Gonorrhea – it’s not exactly the number one topic of conversation but maybe it should be. Reported incidences of gonorrhea are on the rise, with many more cases going undetected. Even worse, according to the Centers for Disease Control and Prevention (CDC) there is an ominous increase in multi-drug resistant strains of this sexually transmitted infection, which do not respond to even powerful antibiotics.

If left untreated, gonorrhea can cause infertility in both women and men, create dangerous pregnancy complications, and be passed on to newborns. Gonorrhea can also facilitate the transmission of HIV. Gonorrhea disproportionately affects gay, bisexual, and other men who have sex with men (MSM), as well as blacks, adolescents, and young adults.

The Affordable Care Act (ACA) presents an important opportunity to help combat gonorrhea and other Sexually Transmitted Infections (STIs). The ACA requires new health insurance plans to provide, without out-of-pocket costs, screening and preventive services recommended with an A or B rating by the U.S. Preventive Services Task Force (USPSTF). USPSTF grades services with an A or B when recommended with high or moderate certainty that there is a substantial or moderate benefit. The ACA also allows state Medicaid programs to receive a one percent increase in their federal match for covering the USPSTF recommended screenings without charge to enrollees.

The USPSTF is a Congressionally-mandated panel comprised of experts in prevention and medicine. It conducts scientific review of clinical preventive health care research data and evidence, and makes recommendations for clinicians on preventive screenings and services that can substantially benefit adults and children.

Currently, the USPSTF recommends gonorrhea screenings for sexually active women, but not men. The difference, according to the USPSTF, is because urethral infections in men are symptomatic, unlike gonorrhea in women that is asymptomatic and might otherwise go undetected.

However, not all gonorrhea infections in men are urethral. A 2010 study of MSM found that rectal gonorrhea also fails to produce symptoms. The study also notes that there is a “dearth of research on rectal immunology” and its correlation to HIV transmission.

The USPSTF calls for more research on MSM and sexually active males younger than 24 years old in a recent proposal to update its recommendation. However, although men have been omitted from the gonorrhea screening recommendation since it was first established in 2005, the USPSTF still declines to expand its recommendation, instead proposing to further limit gonorrhea screening to only sexually active women younger than 24 years old, and older women with increased risk of infection.

The public comment period for the USPSTF proposal closed May 26, but health advocates can propose recommendations any time.

To add or expand a USPSTF recommended screening, the Task Force considers:

• Risk and burden of the condition on a subgroup of people based on age, gender, ethnicity and particular behaviors
• Whether the harms, feasibility and efficacy in treatment differ for subgroups
• Whether research has been limited to particular groups

In the meantime, state and local public health departments will continue to shoulder the lion’s share of STI detection and surveillance, with budget cuts that have severely impacted STI and other public health programs. As multi-drug resistant strains spread, more people may reluctantly find themselves talking about gonorrhea.

This guest blog post was created by Wayne Turner, Staff Attorney, and Jamille Fields, J.D./ M.P.H., Reproductive Justice Fellow, at the National Health Law Program.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. This blog post does not represent the views of the Robert Wood Johnson Foundation.