"We came to a point where we said we have to do something," said Tanya Phillips, health promotion manager for Jackson County.

Gonorrhea cases have risen nationwide as well, but Oregon's rate has spiked in comparison.

The bacteria are spread through sexual intercourse or anal or oral sex. Symptoms are often undetected in women while men can experience painful urination or a penile discharge. Untreated, gonorrhea can cause infertility.

In 2010, the state had 28 cases per 100,000 residents. That compared with 101 per 100,000 people nationwide. In 2016, Oregon's rate rose to 107 infections per 100,000 residents – an increase that puts it on par with the U.S. rate.

Gonorrhea no longer responds to the antibiotic ciprofloxacin that had been effective in treating it.

"It tends to be a bacterium that becomes resistant much more easily than other bacteria to antibiotics," said Kim Toevs, director of the sexually transmitted disease program in Multnomah County.

Providers switched to other antibiotics, including ceftriaxone and cefixime. But now the latter appears to be losing its effectiveness, with resistant cases turning up outside the United States, according to the federal Centers for Disease Control and Prevention.

"There is nothing to suggest that anyone would fail treatment at this point," said Dr. Sean Schafer, Oregon's medical epidemiologist for sexually transmitted disease. "But we're very concerned that gonorrhea at some point will acquire the ability to resist treatment to the main drugs we use right now."

Men, especially homosexual men, account for the majority of cases in Oregon and nationwide.

Public health officials suspect that's because treatment for HIV has improved. There are now medications that protect uninfected individuals from HIV and suppress the virus in those who are infected. The drugs have helped lower new infection rates from 270 cases per 100,000 in 2012 to 220 last year.

That drop coincides with the rise in gonorrhea: "People have become less concerned about acquiring HIV and so condom use is declining," Schafer said.

Along with a rise in gonorrhea, syphilis cases have also increased, also mainly among gay men. Public health officials suspect those trends are related.

Syphilis is transmitted sexually through contact with a sore during vaginal, anal or oral sex. Initial sores can disappear but the disease can return a decade or more later and be fatal.

Women represent a minority of cases. But the state has seen an uptick in gonorrhea cases among heterosexuals under 25, especially women.

Get help

For information about testing and other issues in Oregon go to the HIV/STD hotline at http://www.oregonaidshotline.com/ or call 800-777-2437.

In Multnomah County, the lack of affordable housing is probably partly to blame for the rise in infections among young people, said Toevs, the county's STD specialist.

The county's disease investigators say an increasing number of young patients are couch surfing.

"The housing instability has definitely had an impact of how people have sex and the number and overlapping nature of their sexual partners," Toevs said. "Sometimes sexual relations go along with a place to spend the night."

A year and a half ago, the county ran a syphilis awareness campaign that featured ads on TriMet buses urging men to get treated. Lane County ran a similar campaign this year.

Word may have gotten out. Syphilis cases in Oregon leveled off in 2016.

They could rise this year in the two counties. Provider surveys in Multnomah County indicate that more patients are asking for testing and that more tests are being ordered following the campaign.

Like gonorrhea, syphilis can be cured with antibiotics. Unlike gonorrhea, the syphilis bacterium isn't so adept at mutating to resist treatment.

Syphilis cases are low in some counties; Umatilla, for instance, had seven infections last year, but its gonorrhea rate has caused alarm, rising from four cases in 2012 to 88 last year.

The communicable disease nurse in Umatilla County, Riann Roggiero, made it her priority last year. With a state official, she knocked on doors of newly infected people, urging them and their partners to get treated. She was armed with injectable ceftriaxone and azithromycin pills to treat people on the spot.

"We tried to hit it as hard as we could in 2016," Roggiero said.

She also made phone calls. One of the biggest challenges is to track down everyone who might have been exposed.

"It's like a spider web," Roggiero said. "If one person tests positive and has had more than one partner then we need to go after those people and get them tested."

Jackson County's health staff has also taken action against gonorrhea. In June, they started a social media campaign on Facebook, Instagram, YouTube and Google to urge people to get tested. The county also added an innovation: ads on Grindr and Scruff, two popular networking apps geared toward gay men.

"It's a way to push information and testing reminders," said Phillips, the county health official who came up with the idea. "If we can get everyone treated, that will help get those numbers down.

-- Lynne Terry