In the year 2009, the rates of reported gonorrheal infections in the United States were at an all-time low. However, since then the rates have risen 75.2% (Centers for Disease Control and Prevention, 2018). The United States as a whole is experiencing a major increase in instances of gonorrhea, and one of the goals of the U.S. Department of Health and Human Services’ Healthy People 2020 initiative is to “reduce gonorrhea rates among males aged 15-44” (U.S. Department of Health and Human Services, 2018). The country as a whole is at risk of not meeting this goal as rates of gonorrhea continue to climb, and Milwaukee County is no exception. In Milwaukee County, the population of males aged 15-44 is at risk for an increase in the rates of gonorrhea, and an intervention is needed to prevent this from happening.
Gonorrhea is becoming increasingly more common, especially among males aged 15-44 living in Milwaukee County. The CDC stated that “during 2013-2016, the rate of reported gonorrhea cases among males was higher than the rate among females in 2017” (2018), which is a concerning statistic when it is considered that according to data provided by the United States Census Bureau, more females live in the United States than males. Milwaukee County specifically is also at a major risk of a gonorrhea outbreak, as rates have continued to climb over the years. It was reported that “the 4,400 cases of gonorrhea in Milwaukee last year were the most in the nation” (Wainscott 2018). The raising rates of gonorrhea in Milwaukee County, combined with the fact that more males than females are infected with the disease is a significant cause for concern. The CDC also reported that the majority of males who are having sexual intercourse are not using condoms. 66.0% of males use condoms none of the time, 10.2% use condoms some of the time, and 23.8% of males use condoms all of the time. (CDC 2018) This is a major issue, considering that gonorrhea is prevented when condoms are used, and the average male reported that they have an average of 6.1 sexual partners in their lifetime. (CDC 2017) If condoms are only being consistently used 23.8% of the time, there is a huge opportunity for gonorrhea to spread to all or some of the 6.1 sexual partners. Gonorrhea is also becoming completely antibiotic resistant. The CDC stated that “Gonorrhea has developed resistance to nearly all of the antibiotics used for its treatment” and that they are “…currently down to one last recommended and effective class of antibiotics…” to treat the infection (2018). This is a major cause for concern. Gonorrhea is the second most reported STD in the country (source), and without a treatment, it has the potential to become an epidemic. (TRANSITION)
According to the Wisconsin Department of Health Services, the number of males aged 15-44 living in Milwaukee County in 2015 was 203,633, with 53% of the aggregate being Caucasian, 22% being African American, 12% Hispanic or Latino, 3% Asian, and 10% other race or multiple races. In 2016, the average income of people living in Milwaukee County was $45,263. (United States Census Bureau) Milwaukee County’s crude death rate in 2017 was reported to be 849.5 per 100,000, and the crude live birth rate was 14.6 per 1,000. Deaths related to alcohol and other drugs was 169,3 per 100,000. The percent of people in poverty in Milwaukee County is 19.8%. (United States Census Bureau) Population per square mile in Milwaukee County was reported to be 3,926.0. (United States Census Bureau, 2010). The rates of new cases of gonorrhea each year in the United States is currently 307.6 per 100,000, with Wisconsin’s rate being 220.3 per 100,000, (source) and the Healthy People 2020 goal for Wisconsin as 194.8 per 100,000 (source). Europe, however, presents a very interesting statistic. The European Centre for Disease Prevention and Controls reported that the rate of gonorrhea in 2014 was 20 new cases per 100,000 people. The highest rate was seen in the United Kingdom, with a rate of 60 per 100,000. (European Centre for Disease Prevention and Control, 2016) The rates of gonorrhea in the United States is ten times higher than that of Europe as a whole. This drastic difference can largely be attributed to the content of sexual education in both European countries, and the United States.
In the United States, sexual education largely focuses on abstinence, which studies have found to not be effective in preventing risky behaviors (Source) such as unprotected sex, which spread sexually transmitted diseases and infections, and contribute to the high rate of gonorrhea among men aged 15-44 in the United States. In European countries, sex education “aims at ‘disseminating general and technical information, facts and issues which create awareness and provide young people with the essential knowledge and training in communication and decision making skills they need to determine and enjoy sexuality both physically and emotionally, individually as well as in relationships’” (Beaumont & Maguire 2013). Because of the large difference between rates of gonorrhea infections in the United States and in Europe, it can be assumed that this is due to the difference in what is taught in regard to sex education. Wisconsin specifically is at a higher risk for sexually transmitted diseases and infections due to the state’s current abstinence only education bill. This policy affects all age groups, especially those in the 15-18 age range. While abstinence is the most effective form of protection from any sexually transmitted infection or disease, this is not realistic. The CDC reported that in the United States, by the age of 19, 62.9% of females and 64.3% of males have had sexual intercourse. This statistic shows the importance of comprehensive sex education, as the majority of students are not following the current abstinence-only way of thinking. The push towards abstinence only sex education does not provide students with sufficient information on how to prevent sexually transmitted diseases and infections, which is something that they carry with them into adulthood. This most definitely contributes to the rising rates of gonorrhea and other sexually transmitted diseases and infections. The lack of comprehensive sex education like that provided in Europe is certainly a contributing factor to the increase in rates of gonorrhea among males aged 15-44 in Milwaukee County.
Males aged 14-55 face many disadvantages????when it comes to increased rates of gonorrhea in Milwaukee County. A CDC fact sheet on gonorrhea published in 2017 listed people who were encouraged to be tested for gonorrhea as women, and gay or bisexual men. Heterosexual males were not urged to be tested unless they showed symptoms. This is a major contributing factor to the rising rates of gonorrhea, as gonorrhea can be asymptomatic in males. (CDC, 2017) This causes men to infect other people without even being aware of it. However, there are strengths?????in this aggregate.
The symptoms of gonorrhea in males are typically very noticeable and unpleasant, so the disease does not go ignored. In women, gonorrhea is commonly asymptomatic, however, women are being tested for STDs more often than men, (source) so this is not a major issue. Because the symptoms often present themselves in males, cases are easily diagnosed, and there is less of a chance that a person will pass on the infection without knowing. Milwaukee County itself proves to be a major advantage when it comes to treatment and screenings for gonorrhea. There is an extensive list of clinics that provide screenings for sexually transmitted infections and diseases, so most people have access. (source?) If a patient does not have health insurance, it can be provided by Planned Parenthood if the patient qualifies, (source) which eliminates the concern over lack of treatment for gonorrhea due to inadequate health insurance. TRANSITION
The increasing rates of gonorrhea in Milwaukee County among males aged 15-44 can be attributed to three main factors: social, economic, and political. The social aspect is perhaps the most impactful. Across the United States, STDs are stigmatized. This stigma surrounding STDs causes people to resist going to the doctor to be tested, as well as reduces the insistence that protection such as condoms be used (Cody, 2015).