The rate of sexually transmitted diseases has risen sharply nationwide, including in Kansas.

Health care providers have been working to combat a recent outbreak in Neosho County, where 15 cases of early syphilis were reported in 2017, compared with one the year before.

"The state of Kansas has been helping us," said Teresa Starr, administrator of the Neosho County Health Department. "We have been tracking the people that are (affected), and most of them, unfortunately, also have some drug issues. What we're trying to do is follow them and get them treated."

KDHE's Bureau of Disease Control and Prevention includes a Disease Intervention Program to reach out to every individual who has been diagnosed and identify all of his or her sex and needle partners. Through Partner Services, the state then works to track down those people who also are at risk of infection and get them tested and treated. Skilled workers educate patients and health care providers about STDs and prevention.

"We're able to intervene in the transmission process," said Jennifer VandeVelde, director of the Bureau of Disease Control and Prevention.

Testing is key to stopping the spread of syphilis because many people don't realize they are infected or, because the disease mimics many other diseases, they think they have something else. It often starts with a single painless lesion that goes away.

"The average person during their infectious period will infect anywhere from three to 10 people," VandeVelde said.

Along with syphilis, the state also has seen increases in chlamydia and gonorrhea. The state's rate of STDs, which includes all three diseases, averaged 6.3 cases per 1,000 population in 2017, up from 4.7 in 2012, according to data from the KDHE reported by Kansas Health Matters. The rate ranges from 0 in Comanche County to 12.9 in Wyandotte County.

Nationwide, there were 1.7 million cases of chlamydia, 555,608 cases of gonorrhea and 30,644 cases of primary and secondary syphilis in 2017, up 22 percent, 67 percent and 76 percent since 2013 respectively, according to the Centers for Disease Control and Prevention.

The three predominant STDs — chlamydia, syphilis and gonorrhea — have very different risk factors, VandeVelde said.

Chlamydia, which mostly affects young people ages 15 to 24, is widespread throughout the state, with a total of 13,549 cases reported in 2017, appearing in all but two counties: Graham and Comanche.

Gonorrhea is concentrated in more densely populated areas and is associated with higher rates of drug use and multiple partners. A total of 4,545 cases of gonorrhea were reported in Kansas in 2017, with the highest incidence being in Sedgwick County (1,309), followed by Wyandotte County (622), Shawnee County (596) and Johnson County (581).

Syphilis is episodic, with risk factors that vary depending on when and where the outbreak occurs, VandeVelde said. During the past 10 years, it has occurred predominantly among gay men, but in more recent years it has appeared among heterosexual meth users. The state saw 330 cases of early syphilis in 2017.

Gonorrhea is the STD that sees the most changes.

"It is able to mutate and create different hormones and enzymes that counteract the medicines, so it's a very tricky little bug," VandeVelde said.

Kansas hasn't seen the antibiotic-resistant strains of gonorrhea that have troubled health care providers in other areas of North America. Gonorrhea has become resistant to all but one class of antibiotic, according to the CDC.

"We are fully prepared to do resistance testing on gonorrhea cases if we see resistance in Kansas," VandeVelde said.

It's unclear why the rates of STDs are up, but the trends could reflect increased awareness, testing and treatment, VandeVelde said.

Most cases of chlamydia, gonorrhea and syphilis go undiagnosed and untreated, according to the Centers for Disease Control and Prevention. While the diseases are treatable with antibiotics, they can cause severe health effects, including infertility, ectopic pregnancies and stillbirth in infants, if untreated.

"We recommend that anyone that's sexually active be tested annually for any STI," said Hope Harmon, a registered nurse at Crawford County Health Department.

Testing is available at county health departments for low or no cost.

"We don't turn anyone away," Harmon said.

Those who test positive for an STD can receive treatment at the health department. Hepatitis C or HIV patients are referred to a Federally Qualified Health Center.

County health departments reach out to their communities in a variety of ways.

The Neosho County Health Department works to educate the public about STDs, sharing information through visits to the local college and posts on the department's Facebook page. Health department officials talk about abstinence and ways to reduce the risk of STDs and the importance of using condoms, even for those who believe their relationship is monogamous.

"You may think you're sleeping with one person, but that one person may have just slept with 20," Starr said.

Jonna Lorenz is a freelance writer. She can be reached at jonnalorenz@gmail.com.